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Lower Back Disorders Flashcards

1
Q

Define Lordosis

A

Increased anterior convexity in the curvature of the spine

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2
Q

Define Kyphosis

A

Exaggeration of posterior convexity of the thoracic vertebral column found commonly with OA & osteoporosis

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3
Q

Define Scoliosis

A

Lateral curve of the spine usually right convex thoracic, most of which are idiopathic

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4
Q

Define Spondylolisthesis

A

Anterior slip, bilateral pars defect

Palpable step off with or without neurological symptoms

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5
Q

Define Stenosis

A

Narrowing of the spinal canal or neural foramen producing root ischemia or neurogenic claudication

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6
Q

Define Spondylolysis

A

Stress fracture of pars interarticularis

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7
Q

What on physical exam may indicate hip joint pathology?

A

Decreased internal rotation or external rotation

Reproduction of pain

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8
Q

L4 Reflex, Motor, and Sensory

A

R: patellar
M: ankle
S: medial foot and leg

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9
Q

L5 Reflex, Motor, and Sensory

A

R: none
M: extensor hallucus longus
S: lateral leg & dorsum of foot

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10
Q

S1 Reflex, Motor, and Sensory

A

R: Achilles
M: peroneus longus & brevis
S: lateral foot

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11
Q

Parts of a Vertebral Disc

A

Nucleus pulposus

Annulus Fibrosis

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12
Q

Ligaments of the Lumbar Spine

A

Anterior longitudinal ligament
Posterior longitudinal ligament
Interspinous
Supraspinous

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13
Q

Where does the anterior longitudinal ligament lie?

A

Anterior surface of the vertebral bodies

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14
Q

Where does the posterior longitudinal ligament lie?

A

Posterior surface of vertebral bodies inside the vertebral canal

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15
Q

What ligaments connect the spinous processes?

A

Interspinous

Supraspinous

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16
Q

Diagnostic Tests for Low Back Pain

A 
Plain radiographs
Bone scan
Diskography
CT myelogram
MRI
Labs
Tests for neurogenic pain
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17
Q

What can a bone scan rule out?

A

Infection

Occult metastatic tumor

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18
Q

What test is an accurate assessment of stenosis?

A

CT Myelogram

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19
Q

What test is the most useful for disc injury?

A

MRI

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20
Q

Which patients should you run labs on for low back pain?

A

High risk

Unimproved after 8-12 weeks of conservative treatment

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21
Q

Patients with High Risk Features for Low Back Pain

A

Poorly controlled DM
Infection
Nursing home
Hx of CA

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22
Q

Symptoms of a Herniated Disc

A

Some degree of back pain
Pain that radiates into the leg
Shooting or stabbing pain

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23
Q

Which is worse: straight leg raise or crossed straight-leg raise?

A

Crossed straight-leg raise

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24
Q

Most Useful Test for Herniated Discs

A

MRI

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25
Treatment for Disc Herniation
Conservative: PT, NSAIDs/steroids, & muscle relaxants; epidural steroid injections Surgical
26
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
27
Define Spinal Stenosis
Spinal canal narrowing with possible subsequent neural compression
28
Causes of Spinal Stenosis
``` Facet hypertrophy of the vertebra Vertebral body osteophytes Ligamentum flavum hypertrophy Disc degeneration Neoplasm Acromegaly Paget's disease Ankylosing spondylitis ```
29
What is neural claudication due to spinal stenosis exacerbated by?
Standing erect | Downhill ambulation
30
What is neural claudication due to spinal stenosis alleviated by?
Lying supine | Forward flexion
31
Diagnostic Tests for Spinal Stenosis
Radiographs MRI: imaging of choice Vascular studies if unsure
32
Treatment of Spinal Stenosis
PT stressing good spinal flexion Maintain fitness level Laminectomy
33
Define Degenerative Disc Disease
Disc dries out & loses shock absorption effect | Physiologic event modified by trauma, hereditary, & smoking
34
Management of Degenerative Disc Disease
NSAIDs Back education program MRI if no relief with above or if neuro symptoms develop
35
Define Facet Syndrome
Degenerative Joint Disease of articulating surfaces of vertebrae
36
Diagnostic Test for Facet Syndrome
Radiographic diagnosis
37
Treatment of Facet Syndrome
NSAIDs Back education program Focal injections Nerve obliteration
38
What is a muscle strain/sprain caused by?
Repetitive lifting Bending Other trauma
39
Management of Muscle Sprain/Strain
NSAIDs Back education program Relative rest Activity modification
40
Cauda Equina Syndrome
Mechanism: trauma, spinal cord injury, compression of sacral nerve roots Urinary retention with neurogenic bladder
41
Evaluation of Cauda Equine Syndrome
Rectal tone Bulbocavernosus reflex S1, S2, S3 Sacral sparing evaluating perianal sensation
42
Management of Cauda Equine Syndrome
REFER
43
Describe Bulbocavernosus Reflex
Pull on a catheter that has the balloon inflated
44
Define Ankylosing Spondylitis
Chronic & progressive form of seronegative arthritis
45
How does ankylosing spondylitis occur?
Formation of bony bridges between adjacent vertebrae | Progressive ossification of extra spinal joint capsules & ligaments
46
Who is most commonly affected with ankylosing spondylitis?
Young males | Peak: 15-35 years old
47
Presentation of Ankylosing Spondylitis
Repeated episodes of nocturnal back pain | Associated with spinal stiffness in the morning
48
Presenting Sign on Radiographs for Ankylosing Spondylitis
Bamboo spine
49
Treatment of Ankylosing Spondylitis
Lifelong exercises | NSAIDs
50
Most Common Population for Compression Fractures
Osteoporotic elderly
51
Define Burst Fracture
Bone shatters into many pieces
52
Describe the Pain in a Compression Fracture
``` Axial Non-radiating Aching Stabbing May be severe & disabling ```
53
What are important neurologic signs for a compression fracture?
Lower extremity weakness or numbness
54
Diagnostics for Compression Fractures
AP/lateral radiographs | MRI: determine acute from chronic
55
Treatment of Compression Fractures
Conservative | Surgical
56
Conservative Treatment of Conservative Fractures
Bracing Analgesic medications Rest
57
Cause of Scoliosis
Genetic in nature
58
What does scoliosis cause?
Lateral curvature of the spine greater than 10 degrees away from the central axis
59
Diagnosing Scoliosis
Forward flexion test | High sided scapula/shoulder
60
Treatment for Scoliosis less than 25 degrees
Observe with serial x-rays over time
61
Treatment for Rapidly Progressing Curves with 20+ Degrees
Bracing
62
Treatment for Scoliosis for 20-40 Degrees
Bracing
63
Treatment for "Inflexible" curves in Scoliosis
Surgery
64
Describe the Cobb Angle
Measure of the resulting scoliosis angle based on radiographs
65
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
66
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 ```
67
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 ```

Ortho (22 decks)

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