Lumbar 2 Flashcards
What is Lumbar stenosis?
Narrowing of the lumbar spinal canal and nerve root canal
Who does lumbar stenosis usually present in and how does it occur?
Adults >50 yrs
Insidious onset
What are signs and symptoms seen with Lumbar stenosis?
Begins with low back pin and morning stiffness
Pain expands into buttocks and lower extremities
Neurologic claudication with walking or from prolonged standing
What sign do people with lumbar stenosis typically exhibit and why?
Shopping cart sign
Pain is relieved by flexion vs standing upright/extension
What are signs associated with vascular claudication?
Cramping
Tightness
Relief while standing
Pulses are absent
What are signs associated with neurogenic claudication?
Numbness, ache, sharp pain Relief while sitting Atrophy Weakness Loss of ROM
What diagnostic tool is used to assess lumbar stenosis?
MRI–> will see narrowing of spinal canal
What is Spondylolysis?
Defect or stress fractures that happen in the pars interarticularis?
What motions cause spondylolysis occur?
Trunk extension and hyperextension
What sports are high risks in causing spondylolysis?
Ballet
Ice skating
Gymnastics
What major complication can occur from continuous spondylolysis?
Spondylolisthesis - forward movement of the the vertebrae
What are the different grades of spondylolisthesis?
Grade 1 = 25% translation
Grade 2 = 50%
Grade 3 = 75%
Grade 4 = 100%
What diagnostic study should evaluate spondylolysis?
Plain x-rays
What views are used to evaluate spondyloysis?
Which view is the most SENSITIVE view?
Which view is the most SPECIFIC view?
AP
Lateral ==> MOST SENSITIVE
Lateral Oblique ==> MOST SPECIFIC
Which view is used to best see if spondylolisthesis is occuring
Lateral view
Which classic image is seen on x-rays depicting sponylolysis?
Scotty dog effect
In a stress reaction how does osteoblast formation compare with osteoclast
Osteoclast activity surpasses osteoblast activity
What is the pathololgy behind repeated stress reactions and bones?
Tiny micro-fractures occur
Initiation of inflammatory response
What happens in grade 1 stress reactions
Periosteal edema
What happens in grades II-III stress reactions
Bone marrow edema
What happens in grades IV stress reactions
Cortical fracture lines
What imagins studies are used to assess stress fractures?
MRI
Bone scans
What is the treatment routine used to stress fractures?
1-5 wks ==> activity restrictions
5-12wks ==> PT
9-12wks ==> gradual return to activity
Consider using a brace
When should surgery be an option for stress fractures?
Surgery is considered in Grade III approaching Grade IV spondylolisthesis
Or Grade IV spondyloisthesis
