Lumbar Spine Flashcards
Injury to Muscle
Strain
Injury to Ligaments, Facets, Annulus, or Tendons
Sprain
Acute onset of Lumbar Back Pain that impairs function. It is the most common cause of time loss and disability in patients less than 45 years old.
Low Back Strain
Low Back Strain Treatment
Rest
NSAIDs + Tylenol
PT
Avoid Narcotics, Muscle Relaxers, and Steroids
Refer to Specialist if not better after 4 weeks of PT.
Chronic low back pain that has been symptomatic for longer than three months. It is associated with depression and can be a result of:
- Weight
- Trauma
- Infection
- Hereditary
- Tobacco Use
Lumbar Degenerative Disc Disease
(Lumbar Arthritis)
Symptoms of Lumbar DDD
Back Pain that Radiates to One or Both Buttocks
- negative straight leg raise
X-Ray Findings of Lumbar DDD
- Disc Space Collapse
- Osteophytes
- Vacuum Sign
Nerve dysfunction of the leg caused by:
- Herniated Nucleus Pulposus
- Stenosis
- Arthritis
Lumbar Radiculopathy
(Sciatica)
Signs and Symptoms of Lumbar Radiculopathy
Unilateral + Abrupt Pain
Worse with Sitting, Coughing, and Sneezing
Lying on back with pillows under knees or in fetal position gives relief
What test should be performed on a patient with suspected Lumbar Radiculopathy?
Seated Straight Leg Raise
- “Flip Sign”
Lumbar Radiculopathy Treatment
NSAIDs
Steroids
Pain Meds
Rest
PT
Surgery
Lumbar Radiculopathy Nerve Root Chart
MUST KNOW WILL BE ON THE TEST
Congenital or acquired narrowing of the spinal canal with compression of nerve roots
Spinal Stenosis
Signs and Symptoms of Spinal Stenosis
Neurogenic Claudication
- poor walking tolerance due to leg pain
“My Legs Don’t Work Right”
- sitting down to find relief
- Shopping Cart Sign
Proximal to Distal Symptoms
Spinal Stenosis Treatment
NSAIDs
Steroids
PT
Surgery (definitive treatment)
Slippage of one vertebral body in relation to the one below
Pars and Lamina Intact
Facet Joints + Disk are Abnormal
Degenerative Spondylolisthesis
AKA → Spondy
(listhesis = slippage)
Canal Narrowing due to Slippage
Anterior Slip
(Most Common)
Neuroforaminal Narrowing due to Slippage
Posterior Slip
Symptoms of Degenerative Spondylolisthesis
Weakness
Neurogenic Claudication
Radiculopathy
Herniated Nucleus Pulposus
Mechanical Back Pain
Causes of Spondylolisthesis
Post Traumatic
Pars Defect
Iatrogenic
- decompression or discectomy
Degenerative Spondylolisthesis Treatment
Activity Modification
NSAIDs
Bracing
Surgery
Defect of the Pars Articularis (usually between L5 and S1) that is common in gymnast, weight lifters, and football players.
Adolescent Spondylolisthesis
no slippage → spondylolysis
slippage → spondylolisthesis
Symptoms of Adolescent Spondylolisthesis
Low Back Pain
Acute Spasms
Posterior Radiation of Pain below the Knee
Adolescent Spondylolisthesis Exam Findings
(+) Straight Leg Raise
Tight Hamstrings
Diminished Lordosis
Flattening of the Buttocks
What imaging should be done for a patient with Adolescent Spondylolisthesis?
X-Ray
- AP
- Lateral
- Oblique
SPECT Imaging
- looking for pars defect
MRI
- edema in Pars
Bone Scan
What can be seen on an Oblique X-Ray of a patient with Adolescent Spondylolisthesis?
Scotty Dog Collar
Adolescent Spondylolisthesis Treatment
Rigid Bracing
Rest
Surgery (if refractory)
Sudden onset of compression of cauda equina (L2 - S4 nerve roots)
S2 - S4
Keeps your penis and poop off the floor
Cauda Equina Syndrome
Causes of Cauda Equina Syndrome
Large Herniated Nucleus Pulposus
Epidural Hematoma
Abscess
Trauma
Symptoms of Cauda Equina Syndrome
Pain + Numbness (Bilaterally)
Perianal Saddle Numbness
Significant Weakness
Urinary Retention or Loss of Control
Cauda Equina Treatment
Surgical Emergency
Incidental finding when assessing lumbar back pain.
Often the first radiologic sign is lost integrity of pedicle.
Metastatic Disease
“Winking Owl Sign”
Abnormalities of coronal, axial, or sagittal planes of the back. Can be childhood onset or degenerative.
“Hump” on back
Scoliosis
How do you treat Scoliosis?
NSAIDs
PT
Surgery
- measure Cobb Angle on Full-Length X-Ray
Rounded upper back that is more common in the elderly.
- can be caused by Scheuermann’s Disease
Kyphosis
