Conditions Lx Region Flashcards
What are the 4 red flags for back pain?
- signs of systemic infection / unwellness
- inflammatory diseases
- hx trauma or malignancy
- cauda equina symptoms
Describe the classification and prognosis for LBP
Very common - up to 85% will experience
Peak incidence in 20-30 y.o.
Prognosis:
- majority improve within 3 months
- 20-30% become chronic
- high recurrence rate (50-80%
Acute: <6 wks
Sub-acute: 6wks -3mths
Chronic: 3mths and over
Describe the condition of cauda equina
The compression of the cauda equina within the lumbar spine (cauda equina between L1/2 to sacral spine and contains the roots for all spinal nerves inferior to L1)
usually caused by Lx disc pathology involving severe central herniation or sequestration of the nucleus pulposis. Can also be caused by stenosis, spondylolisthesis, trauma, haematoma, tumour or abscess.
SSX:
- severe LBP
- saddle paraesthesia or anesthesia
- bladder, bowel, or sexual dysfunction
- lower limb motor & sensory deficits (can be bilateral or unilateral)
- hyporeflexia or areflexia of the lower limb reflexes
EMERGENCY MEDICAL INTERVENTION REQUIRED
Describe the condition of lumbar disc pathology including the prognosis & treatment
Classification - as per Cx lumbar pathology (protrusion, prolapse, extrusion, sequestration)
Peak incidence 20-50 y.o. (less likely in older populations as disc dehydrates
- usually postero-lateral
SSX:
- in Lx the herniation affects the root below (ie: L4 herniation affects L5)
- can be asymptomatic
- centralized or unilateral dull pain
- sharp pain on movement
- pain aggravated by sitting, prolonged standing, coughing, straining
- may have protective scoliosis away from site of pain
- restricted Lx ROM and protective guarding of Lx mm
- radiculopathy SSX including sharp lancinating pain, dermatomal radicular SSX, myotomal weakness
Treatment:
- reassure: most cases self-resolve 3-6 months
- monitor for CES SSX
- exercise & mobilize with care
- anaglesic neuropathic pain management if appropriate
Describe the distribution of referred facet pain from the lumbar spine
L1-5:
low back
L2/3 - S1: low back glutes posterior thigh lateral thigh
L3-S1:
groin
anterior thigh
What is the difference between stenosis, spondylosis, spondylolysis, and spondylolisthesis?
Stenosis = narrowing of the intervertebral foramina and potential radiculopathy associated. Degenerative.
Spondylosis = degenerative compression / narrowing of vertebral column, with or without associated osteophytic growth
Spondylolysis = pars articularis fracture (of the base of the facet and/or lamina, pedicle)
Spondylolisthesis = displacement of the vertebrae in relation to adjacent vertebrae, often a secondary condition caused by spondylosis reducing bony integrity of vertebral joints
Describe lumbar spondylolysis
Pars articularis fracture (at base of superior articular facet, and may also include pedicle / lamina)
usually caused by high force during landing or repetitive loading
common mechanism hyperextension with rotation
SSX:
- may be asymptomatic
- gradual onset LBP aggravated by loading, hyperextension, rotation & lateral SB
- pain may refer to buttock / posterior thigh
- localized tenderness to palpation
- can progress to spondylolisthesis (as there is less bony integrity of the vertebral joints)
Healing:
- up to 8 weeks: Fx healing, avoid loading
- 9-16 weeks: protective reloading
- 4 mths +: functional retraining
Describe the condition of lumbar spondylolisthesis
displacement of the vertebra on adjacent vertebrae - often caused by lumbar spondylolysis, or degeneration
Classifications:
- anterolisthesis (anterior slippage)
- retrolisthesis (posterior slippage)
- Grade 1: slipped up to 25%
- Grade 2: 25-50%
- Grade 3: 50-75%
- Grade 4: 75% or more
- Grade 5: complete displacement
SSX:
- often asymptomatic and undiagnosed
- LBP gradual onset aggravated by extension
- maybe step off palpable
- maybe neuro SSX
