Laslett's/Pathoanatomic LBP Classification Flashcards
What are the 3 assumptions of the Laslett’s Classificaiton System?
- Most cases of LBP have non-specific diagnosis
- Majority of LBP has pathologic basis
- Identifying subgroups of patients with LBP will direct most appropriate treatment
What 4 groupings of symptoms does the Laslett Classification System sift through?
(1) Disc Syndrome
(2) Symptoms below gluteal fold
(3) Symptoms above gluteal fold
(4) Symptoms of secondary classifications that can occur alongside the others
What are the pain generators in disc syndrome?
annulus, nerve root, and dural sleeve are the predominant pain generators
What are the mechanical causes of disc syndrome? (3)
(1) protusion or bulging
(2) annular tear
(3) discitis
What is a mechanical reducible disc?
LBP and/or referred pain caused by displacement of nucleus that is reversible by specific loading strategies
What are the criteria for a mechanical reducible disc? (3)
- At least one movement painfully limited
- Either loading strategies centralize symptoms
- Or midline pain decreases and remains better and loading strategy in other direction increases midline pain that remains worse
What is a mechanical irreducible disc?
LBP and/or referred pain caused by displacement of nucleus that is not reversible by loading strategies
What are the criteria for a mechanical irreducible disc? (4)
- At least one movement painfully limited
- No loading strategies that centralize symptoms
- Either at least one loading strategy peripheralizes symptoms
- Or distal symptoms increase and remain worse by a loading strategy
What is a non-mechanical disc?
LBP with or without referred pain, with dominant symptoms above gluteal fold, in which principal source of nociceptor activity is a chemically sensitive disc
What are the criteria for a non-mechanical disc? (5)
- Previous criteria not satisfied
- Loading strategies in any direction increase symptoms and remain worse
- No loading strategies decrease or abolish symptoms
- Range of movement unaffected by loading strategies
- One or more other disc characteristics
What is an adherent nerve root syndrome?
Dominant symptoms below gluteal fold with limited nerve root mobility caused by fibrosis or scarring of one or more lumbosacral nerve roots
What are the criteria of adherent nerve root syndrome? (4)
- History of acute sciatica or lumbar spine surgery at least 2 months prior
- Flexion in standing limited and produces symptoms at end range of movement
- Repeated flexion in standing reproduces symptoms but do not result in change
- Extension in standing or lying, and flexion in lying, do not produce symptoms
What is a nerve root entrapment syndrome?
Dominant symptoms below gluteal fold caused by persistent compression and movement limitation of lumbar nerve root
What are the criteria for nerve root entrapment syndrome? (6)
- Criteria for disc and adherent nerve root not satisfied
- History of acute disc lesion causing nerve root symptoms at least 2 months prior
- Flexion in standing limited and produces or increases distal symptoms
- Repeated flexion in standing reproduces or increases symptoms but they do not remain worse
- Repeated flexion in standing may temporarily increase in movement
- No loading strategies centralize or abolish symptoms
What is a nerve root compression?
Dominant symptoms below gluteal fold caused by compression of nerve root that is not made worse or better by loading strategies (no changes in sensation)
What are the criteria for a nerve root compression? (1)
•Straight leg raise positive and one of following present (weakness or reflex deminished)
What is spinal stenosis syndrome?
Dominant symptoms below gluteal fold secondary to narrowing of lumbar spinal canal or lumbar intervertebral foramen
What are the criteria for spinal stenosis syndrome? (4)
- Criteria for disc, adherent nerve root, nerve root entrapment and nerve root compression not satisfied
- History of standing or walking intolerance (extension intolerance)
- Symptoms improved in sitting or improved walking tolerance with flexion (shopping cart sign)
- Worst posture with regard to symptoms is standing/walking whereas best posture is sitting
What is vascular stenosis?
Pain onset not related to spinal position that is instead provoked only by aerobic demand that exceeds arterial capacity
What are the symptoms of Central stenosis?
- Bilateral sciatica
- Neurogenic claudication walking or standing
- Relief with sitting or lumbar flexion
- Extension worsens
- Confirmation with CT or MRI
Spondylolisthesis a possible cause
What are the symptoms of Lateral Stenosis?
- Unilateral sciatica
- Neurogenic claudication walking or standing
- Ipsilateral flexion and extension provoke leg symptoms
- Relieved by flexion and contralateral flexion
- Confirmation with CT or MRI
What is zygapophyseal joint syndrome?
LBP with or without referred pain with dominant symptoms above gluteal fold in which principal source of nociceptive activity is a zygapophyseal joint syndrome (two subcategories = mechanical and inflammatory)
What are the criteria for zygapophyseal joint syndrome?
3 or more of following positive:
- Age > 50
- Symptoms best when walking
- Symptoms best when sitting
- Onset pain is paraspinal (one side)
- Positive extension/rotation test (Kemp’s test)
What is postural syndrome?
LBP with or without referred pain with dominant symptoms above gluteal fold resulting form mechanical deformation of innervated normal soft tissues by prolonged static end range loading
