Lumbar Common Presentations Flashcards
Hx of neoplasms findings
- PMH includes cancer
- fatigue
- weight loss
- smoking
- pain complaints - persistent, not alleviated with bed rest, worse at night, neuro symptoms
physical exam findings of neoplasms
- non-mechanical presentation
- age > 50 years
- anemia
- neuro signs
- lab tests for confirmation
What is an epidural abscess associated with?
- DM
- chronic renal failure
- IV drug misuse
- alcoholism
- cancer
Hx of vertebral osteomyelitis
- traced with other sources of infection (bladder infection most common)
- weight loss
- fatigue
- fever
- neuro symptoms
pain complaints of vertebral osteomyelitis
- local, focal back pain
- worse with mechanical loading, improves with recumbent positions
physical exam findings of vertebral osteomyelitis
- fever
- local tenderness
- aggravated with local percussion
- neuro signs
red flag cluster findings for vertebral fractures
- age > 70
- significant trauma
- prolonged corticoid steroid use
- sensory alterations from the trunk down
cluster findings for identifying the presence of osteoporotic vertebral compression fracture
- age > 52 years old
- no presence of leg pain
- BMI </= 22
- does not exercise regularly
- female
What is a fatigue fx of pars interarticularis?
spondylolysis
What is a flail segment?
bilateral pars defect with attached multifidi
What is spondylolysthesis?
anterior slip of the vertebra following bilateral spondylolysis
At what age does the greatest slippage occur?
10-15 y/o
What sign on imagining indicates spondylolisthesis?
scotty dog with a collar
symptoms of spondylolisthesis
localized LBP
- worsened with extension activities
physical exam findings of spondylolisthesis
- excessive lumbar lordosis
- possible step-off deformity
- pain with lumbar extension, rotation
- hamstring tightness
- instability testing and spring testing at involved segment
What can occur with torsion/rotary injury?
discogenic pain - extremely painful
What part of the disc is innervated? What level of disc injury would cause pain?
- outer 1/3 of the disc is innervated
- grade 3 or higher will cause pain
What is considered a focal herniation?
< 25% herniation or < 90 deg
What is considered a broad based herniation
25-50% herniation or > 90 deg
What type of impingement is more likely to have impingement on the spine? Impingement on the lateral foramen?
spine - central impingment
lateral foramen - foraminal
symptoms of disc pathology
- 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
physical exam findings of disc pathology
- high prevalence rates in asymptomatic populations
- postural abnormalities/lateral shift
- multi-directional P/AROM pain
- pain with spring testing
- radicular symptoms
- SLR test
Hx of radicular pain
- actue = trauma (twisting/lifting injury common)
- insidious = progressively more distal as health condition progresses
symptoms of radicular pain
- shooting pain along nerve root
- “band-like”
- pain w/ activities that close foramen (twisting/extension)
physical exam of radicular pain
- lateral shift possible
- painful/limited ROM that compress foramen
- potentially slump test +, SLR test +, well leg raise test +
- tenderness/turgor with guarding paraspinals
Hx of degenerative spinal stenosis
- age > 65 years
- chronic LBP
central canal degenerative spinal stenosis symptoms
- UMN or LMN symptoms
- pain increases with walking/standing (prolonged)
- pain relieved with sitting, or walking with support
- bilateral pain in legs > lower back
physical exam of central canal degenerative spinal stenosis
- diminished lumbar lordosis
- painful/limited extension and lateral flexion P/AROM
- pain improves with flexion
- shortened hamstrings, lengthened hip flexors
- neuro signs = hyperreflexia
lateral canal degenerative spinal stenosis symptoms
- LMN symptoms
- pain increases with walking/standing (prolonged)
- pain relieved with sitting, walking with support
- LBP and LE pain unilateral
lateral canal degenerative spinal stenosis physical exam
- diminished lumbar lordosis
- painful/limited extension and lateral flexion P/AROM
- pain improves with flexion
- neuro signs = hyporeflexia
symptoms of degenerative osteoarthropathy at z joint
- local/referred, unilateral pain
- facet closing motion causes pain
- facet opening motion relieves pain
physical exam findings of degenerative osteoarthropathy at z joint
- P/AROM pain/limitations
- muscle guarding - erector spinae, multifidi
- painful spring testing/UPA
- hypomobility with joint testing
What is the diagnosis if a patient is stuck in a flexed position and can’t stand up?
acute traumatic z joint
- acute locked back
during lumbar flexion, the meniscoid does what in the joint?
drawn out of the joint
during lumbar extension, the meniscoid does what in the joint?
buckles and occupies space
What 3 things are required for a trigger point?
- palpable band
- local and referred tenderness
- local twitch response
- Radiofrequency ablation of medial branch of dorsal rami
- Indicated for pain relief to address z-joint pain
- relief is temporary
medial branch neurotomy
Tissues in neuroforamen compressing nerve tissue removed (lamina, disc, hypertrophied ligaments, etc.)
laminoforaminotomy
Removal of the lamina
laminectomy
Reconstruction of posterior ring at lamina
- increases space for cord
laminoplasty
Aspiration of nucleus via probe – take out (suck out) some of the disc to make it smaller
percutaneous discectomy
Removal of disc that is compressing/ irritating the nerve root
microdiscectomy
