Lumbar Clinical Presentations

Question 1

prognostic indicators for development of recurrent LBP

Answer 1

hx previous episodes
excessive spine mobility
excessive mobility in other joints

Question 2

prognostic indicators for development of chronic LBP

Answer 2

presence of symptoms below the knee
psychosocial distress or depression
fear of pain, movement, re-injury or low expectations of recovery
pain of high intensity
passive coping style

Question 3

lumbar spine pain

Answer 3

T12-S1

Question 4

sacral spine pain

Answer 4

area of PSISs through S1 and sacrococcygeal joints

Question 5

neoplasms common site for metastasis

Answer 5

prostate
breast
kidney
thyroid
lung

Question 6

what kind of pain complaints do u see with neoplasms

Answer 6

persistent
not alleviated with bed rest
worse at night
neurologic symptoms

Question 7

physical exam w neoplasms

Answer 7

non-mechanical presentation
age >50
anemia
neurologic signs
lab tests for confirmation

Question 8

vertebral osteomyelitis

Answer 8

misdiagnosed alot
infxn in vertebraes

Question 9

epidural abscess

Answer 9

haematogenous spread of bacteria into epidural space

Question 10

what is epidural abscess associated with

Answer 10

DM, chronic renal failure, IV drug misues, alcoholism, cancer

Question 11

if vertebral osteomyelitis what is seen w prior hx

Answer 11

traced to other source of infxn - bladder, dental, pneumonia

Question 12

increased risk for vertebral osteomyelitis

Answer 12

immunocompromised pt
DM

Question 13

SxS with vertebral osteomyelitis

Answer 13

wt loss
fatigue
fever
neurologic symptoms
local back pain
worse w mechanical loading

Question 14

progression of epidural abscess

Answer 14

local, back pain
radicular SxS
paralysis

Question 15

vertebral fx red flags

Answer 15

old age
significant trauma
corticosteroid use
contusion/abrasion

Question 16

vertebral fx red flags cluster from Roman and Henschke

Answer 16

age >70
significant trauma
prolonged corticosteroid use
sensory alterations from trunk down

Question 17

vertebral fx red flags cluster from Roman and Cook - QUADAS

Answer 17

age >52
no presence of leg pain
BMI less than or equal to 22
does not exercise
female

Question 18

spondylolysis

Answer 18

fatigue fx of pars interarticularis

Question 19

acquired spondylolysis

Answer 19

repetitive microtrauma with extension/extension with side bending activities

Question 20

flail segment

Answer 20

bilateral pars defect with attached multifidi

Question 21

spondylolysthesis

Answer 21

anterior slip of vertebra after bilateral spondylolysis

Question 22

symptoms of spondylolysis & spondylolysthesis

Answer 22

localized LBP worse w extension

Question 23

physical exam for spondylolysis & spondylolysthesis

Answer 23

neuro test
excessive lumbar lordosis
step off deformity
pain w ext & rotation
HS tightness
+ instability & spring testing

Question 24

what is latrogenic discitis

Answer 24

infxn of the disc due to another medical procedure

Question 25

latrogenic discitis

Answer 25

bacterial infxn from needle during discography painful

Question 26

internal disc disruption

Answer 26

disc degrades within can get schmorl's nodes blood extruded from intraosseous veins in marrow spaces

Question 27

IDD occurs from what

Answer 27

following rotary injury or end plate injury

Question 28

what grade do you start to feel pain with IDD

Answer 28

grade 3 due to annulus being innervated

Question 29

what does IDD lead to

Answer 29

nucleus less able to bind water disc loses height excessive loading on facet joints

Question 30

disc pathology is what

Answer 30

bulging disc herniating disc

Question 31

what % of the disc must be compromised to have pathology

Answer 31

more than 50%

Question 32

bulging disc

Answer 32

involves 50-100% of circumference and can be symmetrical or asymmetrical disc is just kinda squished

Question 33

herniated disc

Answer 33

disc has hole and can leak out fluid

Question 34

herniated disc types

Answer 34

broad based focal extrusion sequestered

Question 35

broad based herniation

Answer 35

25-50% protrusion 90-180 degree angle

Question 36

focal herniation

Answer 36

<25% protrusion <90 degrees

Question 37

sequestered extrusion

Answer 37

goes back into the disc and some outside the disc

Question 38

foraminal herniation zone

Answer 38

herniation occurs in the foramen

Question 39

central herniation zone

Answer 39

occurs in central aspect, posterior cord or caude equina

Question 40

symptoms of disc pathology

Answer 40

sudden or gradual onset recurrent episodes, worse w each episode dull, constant, aching multi-directional trunk motions painful - worse at end range - compression loading painful

Question 41

two important signs of disc patholgy

Answer 41

pain/stiffness worse when first getting up - improves with activity worsens over the day

Question 42

physical exam with disc pathology

Answer 42

lateral shift / postural abnormalities multi-directional PROM/AROM limitations spring testing painful radicular signs (LMN) + SLR test