Lumbar Spine Flashcards
What is radiculopathy?
A non-specific diagnosis characterized by nerve root ‘irritation’ and pain radiating down the extremity.
At what age does the peak incidence of herniated nucleus pulposus occur? What gender is more likely to develop it?
30-50 years old, males 2:1
True or False: Herniated nucleus pulposus primarily occurs in the cervical spine.
False
What is the most common site for herniated nucleus pulposus?
L4-L5 and L5-S1
What are the common symptoms of a lumbar strain?
- Deep, steady pain in the low back
- Pain with activity, relieved by rest
- Stiffness
- Muscular tenderness
- may radiate to buttock or posterior thigh
What is the significance of the Babinski reflex in a neurological exam?
Indicates central pathology (brain + spinal cord) if the great toe extends with flexion of other toes in individuals greater than two years old.
Fill in the blank: The standard diagnostic modality of choice for herniated nucleus pulposus is _______.
MRI
What is ankylosing spondylitis?
An autoimmune spondyloarthropathy characterized by inflammation of the spine and associated structures.
What is the typical demographic for ankylosing spondylitis?
Caucasian males around age 30
What does a positive Schober’s test indicate?
Decreased spine range of motion in ankylosing spondylitis.
What is spondylolysis?
A fracture in the pars interarticularis, often asymptomatic but can lead to low back pain.
What is the typical risk factor for developing spondylolysis?
Repetitive hyperextension activities, such as gymnastics or pole vaulting.
What imaging findings are associated with degenerative disc disease?
- Loss of disc height
*loss of disc hydration - Osteophyte formation
- facet joint arthritis
*ligamentous/joint hypertrophy
What is the hallmark of lumbar spinal stenosis?
Neurogenic claudication, characterized by pain/weakness in the lower extremities precipitated by walking and relieved by rest.
What is the first-line imaging for diagnosing spinal stenosis?
MRI
What are the common treatment options for lumbar spine disorders?
- Heat and/or ice
- Physical therapy
- Medications
- Surgery
What is the condition characterized by anterior or posterior translation of a vertebra?
Spondylolisthesis
Fill in the blank: The presence of bilateral sacroiliitis with positive HLA-B27 and uveitis helps to confirm the diagnosis of _______.
Ankylosing Spondylitis
What are the common associated systemic symptoms of ankylosing spondylitis?
- Uveitis
- Heart disease
- Pulmonary fibrosis
- Renal amyloidosis
- aortic abnormalities
What is the typical age-related prevalence of degenerative disc disease in individuals over 60 years old?
90%
What type of pain is usually described in cauda equina syndrome?
Shooting or stabbing pain
Pain radiates down the affected lower extremity (LE) past the knee and may have associated neurologic symptoms such as weakness and numbness.
What is a common characteristic of patients with cauda equina syndrome?
*Bowel or bladder dysfunction
*unilateral or bilateral lower extremity pains
*saddle anesthesia
*decreased anal sphincter tone
What physical exam finding increases pain in cauda equina syndrome?
Pain increased with coughing, sneezing, or Valsalva maneuver
A positive straight leg raise may also be noted.
What is the most common cause of cauda equina syndrome?
Large disc herniations
L4-L5 is the most commonly affected level, occurring in 1-6% of lumbar herniated discs.
What are the symptoms of cauda equina syndrome?
Unilateral or bilateral LE pains, sensory or motor changes in the LE, bowel or bladder dysfunction
Symptoms may include retention leading to overflow incontinence and saddle anesthesia.
What is the diagnostic test of choice for cauda equina syndrome?
MRI
It is critical to perform emergent surgical decompression within 48 hours.
Define scoliosis.
Lateral curvature of the spine
Classified based on patient age.
What is the most common type of scoliosis?
Adolescent idiopathic scoliosis
Incidence is 3% for curves 10-20 degrees and 0.3% for curves >30 degrees.
What are the potential causes of scoliosis?
- Idiopathic
- Neuromuscular conditions
- Connective tissue disorders
- Genetic conditions
- Asymmetric degenerative changes in adults
Pathophysiology remains unclear for many cases.
What is a common presentation of scoliosis in children?
Painless deformity or through screening
Adults typically present with axial back pain and reduced range of motion.
What is the diagnostic imaging test for scoliosis?
Long/entire spine AP x-ray
A Cobb angle >10° is diagnostic.
How do you calculate the Cobb angle?
Determine the end vertebrae, draw a line parallel to the endplate, and measure the angle at the intersection of the two lines
The end vertebrae are those angled most severely towards the concave portion.
What is the treatment approach for scoliosis with a Cobb angle of 0-30 degrees in skeletally immature patients?
Observation with serial x-rays
Skeletally mature patients with the same curve may require no intervention.
At what point are surgical options considered with scoliosis?
Cobb angle greater than 50 degrees or if patient is symptomatic
True or False: MRI is necessary for diagnosing scoliosis in all cases.
False
MRI is not necessary unless neurological deficits or significant radicular symptoms are present.
Who is at greatest risk for ankylosing spondylitis?
Caucasian males around age 30
What gene is ankylosing spondylitis associated with?
HLA-B27
Schobers test
Physical test used in diagnosing ankylosing spondylitis. Measurements are taken 10 cm above and 5 cm below lumbosacral junction, should expand greater than 15 cm with forward flexion, positive if no expansion
How are spinal radiographs typically referenced in patients with ankylosing spondylitis?
Bamboo spine
What are the typical treatments for ankylosing spondylitis?
Symptomatic treatment with TNFa inhibitors, if ineffective JAKi inhibitors, surgical treatment for complications
Spondylolisthesis
Fracture of pars interarticularis with vertebral shift due to instability
What injury is associated with a “Scotty dog” sign on X-ray?
Spondylolysis
What site is spondylolisthesis most common?
L4-L5
Spinal stenosis
Narrowing of spinal cord, number 1 reason for spine surgery of patients >65 years old
What is the diagnostic test of choice for spinal stenosis?
MRI
Sciatica
Radiculopathy of sciatic nerve, with most cases secondary to herniated disc
Typical symptoms associated with sciatica.
Shooting or stabbing pain, radiates down lower extremity, may have associated weakness, numbness, parenthesis , often cannot get comfortable or tolerate sitting
What medications will be prescribed if there is an underlying cause contributing to nerve symptoms of sciatica?
Gabapentin or Pregabalin
What disorder requires emergent surgical decompression within 48 hours to prevent permanent lower extremity detriments?
Claudia equina
