Lumbar Common Presentations

Question 1

Hx of neoplasms findings

Answer 1

• PMH includes cancer
• fatigue
• weight loss
• smoking
• pain complaints - persistent, not alleviated with bed rest, worse at night, neuro symptoms

Question 2

physical exam findings of neoplasms

Answer 2

• non-mechanical presentation
• age > 50 years
• anemia
• neuro signs
• lab tests for confirmation

Question 3

What is an epidural abscess associated with?

Answer 3

• DM
• chronic renal failure
• IV drug misuse
• alcoholism
• cancer

Question 4

Hx of vertebral osteomyelitis

Answer 4

• traced with other sources of infection (bladder infection most common)
• weight loss
• fatigue
• fever
• neuro symptoms

Question 5

pain complaints of vertebral osteomyelitis

Answer 5

• local, focal back pain
• worse with mechanical loading, improves with recumbent positions

Question 6

physical exam findings of vertebral osteomyelitis

Answer 6

• fever
• local tenderness
• aggravated with local percussion
• neuro signs

Question 7

red flag cluster findings for vertebral fractures

Answer 7

• age > 70
• significant trauma
• prolonged corticoid steroid use
• sensory alterations from the trunk down

Question 8

cluster findings for identifying the presence of osteoporotic vertebral compression fracture

Answer 8

• age > 52 years old
• no presence of leg pain
• BMI </= 22
• does not exercise regularly
• female

Question 9

What is a fatigue fx of pars interarticularis?

Answer 9

spondylolysis

Question 10

What is a flail segment?

Answer 10

bilateral pars defect with attached multifidi

Question 11

What is spondylolysthesis?

Answer 11

anterior slip of the vertebra following bilateral spondylolysis

Question 12

At what age does the greatest slippage occur?

Answer 12

10-15 y/o

Question 13

What sign on imagining indicates spondylolisthesis?

Answer 13

scotty dog with a collar

Question 14

symptoms of spondylolisthesis

Answer 14

localized LBP
- worsened with extension activities

Question 15

physical exam findings of spondylolisthesis

Answer 15

• excessive lumbar lordosis
• possible step-off deformity
• pain with lumbar extension, rotation
• hamstring tightness
• • instability testing and spring testing at involved segment

Question 16

What can occur with torsion/rotary injury?

Answer 16

discogenic pain - extremely painful

Question 17

What part of the disc is innervated? What level of disc injury would cause pain?

Answer 17

• outer 1/3 of the disc is innervated
• grade 3 or higher will cause pain

Question 18

What is considered a focal herniation?

Answer 18

< 25% herniation or < 90 deg

Question 19

What is considered a broad based herniation

Answer 19

25-50% herniation or > 90 deg

Question 20

What type of impingement is more likely to have impingement on the spine? Impingement on the lateral foramen?

Answer 20

spine - central impingment

lateral foramen - foraminal

Question 21

symptoms of disc pathology

Answer 21

• gradual/progressive onset
• dull, constant, aching pain
• pain with mulit-directional trunk motions, worse at end range and activities that compress disc (coughing, straining, sitting)
• pain/stiffness worsens when first getting up after recumbency

Question 22

physical exam findings of disc pathology

Answer 22

• high prevalence rates in asymptomatic populations
• postural abnormalities/lateral shift
• multi-directional P/AROM pain
• pain with spring testing
• radicular symptoms
• • SLR test

Question 23

Hx of radicular pain

Answer 23

• actue = trauma (twisting/lifting injury common)
• insidious = progressively more distal as health condition progresses

Question 24

symptoms of radicular pain

Answer 24

• shooting pain along nerve root
• “band-like”
• pain w/ activities that close foramen (twisting/extension)

Question 25

physical exam of radicular pain

Answer 25

- lateral shift possible - painful/limited ROM that compress foramen - potentially slump test +, SLR test +, well leg raise test + - tenderness/turgor with guarding paraspinals

Question 26

Hx of degenerative spinal stenosis

Answer 26

- age > 65 years - chronic LBP

Question 27

central canal degenerative spinal stenosis symptoms

Answer 27

- UMN or LMN symptoms - pain increases with walking/standing (prolonged) - pain relieved with sitting, or walking with support - bilateral pain in legs > lower back

Question 28

physical exam of central canal degenerative spinal stenosis

Answer 28

- diminished lumbar lordosis - painful/limited extension and lateral flexion P/AROM - pain improves with flexion - shortened hamstrings, lengthened hip flexors - neuro signs = hyperreflexia

Question 29

lateral canal degenerative spinal stenosis symptoms

Answer 29

- LMN symptoms - pain increases with walking/standing (prolonged) - pain relieved with sitting, walking with support - LBP and LE pain unilateral

Question 30

lateral canal degenerative spinal stenosis physical exam

Answer 30

- diminished lumbar lordosis - painful/limited extension and lateral flexion P/AROM - pain improves with flexion - neuro signs = hyporeflexia

Question 31

symptoms of degenerative osteoarthropathy at z joint

Answer 31

- local/referred, unilateral pain - facet closing motion causes pain - facet opening motion relieves pain

Question 32

physical exam findings of degenerative osteoarthropathy at z joint

Answer 32

- P/AROM pain/limitations - muscle guarding - erector spinae, multifidi - painful spring testing/UPA - hypomobility with joint testing

Question 33

What is the diagnosis if a patient is stuck in a flexed position and can't stand up?

Answer 33

acute traumatic z joint - acute locked back

Question 34

during lumbar flexion, the meniscoid does what in the joint?

Answer 34

drawn out of the joint

Question 35

during lumbar extension, the meniscoid does what in the joint?

Answer 35

buckles and occupies space

Question 36

What 3 things are required for a trigger point?

Answer 36

- palpable band - local and referred tenderness - local twitch response

Question 37

- Radiofrequency ablation of medial branch of dorsal rami - Indicated for pain relief to address z-joint pain - relief is temporary

Answer 37

medial branch neurotomy

Question 38

Tissues in neuroforamen compressing nerve tissue removed (lamina, disc, hypertrophied ligaments, etc.)

Answer 38

laminoforaminotomy

Question 39

Removal of the lamina

Answer 39

laminectomy

Question 40

Reconstruction of posterior ring at lamina - increases space for cord

Answer 40

laminoplasty

Question 41

Aspiration of nucleus via probe – take out (suck out) some of the disc to make it smaller

Answer 41

percutaneous discectomy

Question 42

Removal of disc that is compressing/ irritating the nerve root

Answer 42

microdiscectomy