LBP Dx and Tx (Guest Lecture)

Question 1

Etiology of LBP

Answer 1

1. Mechanical (80-90%)
2. Neurogenic (5-15%)
3. Other (Fibro, Malingering - 2-4%)
4. Referred Visceral Pain (1-2%)
5. Non-mechanical Spinal Conditions (1-2%)

Question 2

Describe the most common system illness and what condition it is associated with

Answer 2

Vertebral fx associated with osteoporosis

Question 3

Condition: Represents a pathologic state in which the function of the spinal nerve roots is affected

Answer 3

Lumbar Radiculopathy

Question 4

Condition: Consists of radicular pain in a dermatomal distribution in combination with N/T and motor weakness

Answer 4

Lumbar Radiculopathy

Question 5

3 Mechanisms behind radicular pain

Answer 5

1. HNP causing structural and functional changes to adjacent nerve roots leading to sensitization
2. Nerve root compression and stimulation of nociceptors
3. Inflammation and vascular compromise

Question 6

Sx. of Radicular Pain (3)

Answer 6

1. Sharp, shooting, electrical pain
2. Leg pain worse than back pain
3. Radiation below the knee

Question 7

Describe what the seated position allows you to differentiate between

Answer 7

Sitting increases disc sx and decreases stenosis sx

Question 8

Describe the difference between neuropathic and facet pain

Answer 8

Neuropathic = burning, sharping, nawing

Facet = dull, pressure, achy

Question 9

Describe the advantage of the new FM criteria

Answer 9

It provides a graded scale on which to dx FM and can be used to gage pt. outcomes following tx

Question 10

Describe when CT and MRI would be used

Answer 10

MRI - better for soft tissue; impingements, discs

CT - better for bone; facets, non-union of fx

Question 11

Describe the difference in appear of discs with degeneration on MRI

Answer 11

Degenerated discs lack a white middle on imaging. A healthy disc has a white middle indicating the fluid is still present

Question 12

Pharmocological options for LBP (4)

Answer 12

1. Steroids (if they benefit from pills may benefit from an injection)
2. NSAIDs
3. Muscle Relaxants (taken constantly can weaken mm)(
4. Opioids (high risk of addiction)

Question 13

Describe the effect of epidural injections and conditions that they can help

Answer 13

The hope is to decrease the inflammation

Good for: HNP, stenosis, spondys

(Typically not given unless back AND leg pain is present)

Question 14

Describe the difference between a translaminar, transforaminal, and caudal epidural steroid injections

Answer 14

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

Question 15

4 Complications of injections

Answer 15

1. Direct needle trauma
2. Ischemic injury (chance of permanent paralysis is anterior spinal artery clogged)
3. Infection
4. Drug reaction (particulate steroids have a chance of paralysis)

Question 16

Describe the steroid injection timeline

Answer 16

3 injections over 3-5 mo

Most pts. will need more than one injection for sustained benefit

Question 17

Describe the difference between spinal cord stimulation and radiofrequency ablation

Answer 17

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

Question 18

Condition: Lumbar axial pain that may refer to the LE, pain increased with extension and lateral rotation

Answer 18

Lumbar Facet Arthropathy

Question 19

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

Answer 19

Sacroiliitis

Question 20

Condition: Compression of the sciatic nerve, typically presents with similar presentation to L5/S1, LBP/Buttock pain radiation now the posterior thigh/leg

Answer 20

Piriformis syndrome