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OCS Exam > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

What is the lifetime prevalence of LBP?

A

85%

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2
Q

What are indications for low back surgery?

A

-Cauda Equina Syndrome
-Trauma resulting in gross instability
-Stable Fractures
-Herniated Disc
-Spinal Stenosis

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3
Q

What are the emergent surgical conditions for low back pain?

A

-Cauda Equina Syndrome
-Trauma resulting in gross instability

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4
Q

What is a spinal decompression surgery?

A

Removal of bone or neural material suspected to be impinging upon nerves

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5
Q

What is left for stability with a laminectomy?

A

Just facets, unless hardware included

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6
Q

What should be limited s/p discectomy?

A

-Bending
-Twisting
-Sitting >30 minutes

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7
Q

What should be limited with laminectomy?

A

-Bending
-Twisting
-Sitting

All “as tolerated”

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8
Q

What is a typical exercise program for weeks 2-4 after lumbar decompression?

A

-Ankle Pumps
-Quad, Glute, Ham sets
-SAQ
-LAQ
-Midline stabilization
-Treadmill as tolerated

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9
Q

What manual therapy may be used after lumbar decompression surgery?

A

Soft Tissue Mobilization

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10
Q

What positioning and postural education should be performed after lumbar decompression?

A

-Use Lumbar roll
-Neutral posture

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11
Q

At what point to initiate lifting exercises with an individual after spinal decompression surgery?

A

5-12 weeks, progress from 0 to 15-20#

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12
Q

What is the goal timeframe for returning an individual back to prior level of function after spinal decompression surgery?

A

6 months

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13
Q

What are the dos and don’ts of total disk replacement?

A

-No rotation of the lumbar region for the first 3 weeks
-No curving of the lumbar region for the first 6 weeks
-No intense ab exercises for 6 weeks
-No participation in competitive sports for the first 6 months
-Avoid lifting, twisting, and hyperextending for the first 6 weeks
-Try to keep back straight
-Can swim after 6 weeks
-Can jog after 6 weeks
-Can drive after 2 weeks

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14
Q

What is the evidence for activity restriction after lumbar disc surgery (nucleoplasty)?

A

No evidence activities need to be restricted; wait 4-6 weeks for intensive exercise programs

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15
Q

What is the most common cancer to metastasize to the lumbar spine?

A

Prostate

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16
Q

What are medical screening questions for cancer/back-related tumor?

A

-Prior hx
-Neurologic symptoms
-Unexplained weight loss
-Not improved over 1 month
-Age >50
-No relief with bed rest
-Insidious onset

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17
Q

What are signs of back-related spinal infection?

A

-LB, flank, or pelvic pain
-Local tenderness over spinal process with percussion
-Concurrent infection or drug use
-Fever

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18
Q

What are the items indicitive of cauda equina syndrome?

A

-Urine retention
-Saddle anaesthesia
-Sensory or motor deficits in the feet

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19
Q

What are features of a spinal compression fracture?

A

-Major trauma
-Pain and tenderness
-Age >50
-Female

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20
Q

What are signs of an abdominal aortic aneurysm?

A

-Midline lower thoracic/lumbar pain
-Palpable pulsating abdominal mass
-Patient unable to find a comfortable position
-History of cigarette smoking
-Positive family history
-History of AAA or vascular atherosclerotic disorders

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21
Q

Palpable mass in the abdomen wound indicate performing what next?

A

Ascultating for a bruit or chaotic sounding blood flow

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22
Q

What are key factors of ankylosing spodylitis?

A

-Morning stiffness >30 minutes
-Improvment in LBP with exercise but not rest
-Night pain during second half of night only
-Alternating buttock pain

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23
Q

What items would clue you in that back pain is musculoskeletal in origin and not GI related?

A

-worse with coughing, sneezing, taking a deep breath
-Bending, sitting, lifting, twisting, or turning over in bed make the pain feel worse
-No change in bowel habit
-No change with eating certain foods
-No weight change

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24
Q

To question whether renal or urinary disorders may be contributing to low back pain, what questions to ask?

A

-Do you have trouble with urination?
-Any changes in urine color, initiation of stream, incontinence, flow changes (in frequency, urgency, output, volume, retention, pain).

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25
Q

What are the 3 subsystems coordinating for spinal stability?

A

-Passive/Spinal column
-Active/Spinal muscles
-Control/Neural

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26
Q

Spinal stability contributes to?

A

-Protection of spinal cord
-Upright posture
-Transmit weight to lower members

27
Q

Spinal mobility contributes to?

A

-Acting as a shock absorber
-Provides motion for head and trunk
-Attachments for muscles and ligaments

28
Q

How much fluid content of discs is lost each day?

A

25%

29
Q

When is the load on zygapophysial joints the most?

A

With loaded lordotic posture

30
Q

What is the lumbosacral angle?

A

Usually 30 degrees; angle of sacral base

31
Q

What will increase shear forces at the lumbosacral joint?

A

Increased lumbar lordosis

32
Q

How is vertebral motion described?

A

As the superior segment moving on the inferior and in the direction of the anterior surface of the vertebral body

33
Q

According to Fryette’s laws of vertebral motion, in neutral, coupled motions are?

A

Opposite
Lateral flexion in one direction is accompanied by rotation to the other

34
Q

According to Fryette’s laws of vertebral motion, in non-neutral, coupled motions are?

A

Same
Lateral flexion in one direction is accompanied by rotation to the same

35
Q

With rotation, which side of the facet joint is gapped?

A

The ipsilateral side

36
Q

What is important regarding the neuromuscular system and injury?

A

Failure to regain neuromuscular control may place the patient at risk for re-injury

37
Q

If having pain at midrange, which structures to think of with pain?

A

Muscles

38
Q

If having pain at end ranges, think of what structures with low back pain?

A

Passive structures

39
Q

What is the order of the spondys from least to most pathological?

A

-losis
-Lysis
-listhesis

40
Q

What things clue you into RA, Ankylosing SPonylitis, Psoriatic Arthritis, etc?

A

-Multiple joint issues
-Skin issues (psoriatic)
-Abnormal lab values (C-reactive protein and Erythrocyte sedimentation rate)
-Medications such as long term steroids, immunosuppresants

41
Q

What are symptoms of cauda equina?

A

-B leg symptoms
-Saddle anesthesia
-Bowel/bladder changes
-May be vague or intermittent symptoms

42
Q

What is an alternative to ankle dorsiflexion to screen the L4 myotome?

A

Ankle inversion

43
Q

What is another way to screen the S1 dermatome besides ankle plantarflexion?

A

Hip Extension

44
Q

Is a SLR sensitive or specific for a herniated nucleus pulposus?

A

Sensitive

45
Q

Is a cross SLR sensitive or specific for herniated nucleus pulposus?

A

Specific

46
Q

What do you need in addition to pain down the leg to be considered a radiculopathy?

A

One of dermatomal, myotomal, and reflex findings

47
Q

What can cause pain mimicing radicular pain?

A

Facet joint pain (no myo, dermo, reflex findings)

48
Q

What is the minimum to clear the hip with a low back patient?

A

-Observe gait
-PROM with overpressure
-Scour test

49
Q

What has higher evidence? TBC or McKenzie?

A

TBC

50
Q

What are the 3 rehabilitation approaches in the 2015 revision of the TBC?

A

-Symptom Modulation
-Movement Control
-Functional Optimization

51
Q

How many visits does it take to reduce low back pain by 50% with manipulation?

A

2

52
Q

In general, when to use manipulation with low back pain?

A

In acute cases unless not indicated

53
Q

In general, when to use mobilization?

A

To address movement impairments, particularly stiff joints in aging patients

54
Q

What has higher evidence for low back pain, Thrust or nonthrust mobliization or soft tissue mobilization?

A

Thrust or nonthrust mobilization

55
Q

What level of evidence does dry needling have on low back pain?

A

C

56
Q

What level of evidence does directional preference have?

A

A

57
Q

What is actually the problem in individuals needing “spinal stabilization”?

A

Neuromuscular control

58
Q

What happens with “spinal instability?”

A

When the deep muscles aren’t firing they way they should, the bigger muscles start to overreact

59
Q

What does the multifidus do?

A

-Extension
-Control of anterior translation and rotatoin during flexion

60
Q

What muscles fire with side lifts?

A

-Quadratus lumborum
-Multifidus
-External Oblique
-Internal Oblique

61
Q

What are issues of the hip that generally go along with regional interdependence of back issues?

A

-Weak glute med
-Inhibited Glute Max
-Tight Rec FEm
-Tight Iliopsoas
-Tight Hamstrings

62
Q

When is exercise given the highest evidence with low back pain?

A

Wtih chronic low back pain

63
Q

Education gets what level of evidence for chronic low back pain?

A

A

64
Q

What is the order of SIJ tests?

A

-if distraction and thigh thrust tests are negative
-then compression test
-If the compression test is negative, then the sacral thrust test

OCS Exam (12 decks)

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