LBP Dx and Tx (Guest Lecture) Flashcards
Etiology of LBP
- Mechanical (80-90%)
- Neurogenic (5-15%)
- Other (Fibro, Malingering - 2-4%)
- Referred Visceral Pain (1-2%)
- Non-mechanical Spinal Conditions (1-2%)
Describe the most common system illness and what condition it is associated with
Vertebral fx associated with osteoporosis
Condition: Represents a pathologic state in which the function of the spinal nerve roots is affected
Lumbar Radiculopathy
Condition: Consists of radicular pain in a dermatomal distribution in combination with N/T and motor weakness
Lumbar Radiculopathy
3 Mechanisms behind radicular pain
- HNP causing structural and functional changes to adjacent nerve roots leading to sensitization
- Nerve root compression and stimulation of nociceptors
- Inflammation and vascular compromise
Sx. of Radicular Pain (3)
- Sharp, shooting, electrical pain
- Leg pain worse than back pain
- Radiation below the knee
Describe what the seated position allows you to differentiate between
Sitting increases disc sx and decreases stenosis sx
Describe the difference between neuropathic and facet pain
Neuropathic = burning, sharping, nawing
Facet = dull, pressure, achy
Describe the advantage of the new FM criteria
It provides a graded scale on which to dx FM and can be used to gage pt. outcomes following tx
Describe when CT and MRI would be used
MRI - better for soft tissue; impingements, discs
CT - better for bone; facets, non-union of fx
Describe the difference in appear of discs with degeneration on MRI
Degenerated discs lack a white middle on imaging. A healthy disc has a white middle indicating the fluid is still present
Pharmocological options for LBP (4)
- Steroids (if they benefit from pills may benefit from an injection)
- NSAIDs
- Muscle Relaxants (taken constantly can weaken mm)(
- Opioids (high risk of addiction)
Describe the effect of epidural injections and conditions that they can help
The hope is to decrease the inflammation
Good for: HNP, stenosis, spondys
(Typically not given unless back AND leg pain is present)
Describe the difference between a translaminar, transforaminal, and caudal epidural steroid injections
Translaminar is less controlled, the steroid has a wider spread and will follow the path of least resistance
Transforaminal allows the steroid to be directed at a specific nerve root
Caudal is the simplest and provides wide spread that may not reach the affected level
4 Complications of injections
- Direct needle trauma
- Ischemic injury (chance of permanent paralysis is anterior spinal artery clogged)
- Infection
- Drug reaction (particulate steroids have a chance of paralysis)
Describe the steroid injection timeline
3 injections over 3-5 mo
Most pts. will need more than one injection for sustained benefit
Describe the difference between spinal cord stimulation and radiofrequency ablation
Spinal cord stimulation: alleviated pain by electrically activating pain-inhibiting neuronal circuits in the DH and inducing a tingling sensation to make the pain – uses GATE CONTROL THEORY
Radiofrequency ablation: severing the medial branches that innervate the facets in order to block the pain signals
Condition: Lumbar axial pain that may refer to the LE, pain increased with extension and lateral rotation
Lumbar Facet Arthropathy
Condition: Pain with referred pain along the joint line and ipsilateral hip/trochanter, can also refer along posterior thigh to knee, and can resemble lumbar disc pathology
Sacroiliitis
Condition: Compression of the sciatic nerve, typically presents with similar presentation to L5/S1, LBP/Buttock pain radiation now the posterior thigh/leg
Piriformis syndrome
