Chapter 18 - Lumbar Degenerative Disease and Low Back Pain

Question 1

When are XRs indicated in low back pain?

Answer 1

aAfter 6 weeks duration if no red flag signs

If red flag signs (weight loss, fevers, altered mental status, focal tenderness, insidious decline in physical abilities) - get XRs earlier

Question 2

What is a vacuum disc indicative of?

Answer 2

Degenerative disc disease

Question 3

What MRI sequence can minimize metal artifact in post op patients?

Answer 3

T2 fast spin- echo sequences. Also called STIR _ Short tau inversion recovery sequence

Question 4

In fusion for chronic low back pain, what approach has been determined superior?

Answer 4

None - all methods of fusion - PLIF, TLIF, LLIF, ALIF, etc are all equivalent

Question 5

Male to female ratio for thoracic and lumbar disc herniations

Answer 5

Thoracic: Men = women

Lumbar: Men 3x Women

Question 6

What is the treatment of choic for lumbar spinal stenosis in the absence of coronal or sagittal plane deformity without segmental intability?

Answer 6

Laminectomy without fusion

Question 7

What are the indicators of poor outcome after surgery forlumbar spinal stenosis?

Answer 7

Increased surgical time, single level decompression, co-existing comorbidities

Question 8

Does degenerative spondylolisthesis occur more frequently in men or women?

Answer 8

Women 6-10x more frequently than men

Question 9

What is the most common level for degenerative spondylolisthesis to occur?

Answer 9

L4-5, (5-6x more common than any other level). Is associated with sacralization of L5

Question 10

What is the most common level for an isthmic spondylolisthesis to occur?

Answer 10

L5-S1 however an isthmic spondy at L4-5 is more likely to progress because the iliolumbar ligament at L5-S1 tethers the vertebra and imparts stability

Question 11

What age group is most likely to have progression of the slip in their =isthmic spondylolistheis?

Answer 11

pre-pubescent adolescents (<15). During peak growth velocity. once skeletally mature - unlikely to have progression of slip

Question 12

indications for surgery in isthmis spondylolisthesis?

Answer 12

Persistently symptomatic patients with pars defect, no slippage: Pars Repair

Persistently symptomatic patients with high grade slip: Posterior fusion with anterior column support

Persistently symptomatic patients with low grade slip: posterior fusion. Anterior column support has not demonstrated any improvement in the literature

Question 13

In isthmic spondylolisthesis, do you do a reduction or no?

Answer 13

No - reduction has been linked with greatest neurologic risk