Lumbar 2

Question 1

What is Lumbar stenosis?

Answer 1

Narrowing of the lumbar spinal canal and nerve root canal

Question 2

Who does lumbar stenosis usually present in and how does it occur?

Answer 2

Adults >50 yrs

Insidious onset

Question 3

What are signs and symptoms seen with Lumbar stenosis?

Answer 3

Begins with low back pin and morning stiffness

Pain expands into buttocks and lower extremities

Neurologic claudication with walking or from prolonged standing

Question 4

What sign do people with lumbar stenosis typically exhibit and why?

Answer 4

Shopping cart sign

Pain is relieved by flexion vs standing upright/extension

Question 5

What are signs associated with vascular claudication?

Answer 5

Cramping
Tightness
Relief while standing
Pulses are absent

Question 6

What are signs associated with neurogenic claudication?

Answer 6

Numbness, ache, sharp pain
Relief while sitting 
Atrophy
Weakness
Loss of ROM

Question 7

What diagnostic tool is used to assess lumbar stenosis?

Answer 7

MRI–> will see narrowing of spinal canal

Question 8

What is Spondylolysis?

Answer 8

Defect or stress fractures that happen in the pars interarticularis?

Question 9

What motions cause spondylolysis occur?

Answer 9

Trunk extension and hyperextension

Question 10

What sports are high risks in causing spondylolysis?

Answer 10

Ballet
Ice skating
Gymnastics

Question 11

What major complication can occur from continuous spondylolysis?

Answer 11

Spondylolisthesis - forward movement of the the vertebrae

Question 12

What are the different grades of spondylolisthesis?

Answer 12

Grade 1 = 25% translation
Grade 2 = 50%
Grade 3 = 75%
Grade 4 = 100%

Question 13

What diagnostic study should evaluate spondylolysis?

Answer 13

Plain x-rays

Question 14

What views are used to evaluate spondyloysis?

Which view is the most SENSITIVE view?
Which view is the most SPECIFIC view?

Answer 14

AP

Lateral ==> MOST SENSITIVE

Lateral Oblique ==> MOST SPECIFIC

Question 15

Which view is used to best see if spondylolisthesis is occuring

Answer 15

Lateral view

Question 16

Which classic image is seen on x-rays depicting sponylolysis?

Answer 16

Scotty dog effect

Question 17

In a stress reaction how does osteoblast formation compare with osteoclast

Answer 17

Osteoclast activity surpasses osteoblast activity

Question 18

What is the pathololgy behind repeated stress reactions and bones?

Answer 18

Tiny micro-fractures occur

Initiation of inflammatory response

Question 19

What happens in grade 1 stress reactions

Answer 19

Periosteal edema

Question 20

What happens in grades II-III stress reactions

Answer 20

Bone marrow edema

Question 21

What happens in grades IV stress reactions

Answer 21

Cortical fracture lines

Question 22

What imagins studies are used to assess stress fractures?

Answer 22

MRI

Bone scans

Question 23

What is the treatment routine used to stress fractures?

Answer 23

1-5 wks ==> activity restrictions

5-12wks ==> PT

9-12wks ==> gradual return to activity

Consider using a brace

Question 24

When should surgery be an option for stress fractures?

Answer 24

Surgery is considered in Grade III approaching Grade IV spondylolisthesis

Or Grade IV spondyloisthesis