lower back pain

Question 1

LOW BACK PAIN: RISK FACTORS

Answer 1

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.

Question 2

LOW BACK PAIN:ETIOLOGY - when is it considered acute?

Answer 2

Acute low back pain lasts 4 weeks or less

Question 3

LOW BACK PAIN: ASSESSMENT:
OBJECTIVE DATA (guarding what side?)

Answer 3

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

Question 4

LOW BACK PAIN: ASSESSMENT:
OBJECTIVE DATA (just 2 things)

Answer 4

Neuro Assessment:
DTR: deep tendon reflexes
CSM: color, sensation and motion

Question 5

Magnetic Resonance Imaging - what does it visualize? (MR. door)

Answer 5

tumors
Epidural Absceses
Disks
soft tissues
ligaments
cartilage

Question 6

History and physical alone are sufficient to evaluate pts with LPB of less than

Answer 6

than 4 weeks duration.

Question 7

Herniated Disc - most common in what part of the back?

Answer 7

Most common features of a lumbar
herniated intervertebral disk include
Back pain associated with buttock and leg pain along the sciatic nerve (radiculopathy)

Question 8

HERNIATED DISC:
Indications for surgery

Answer 8

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.

Question 9

SURGICAL INTERVENTIONS FOR LOW BACK PROBLEMS - Percutaneous laser discectomy

Answer 9

Laserization of herniated portion of the disk

Question 10

Spinal fusion

Answer 10

Fusing vertebrae together with bone graft (from fibula, iliac crest, donated bone) or prothesis….. 
with or without metal rods, plates, or screws

Question 11

BACK SURGERY POST-OP CARE

Answer 11

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

Question 12

post op care - CSF? and what about blood test? (My beta and glucose has CSF)

Answer 12

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

Question 13

LOW BACK PAIN: when do most cases resolve?

Answer 13

Most episodes of LBP resolve within 6 wks
Pain that lasts longer is a red flag.

Question 14

paralysis - what parts of the spine

Answer 14

cervical - quad
thoracic - para
lumbar - para
sacrum - depends

Question 15

red flag

Answer 15

over 70, pain longer than 6 weeks

Question 16

EMG (ehmygod it’s neuropathy)

Answer 16

determines where neuropathy is

Question 17

herniated disc - straight leg raise test (SLR) - what degree?

Answer 17

+ 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)

Question 18

surgery for lower back - Discectomy

Answer 18

surgical removal of a herniated intervertebral disk to decompress the nerve root.

Question 19

surgery for lower back - Laminectomy (lament the disk)

Answer 19

surgical excision of part of the posterior arch of the vertebra and removal of the protruding disk

Question 20

lower back pain - elderly - must do what if there is trauma?

Answer 20

History of even minor trauma in elderly patients requires X-rays to rule out fractures

Question 21

lower back pain - Straight leg raise indicate what discs are herniated?

Answer 21

Straight leg raise is 80% sensitive for revealing L5 or S1 herniated disk

Question 22

Rectal exam with loss of sphincter tone indicates (2 the rectum)

Answer 22

an S2 defect

Question 23

what test for lower back pain is best?

Answer 23

MRI is the test of choice for evaluating serious causes of LBP.

Question 24

ex. of acute lower back pain

Answer 24

Acute lumbar-sacral strain
Fractures
OA/DJD
Herniation of the disk
Most low back pain is due to strain and sprain from trauma.

Question 25

Test of choice for serious LBP problems

Answer 25

Magnetic Resonance Imaging

Question 26

lower back pain - diagnostics - MRI

Answer 26

considered the best initial test for most patients with LBP requiring advanced imaging.

Question 27

lower back pain - diagnostics - CT (cutie bone)

Answer 27

gives better definition, than MRI, of bony structures

Question 28

lower back pain - diagnostics - X-rays (can’t x-ray my hernia)

Answer 28

do not detect herniated discs but can show evidence of infection, fracture, malignancies and degenerative changes

Question 29

lower back pain - diagnostics - EMG (pinch my EMG)

Answer 29

most helpful in evaluating pts with radiculoplathy (pinched nerve)

Question 30

lower back pain - lab tests (CEC the lab tests)

Answer 30

CBC, ESR (eyrthroctye = inflammation), CRP (c-reactive) are useful in detecting pts with spinal infections or malignancies

Question 31

assessment - objective - strength?

Answer 31

Strength: + 5

Question 32

assessment - objective - straight leg raises - what is a positive test?

Answer 32

SLR: straight leg raises to 30 degrees: (straight leg raises to 30°) Sciatic nerve. Pain radiating ↓ the knee = + test. 80% sensitive.

Question 33

straight leg raises - positive for what?

Answer 33

lumbar disk herniation when radicular pain occurs