Lower Back Disorders Flashcards
Define Lordosis
Increased anterior convexity in the curvature of the spine
Define Kyphosis
Exaggeration of posterior convexity of the thoracic vertebral column found commonly with OA & osteoporosis
Define Scoliosis
Lateral curve of the spine usually right convex thoracic, most of which are idiopathic
Define Spondylolisthesis
Anterior slip, bilateral pars defect
Palpable step off with or without neurological symptoms
Define Stenosis
Narrowing of the spinal canal or neural foramen producing root ischemia or neurogenic claudication
Define Spondylolysis
Stress fracture of pars interarticularis
What on physical exam may indicate hip joint pathology?
Decreased internal rotation or external rotation
Reproduction of pain
L4 Reflex, Motor, and Sensory
R: patellar
M: ankle
S: medial foot and leg
L5 Reflex, Motor, and Sensory
R: none
M: extensor hallucus longus
S: lateral leg & dorsum of foot
S1 Reflex, Motor, and Sensory
R: Achilles
M: peroneus longus & brevis
S: lateral foot
Parts of a Vertebral Disc
Nucleus pulposus
Annulus Fibrosis
Ligaments of the Lumbar Spine
Anterior longitudinal ligament
Posterior longitudinal ligament
Interspinous
Supraspinous
Where does the anterior longitudinal ligament lie?
Anterior surface of the vertebral bodies
Where does the posterior longitudinal ligament lie?
Posterior surface of vertebral bodies inside the vertebral canal
What ligaments connect the spinous processes?
Interspinous
Supraspinous
Diagnostic Tests for Low Back Pain
Plain radiographs Bone scan Diskography CT myelogram MRI Labs Tests for neurogenic pain
What can a bone scan rule out?
Infection
Occult metastatic tumor
What test is an accurate assessment of stenosis?
CT Myelogram
What test is the most useful for disc injury?
MRI
Which patients should you run labs on for low back pain?
High risk
Unimproved after 8-12 weeks of conservative treatment
Patients with High Risk Features for Low Back Pain
Poorly controlled DM
Infection
Nursing home
Hx of CA
Symptoms of a Herniated Disc
Some degree of back pain
Pain that radiates into the leg
Shooting or stabbing pain
Which is worse: straight leg raise or crossed straight-leg raise?
Crossed straight-leg raise
Most Useful Test for Herniated Discs
MRI
Treatment for Disc Herniation
Conservative: PT, NSAIDs/steroids, & muscle relaxants; epidural steroid injections
Surgical
Reasons for Surgical Treatment of a Disc Herniation
Cauda equina syndrome
Profound motor deficits
Progressive neurologic deficit
Persistent bothersome sciatic pain, despite conservative management for 6-12 weeks
Define Spinal Stenosis
Spinal canal narrowing with possible subsequent neural compression
Causes of Spinal Stenosis
Facet hypertrophy of the vertebra Vertebral body osteophytes Ligamentum flavum hypertrophy Disc degeneration Neoplasm Acromegaly Paget's disease Ankylosing spondylitis
What is neural claudication due to spinal stenosis exacerbated by?
Standing erect
Downhill ambulation
What is neural claudication due to spinal stenosis alleviated by?
Lying supine
Forward flexion
Diagnostic Tests for Spinal Stenosis
Radiographs
MRI: imaging of choice
Vascular studies if unsure
Treatment of Spinal Stenosis
PT stressing good spinal flexion
Maintain fitness level
Laminectomy
Define Degenerative Disc Disease
Disc dries out & loses shock absorption effect
Physiologic event modified by trauma, hereditary, & smoking
Management of Degenerative Disc Disease
NSAIDs
Back education program
MRI if no relief with above or if neuro symptoms develop
Define Facet Syndrome
Degenerative Joint Disease of articulating surfaces of vertebrae
Diagnostic Test for Facet Syndrome
Radiographic diagnosis
Treatment of Facet Syndrome
NSAIDs
Back education program
Focal injections
Nerve obliteration
What is a muscle strain/sprain caused by?
Repetitive lifting
Bending
Other trauma
Management of Muscle Sprain/Strain
NSAIDs
Back education program
Relative rest
Activity modification
Cauda Equina Syndrome
Mechanism: trauma, spinal cord injury, compression of sacral nerve roots
Urinary retention with neurogenic bladder
Evaluation of Cauda Equine Syndrome
Rectal tone
Bulbocavernosus reflex
S1, S2, S3
Sacral sparing evaluating perianal sensation
Management of Cauda Equine Syndrome
REFER
Describe Bulbocavernosus Reflex
Pull on a catheter that has the balloon inflated
Define Ankylosing Spondylitis
Chronic & progressive form of seronegative arthritis
How does ankylosing spondylitis occur?
Formation of bony bridges between adjacent vertebrae
Progressive ossification of extra spinal joint capsules & ligaments
Who is most commonly affected with ankylosing spondylitis?
Young males
Peak: 15-35 years old
Presentation of Ankylosing Spondylitis
Repeated episodes of nocturnal back pain
Associated with spinal stiffness in the morning
Presenting Sign on Radiographs for Ankylosing Spondylitis
Bamboo spine
Treatment of Ankylosing Spondylitis
Lifelong exercises
NSAIDs
Most Common Population for Compression Fractures
Osteoporotic elderly
Define Burst Fracture
Bone shatters into many pieces
Describe the Pain in a Compression Fracture
Axial Non-radiating Aching Stabbing May be severe & disabling
What are important neurologic signs for a compression fracture?
Lower extremity weakness or numbness
Diagnostics for Compression Fractures
AP/lateral radiographs
MRI: determine acute from chronic
Treatment of Compression Fractures
Conservative
Surgical
Conservative Treatment of Conservative Fractures
Bracing
Analgesic medications
Rest
Cause of Scoliosis
Genetic in nature
What does scoliosis cause?
Lateral curvature of the spine greater than 10 degrees away from the central axis
Diagnosing Scoliosis
Forward flexion test
High sided scapula/shoulder
Treatment for Scoliosis less than 25 degrees
Observe with serial x-rays over time
Treatment for Rapidly Progressing Curves with 20+ Degrees
Bracing
Treatment for Scoliosis for 20-40 Degrees
Bracing
Treatment for “Inflexible” curves in Scoliosis
Surgery
Describe the Cobb Angle
Measure of the resulting scoliosis angle based on radiographs
Describe Sciatic Pain
Shooting, radiating pain down one or both legs usually below the knee/knees in a dermatomal distribution often with associated numbness & tingling possible local weakness
Differential Diagnosis of Low Back Pain
Herniated disc Lumbar strain or sprain Myofascial pain syndrome (MPS) & fibromyalgia (FM) Facet syndrome Ankylosing spondylosis Spondylolisthesis Compression fracture Spinous/transverse process fracture Sacral stress fracture Central canal stenosis Foraminal stenosis Steersman's disease Diskitis Osteomyelitis Malignancy AAA Endometriosis Prostatitis SI joint dysfunction
Signs/Symptoms of Life Threatening Proportion
Aching nocturnal pain unrelieved by rest S/S of AAA Bladder/bowel incontinence Cauda Equina Spine fracture with instability
