Low Back Pathologies Flashcards
characteristics of multiple myeloma
primary malignant tumor
in bone marrow
usually in older people
incidence of spinal metastases
most common spine tumors
2nd most serious spine pathology
most commonly in the vertebral body (usually anterior)
spine metastases are usually from what cancers
breast
lung
kidney
GI
thyroid
most common areas for metastasis
lung
liver
bone
spinal malignancy is usually in what region
thoracic
then lumbar
rarely cervical
pathogenesis of spine malignancy
healthy bone replaced by tumor
clinical manifestations fo spinal malignancy
severe spine pain
myelopathy S&S
bony alterations
cancer S&S
what vertebral segment is aligned with the end of the spinal cord
L1-L2
etiology of lumbar spinal cord myelopathy
most common = b/c of degenerative changes
malignancy = 20%
rare central disc herniation
how can degenerative changes cause myelopathy
lax/buckling of ligamentum flavum
ARDC/ARJC with arthritis/herniation
vertebral body collapse/fx
pathological instability
specific S&S of lumbar SC myelopathy
extreme spine pain
mechanical reproduction
multi segment nukmbness/weakness
spastic/retentive bladder
hyperactive DTRs
+ UMN tests
hypoactive superficial reflexes
what is cauda equina syndrome
compression to some degree on one of the 20 soinal nn that originate from the end of the spinal cord or conus medullaris
can be acute or chronic
below L1/L2 segment
prevalence of cauda equina
rare
2% of lumbar ARDC
etiology of cauda equina syndrome
1 = mid to lower lumbar ARDC
2= degenerative spinal changes/malignancy
risk factors for cauda equina syndrome
mid to lower lumbar:
-persistent IDD, central > postlat
-central stenosis
-surgery
over 50
obesity
Hx indicating cauda equina
LBP
bowel/bladder incontinence
sex dysfunction
cancer S&S possible
S&S of cauda equina
respective S&S of contributing degenerative conditions
unilateral and bilateral patchy neuro S&S
-paraesthesias in multiple derms
-multiple myotome weakness
-hypoactive DTR
-+dural mobility
-progressive/alternating findings due to SC movement
PT implications for cauda equina
likely emergency
what is osteomyelitis
bone infection
what is discitis
disc infection
incidence of spinal infection
uncommon in wealthier countries
discitis more common in lumbar
etiology of spinal infection
primarily from mycobacterium TB
staphylococcus aureus and brucella are also involved at times
risk factors for spinal infection
immunosupression
surgey
IV drug use
social depravation
Hx of TB or other recent infections
pathogenesis of spinal infection
develops 2-3 years after initial droplet of infection into lungs
spreads via lymph/blood
infection spreads to disc more common in lumbar
abscess grows and causes n root irritation, vertebral body collapse, and cord compression
clinical manifestations of spinal infection
mechanical/progressive spine pain
+ stress test for disc/vertebral body
infection S&S (especially fatigue/fever that started w/ back pain)
unexplained weight loss
TTP
LE and bowel/bladder neuro S&S if untreated
referral for spinal infection
urgent unless cord/cauda equina S&S then emergency
what imaging is good for spinal infection
if b/c of TB = x-ray
MRI = image of choice otherwise; can see infection 3-5 days after onset
what do blood tests test for with spinal infections
not diagnostic
inflammatory markers like RBC anf C reactive proteins are better indicators of infection than WBC
presence of normal WBC does not exclude a spinal infection
what is ankylosing spondylitis
type of spondyloarthropathy or spondyloarthritide
etiology of ankylosing spondylitis
genetics = 90% + for HLA-B27 antigen on blood test
environmental
incidence/prevalence of ankylosing spondylitis
almost as common as RA
males between 15-30 years = most common
usually in lumbosacral region
pathogenesis of ankylosis spondylitis
chronic inflammation of cartilage, tendon, ligament, and synovium attachments to bone
erosive osteopenia and bony overgrowth
leads to fusion of involved joints
common features of spondyloarthropathies or spondyloarthritides
autoimmune S&S
multi joint pain/inflammation
familial predisposition
extraarticular involvement of eyes, skin, GI tract, and renal/cardiac systems
“hurts to see, pee, and bend my knees”
describe the multijoint inflammation/pain associated with spodyloartropathoes or spondyloarthritides
> 30 min pain/stiffness after prolonged position
pain imporves with movement
chronic inflammation of axial skeleton
asymmetric/unilateral extremity involvement to a lesser degree
-localized to entheses
common Hx of those with ankylosing spondylitis
progressive LBP
onset < 40 years
lasting more than 3 months
no change with rest
night pain from static posiiton
butt/hip pain
obervation of those with ankylosing spondylitis
hyperkyphosis
loss of lumbar lordosis
scan findings for ankylosing spondylitis
multi directions of limited motion of involved joints
combined motion = consistent
stress test = pain with prolonged holds
biomechanical scan findings for ankylosing spondylitis
multi direction hypomobile accessory motion
limited thorax excursion with manubrial and rib springs (could compromise breathing)
referral for ankylosing spondylitis
urgent referral to rhematologist
Rx for ankylosing spondylitis
be sensitive to trauma
fall prevention
gentle ROM and exercise considering fragility
postural edu
**all would also help with bone pathologies like osteoporosis, osteomalacia, etc
complications of ankylosing spondylitis may lead to
osteoporosis
fxs
CV sublux
stenosis
fusing in certain positions
extraarticular conditions like IBS or uveitis
cardiopulmonary disorders
