Lumbar Flashcards
Acute low back pain= New onset LBP < ___ weeks duration
Acute low back pain= New onset LBP < 12 weeks duration
What 3 structures are involved in LBP and which is MC?
- Facet joints (MC)
- Ligamentous structure
- Paravertebral spinal muscle
What are the 4 common mechanisms of injury of LBP?
- Poor Lifting technique
- Carrying excessive load
- Making a sudden movement
- Falls
Acute LBP typically follows pattern of what?
irritated facet joint
Which condition?
- TTP over involved facet joint
- Pain w/ extension and rotation–> facet joint compression
- Tightness/pain w/ forward flexion
- Difficulty arising from seated position
- Nml neuro (negative straight leg raise)
Acute LBP
What What are the 7 components of Acute LBP management?
- Avoid complete bedrest
- Ice/heat
- Stretching (hamstring & hip flexors)
- NSAIDs (Ketorolac) or short course of prednisone
- Acetaminophen
- Muscle Relaxers (Cyclobenzaprine, Metaxalone, Carisporodol)
- PT
How long does Acute LBP usually last?
Most cases self limited
Several days to 4 weeks
What 4 sxs does Lumbar Radiculopathy cause?
- Pain
- Sensory impairment
- Weakness
- Diminished DTRs
(distribution key to determining involved nerve root)
What special test would be positive in a lumbar radiculopathy?
Straight leg raise
(seated straight leg raise would also be positive)
What does straight leg raise evaluate for?
Sciatic nerve irritation
Lumbar nerve root irritation
Supine leg raise:
Radicular pain brought on w/ testing of the contralateral leg is highly specific for what?
Lumbar nerve root entrapment/irritation
What imaging is used to evalulate Lumbar radiculopathy?
- 1st: X-ray
- If neg, try conservative tx
- if doesn’t get better- consider MRI
How do you tx Lumbar radiculopathy (5)
- 1st line: NSAIDs, PT
- Prednisone
- Injections
- Epidural (max 3)
- Sx?
What condition?
- Bilateral sciatica (pain radiating down legs)
- Bilateral LE weakness
- Saddle anesthesia
- Sphincter dysfunction (DRE)
-
Bowel/bladder dysfunction
*

Cauda Equina Syndrome
How do you treat cauda equina syndrome?
Emergent Neurosurgery consult
What condition?
- Disc degeneration
- arthritic changes involving lumbar vertebrae and facet joints
- Thickening of ligamentum flavum
- Bone spurs
- Narrowing of spinal canal and nerve root canal
Lumbar Spinal stenosis
Clinical presentation of what condition?
- >50y/o
- Insidious onset
- Start w/ LBP and morning stiffness
- Pain expands to buttocks and LE
- Neurogenic claudication
- _Shopping cart sign**_
- WEAKNESS NOT COMMON
- Nml neuro
Lumbar SPinal stenosis
Which condition has the shopping cart sign?
Lumbar Spinal Stenosis
(b/c leaning forward relieves pressure, lessening sxs)

Lumbar spinal stenosis:
- Weakness not common, but if it is present you may see what 2 things
- Partial foot drop
- Plantar flexion weakness w/ prolonged walking
What 3 diagnostic studies are used to evaluate lumbar spinal stenosis?
- X-rays
- MRI
- arterial US to r/o vascular claudication
What is Spondylolistheis?
- Forward translation of one vertebra on another
- often occurs during growth spurt
What are grades 1-4 for Spondylolisthesis?
Grade 1- < 25% translation
Grade 2- < 50% translation
Grade 3- < 75% translation
Grade 4- < 100% translation
How do you tx Lumbar spinal stenosis? (9)
- NSAIDs/Acetaminophen
- Duloxetine
- Amitryptiline (for sleep)
- Gabapentin
- _Weight loss***_
- PT/OT
- epidural injections
- Radiofrequency ablation
- Sx- spinal cord stimulator, fusion
What condition?
- Defect/ stress fx in pars interarticularis of the lumbar vertebra
- NO neuro sxs or radiculopathy
- MC women
Spondylolysis