Low-Back Pain Flashcards
Conservative treatment for low-back pain consists of therapy for first 4 to 6 weeks which includes physiotherapy, analgesics (NSAIDS), and sometimes epidural steroid injections (only in acute radiculopathy cases). Which of the following are the indications for MRI of lumbosacral spine in patients with backache with subsequent surgical treatment of identified problem appropriately?
● A. Progressive neurologic deficit (e.g., weakness)
● B. Cauda equina syndrome (includes bladder issues, saddle anesthesia)
● C. Intractable pain
● D. Failure of medical treatment
● E. All of the above
E. All of the above
Generalized displacement of disk material is defined as displacement of more than 50% or 180 degrees beyond the peripheral limit of disk space. On the other hand, herniation is localized displacement of disk material less than 50% or 180 degrees beyond the limits of the intervertebral disk space. Following statements are true regarding herniation of disk except?
● A. Focal herniation is less than 25% of disk space
● B. Broad based disk herniation is 20 to 25% of the disk herniation
● C. Schmorl’s node is not a type of disk herniation
● D. Protrusion is a type of disk herniation in which the fragment does not have a neck
● E. Extrusion is a type of disk herniation in which the fragment has a neck which is further subdivided into sequestration and migration
C. Schmorl’s node is not a type of disk herniation
Dysfunction of nerve root, which may include pain in the distribution of the nerve root or dermatomal sensory disturbances or weakness of the muscle innervated by that nerve root or hypoactive muscle reflexes of the same muscles or a combination of these, is termed as?
● A. Myelopathy
● B. Mechanical low-back pain
● C. Sciatica
● D. Radiculopathy
● E. None of the above
D. Radiculopathy
Diminished sensations over medial malleolus plus medial foot, dorsum of foot, and lateral malleolus plus lateral foot suggests L4, L5, and S1 nerve root involvement, respectively. A patient presenting with history of fever with vertebral tenderness and very limited range of spinal motion has most likely
which of the following?
● A. Spinal tumor
● B. Spinal osteoarthritis
● C. Spinal infection
● D. Spinal degenerative disease
● E. Spinal instability
C. Spinal infection
Abnormal disk morphology on MRI is loss of T2WI signal intensity (black disk), disk space collapse, Modic changes, and high intensity zones (these findings also frequently occur in asymptomatic patients). Diskography (injection of water-soluble contrast agent directly into the nucleus pulposus of the intervertebral disk) is done through the Kambin’s triangle to find out pathologic disk. Following are included in the boundaries of Kambin’s triangle except?
● A. Exiting nerve root
● B. Superior end plate of inferior vertebral body
● C. Thecal sac
● D. Inferior facet of superior vertebral body
● E. All are included in the boundaries of Kambin’s triangle
D. Inferior facet of superior vertebral body
To see dynamic instability in spine, which of the following tests is done?
● A. Flexion–extension lumbar spine X-rays
● B. Oblique X-rays
● C. Standing scoliosis X-rays
● D. Lateral spine X-rays
● E. Anteroposterior spine X-rays
A. Flexion–extension lumbar spine X-rays
Following are the advantages of CT scan over MRI except?
● A. Excellent bony detail
● B. Less expensive
● C. Outpatient evaluation
● D. More claustrophobic
● E. Faster scanning
D. More claustrophobic
Following are included in the conservative treatment of low-back pain except?
● A. Bed rest for the first 2 to 3 days, activity modification (like prolonged sitting, bending or twisting, limiting lifting objects)
● B. Exercise starting from walking in the first 2 weeks then conditioning exercises for the trunk muscles
● C. NSAIDs and paracetamol
● D. Epidural injection for short-term relief of radicular pain
● E. Oral steroids
E. Oral steroids
Which of the following is an indication of lumbar fusion in case of disk herniation?
● A. Evidence of preoperative lumbar spinal deformity or instability
● B. In patients with chronic axial low-back pain associated with radiculopathy
● C. Both A and B
● D. Spondylolisthesis grade 1 without degenerative changes
● E. None of the above
C. Both A and B
Which of the following statements is correct regarding surgical option for low-back problems?
● A. Routine HLD or initial recurrence of HLD is treated with standard diskectomy or with microdiskectomy
● B. Foraminal or far-lateral HLD can be treated with partial or total facetectomy, extra canal approach or endoscopic techniques
● C. Only lumbar spinal stenosis can be treated with simple decompression laminectomy
● D. Patients with degenerative spondylolisthesis, stenosis and radiculopathy, adult degenerative scoliosis, or instability are treated with laminectomy plus fusion
● E. All of the above
E. All of the above
Failure to satisfactorily improve low-back pain or radiculopathy following back surgery is called as failed back surgery syndrome. Which of the following are the causes of “failed back
surgery syndrome”?
● A. Incorrect initial diagnosis or continued compression caused by residual disk, epidural hematoma, or pseudomeningocele
● B. Permanent nerve root injury preoperatively or after surgery
● C. Adhesive arachnoiditis or diskitis
● D. Spondylosis
● E. All of the above
E. All of the above
Surgery for failed back syndrome is recommended only for recurrent or residual disk, instability, or a pseudomeningocele. Following are true regarding MRI study of patients after operation for back pain except?
● A. MRI study done after surgery is always done with contrast if there is no contraindication
● B. Scar enhances on post-contrast MRI study
● C. Disk does not enhance on contrast MRI
● D. MRI is done only without contrast in all cases
D. MRI is done only without contrast in all cases
Myelographic classification of arachnoiditis includes which of the following?
● A. Unilateral focal filling defect centered on nerve root sleeve adjacent to disk space
● B. Circumferential constriction around thecal sac
● C. Complete obstruction with stalactites or candle guttering
● D. Infundibular cul de sac with loss of radicular striations
● E. All of the above
E. All of the above
In disk herniation, sequestration is when the fragment has lost continuity with the disk of origin. It is a subtype of which of the following?
● A. Disk bulge
● B. Extrusion
● C. Focal
● D. Broad based
● E. Extrusion
B. Extrusion
Bone marrow edema associated with acute or subacute inflammation showing hypointensity on T1WI and hyperintensity on T2WI is what Modic type?
● A. I
● B. II
● C. III
● D. IV
● E. V
A. I
