lower back pain Flashcards
LOW BACK PAIN: RISK FACTORS
Poor muscle tone
Obesity
Poor body mechanics
Stress
Repetitive heavy lifting
Excessive vibration stress ( Jackhammer operator)
Sedentary work: Prolonged periods of sitting.
Psychological factors: somatization disorders, anxiety, depression.
LOW BACK PAIN:ETIOLOGY - when is it considered acute?
Acute low back pain lasts 4 weeks or less
LOW BACK PAIN: ASSESSMENT: OBJECTIVE DATA (guarding what side?)
Musculo-skeletal:
General comments about pt:
Pt appears to be in pain
Guarding left back while slowly moving
ROM: full flexion and extension of spine and extremities
+ point tenderness and spasms of paraspinous muscles
Locomotion: pt ambulate with obvious pain
LOW BACK PAIN: ASSESSMENT: OBJECTIVE DATA (just 2 things)
Neuro Assessment:
DTR: deep tendon reflexes
CSM: color, sensation and motion
Magnetic Resonance Imaging - what does it visualize? (MR. door)
tumors
Epidural Absceses
Disks
soft tissues
ligaments
cartilage
History and physical alone are sufficient to evaluate pts with LPB of less than
than 4 weeks duration.
Herniated Disc - most common in what part of the back?
Most common features of a lumbar
herniated intervertebral disk include
Back pain associated with buttock and leg pain along the sciatic nerve (radiculopathy)
HERNIATED DISC: Indications for surgery
Most patients with a herniated disk recover with conservative treatment.
Indications for surgical intervention include:
Failure of conservative treatment
Pain becomes progressively worse.
Loss of bowel or bladder control.
SURGICAL INTERVENTIONS FOR LOW BACK PROBLEMS - Percutaneous laser discectomy
Laserization of herniated portion of the disk
Spinal fusion
Fusing vertebrae together with bone graft (from fibula, iliac crest, donated bone) or prothesis….. with or without metal rods, plates, or screws
BACK SURGERY POST-OP CARE
Maintain proper alignment of the spine at all times
Pay close attention to activity orders
Log rolling
Monitor neurologic status of lower extremities (MAE, Sensation, DTR, Strength
post op care - CSF? and what about blood test? (My beta and glucose has CSF)
Monitor for spinal fluid leak (CSF) - Severe headache
CSF on dressings
Bulls-eye sign: blood in middle with yellowish clear ring
CSF is positive for glucose 80% of time
Beta-2 transferrin assay 99% (+) positive for CSF
LOW BACK PAIN: when do most cases resolve?
Most episodes of LBP resolve within 6 wks
Pain that lasts longer is a red flag.
paralysis - what parts of the spine
cervical - quad
thoracic - para
lumbar - para
sacrum - depends
red flag
over 70, pain longer than 6 weeks
EMG (ehmygod it’s neuropathy)
determines where neuropathy is
herniated disc - straight leg raise test (SLR) - what degree?
+ SLR: Positive straight leg raises:
Pain down leg with passive elevation of leg to 30º
↓ Reflexes (may be depressed or absent)
Parasthesias (tingling, sensory sensations)
surgery for lower back - Discectomy
surgical removal of a herniated intervertebral disk to decompress the nerve root.
surgery for lower back - Laminectomy (lament the disk)
surgical excision of part of the posterior arch of the vertebra and removal of the protruding disk
lower back pain - elderly - must do what if there is trauma?
History of even minor trauma in elderly patients requires X-rays to rule out fractures
lower back pain - Straight leg raise indicate what discs are herniated?
Straight leg raise is 80% sensitive for revealing L5 or S1 herniated disk
Rectal exam with loss of sphincter tone indicates (2 the rectum)
an S2 defect
what test for lower back pain is best?
MRI is the test of choice for evaluating serious causes of LBP.
ex. of acute lower back pain
Acute lumbar-sacral strain
Fractures
OA/DJD
Herniation of the disk
Most low back pain is due to strain and sprain from trauma.
Test of choice for serious LBP problems
Magnetic Resonance Imaging
lower back pain - diagnostics - MRI
considered the best initial test for most patients with LBP requiring advanced imaging.
lower back pain - diagnostics - CT (cutie bone)
gives better definition, than MRI, of bony structures
lower back pain - diagnostics - X-rays (can’t x-ray my hernia)
do not detect herniated discs but can show evidence of infection, fracture, malignancies and degenerative changes
lower back pain - diagnostics - EMG (pinch my EMG)
most helpful in evaluating pts with radiculoplathy (pinched nerve)
lower back pain - lab tests (CEC the lab tests)
CBC, ESR (eyrthroctye = inflammation), CRP (c-reactive) are useful in detecting pts with spinal infections or malignancies
assessment - objective - strength?
Strength: + 5
assessment - objective - straight leg raises - what is a positive test?
SLR: straight leg raises to 30 degrees: (straight leg raises to 30°) Sciatic nerve. Pain radiating ↓ the knee = + test. 80% sensitive.
straight leg raises - positive for what?
lumbar disk herniation when radicular pain occurs
