Back & Spine Flashcards
A strain of the back involves the _______ (muscles/ligaments) and a sprain involves the ________ (muscles/ligaments)
Muscles
Ligaments
Up to ___ of the population will experience lower back pain
70%
Lower back pain is considered acute if the onset is less than __ weeks
6 weeks
Why is radiation of pain an important history question when evaluating lower back pain?
Sciatica
What systemic (constitutional) symptoms would be ‘red flags’ in the setting of lower back pain?
Fever
Chills
Weight Loss
Other than constitutional symptoms….
What are “red flags” associated with lower back pain?
Urinary Incontinence
Fecal Incontinence
Neurological Deficits
Unrelenting Pain
Is imaging warranted for diagnosing acute (<6 weeks) lower back pain?
No
What are the mainstays of LBP treatment?
Rest and modified activity
Physical Therapy (Core strengthening)
NSAIDs (NO Opioids)
_______ is defined as lateral curvature of the spine.
Scoliosis
Are teenage females or males more likely to develop scoliosis?
Females
What physical Examination findings may alter you to the potential of scoliosis?
Off-center head
One hip/shoulder may appear higher
Obvious curvature of the rib cage
What ‘angle’ is measured on an XR with lateral spine curvature?
Between what degrees should a patient be monitored every 4 - 6 months?
Cobb’s Angle
Monitor between 10 - 25 degrees
What brace is commonly used in treating scoliosis?
Boston Brace
How could scoliosis be managed surgically?
Spinal Fusions
What is a medical term for a “slipped disc”?
Herniated Nucleus Pulposis (HNP)
What physical examination finding may be present on a patient with HNP?
If this is positive, what nerve roots are likely effected?
Straight Leg Raise
L4, L5, S1
What is the diagnostic imaging study of choice when working up HNP?
MRI
How can HNP be treated?
Bed Rest NSAIDs or Prednisone Muscle Relaxants (Flexeril) Narcotics PT
Steroids can be given by what route to treat HNP?
Epidural
When would surgical intervention be warranted in treating HNP?
Conservative management fails
Severe pain
Neurological deficits
______ ______ results from thickening of ligaments and bones in the spine which impinges on nerves and the spinal cord resulting in back pain and numbness.
Spinal Stenosis
What are THREE examples of spinal stenosis?
Central Stenosis
Foraminal Stenosis
Extra-Foraminal Stenosis
How would lumbar spinal stenosis present?
Dull aching back pain
Numbness (“pins and needles”) in legs, calves, buttocks
Weakness/Loss of balance
________ (standing/sitting) exacerbates symptoms in spinal stenosis while ________ (standing/sitting) would relieve the symptoms
Standing
Sitting
What is the most diagnostic imaging study for working up spinal stenosis?
MRI
How is mild spinal stenosis manged compared to severe?
Mild:
Epidural Injection
PT
NSAIDs
Weight Loss and lifestyle changes
Severe:
Laminectomy +/- Fusion
What condition of the lower back is considered a surgical emergency?
Cauda Equina Syndrome
Where is the most common site of disc herniation that results in Cauda Equina Syndrome?
L4-L5
A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an “electric shock” radiate down both his posterior legs.
At this point, the presence of what THREE symptoms would arise concern for cauda equina syndrome?
Urinary Retention (followed by incontinence)
Fecal Incontinence
Saddle Anesthesia
A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an “electric shock” radiate down both his posterior legs. Interestingly, he admits to urinary incontinence on the ride over. On examination, he note decreased rectal sensation and weakness in his lower extremities.
What is the most immediate next step in management of this patient?
MRI
A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an “electric shock” radiate down both his posterior legs. Interestingly, he admits to urinary incontinence on the ride over. On examination, he note decreased rectal sensation and weakness in his lower extremities. MRI confirms cauda equina syndrome?
How does this patient need to be managed?
Surgically! (Laminectomy)
Immediately within 24 hours
If surgical intervention does not occur in cauda equina syndrome, what permanent deficit may the patient have?
Bladder and Bowel Incontinence
Where is the most common site of spondylolysis?
Where is the most symptomatic site of spondylolysis?
Common: L5
Symptomatic: L4
What is the most common cause of spondylolysis?
Overuse (Hyperextension)
On XR, how is spondylolysis described?
“Scottie Dog with a collar”
Other than XR, how is spondylolysis diagnosed?
SPECT Scans
What imaging modality can be used to classify spondylolysis?
CT
Focal bone absorption with a hairline deficit would be considered _______ spondylolysis
Early
Wide defect with small fragments present would be considered _______ spondylolysis
Progressive
The presence of sclerotic changes would be considered _______ spondylolysis
Terminal
___________ is the anterior or posterior translation of one vertebral body over another
Spondylolisthesis
What imaging modality is used to diagnosis Spondylolisthesis?
XR
T/F: 90% of Ankylosing Spondylitis patients will express the HLA-B27 gene
True
Which NSAID is the “drug of choice” for treating ankylosing Spondylitis?
Indomethacin
Which DMARD can be used in ankylosing spondylitis?
Sulfasalazine
Hyperkyphosis may also be referred to as what?
“Dowager’s Hump”
Are vertebral fractures common in kyphotic patients?
Yes
