Lumbar Spine Flashcards
What percent of the population will develop back pain in their lifetime?
90%, 60% of these will seek medical care
When assessing a patient with back pain, what are important details/ symptoms to ask about?
numbness or weakness is the pain activity or position related describe the onset/ inciting injury does the pain radiate? is there any associated bowel or bladder dysfunction
When is appropriate to order X-rays or MRI to assess back pain?
after 6 weeks of symptoms if there are red flag symptoms
What is the predominant cause of lower back pain?
acute lumbar strain due to muscle, tendon or ligament injury, often injury related; not associated with radiating radicular pain
What is the predominant cause of lower back pain?
acute lumbar strain due to muscle, tendon or ligament injury, often injury related; not associated with radiating radicular pain
What is the treatment for acute lumbar strain?
ice then heat, only 1-2d bedrest
use of anti-inflammatories, short course narcotics and muscle relaxants
physical therapy for trunk stabilization is often important
What is the treatment for acute lumbar strain?
ice then heat, only 1-2d bedrest
use of anti-inflammatories, short course narcotics and muscle relaxants
physical therapy for trunk stabilization is often important
What is often the cause of chronic pain and how is it typically treated?
often related to degenerative changes to the disk and facet joints (OA-like)
surgery and narcotics do no address the problem, treatment includes aerobic exercise, PT, weight loss and patient education
Describe 3 ways in which degenerative change occur to intervertebral discs.
tear (annular tear)
herniate (protrusion or extrusion of pulposus
dengeration of age
Describe how acute disc herniation occurs and who it normally effects.
24-45, often occurs in healthy discs
usually occurs as the posterolateral corner of the disc buckles and the nucleus protrudes through the annulus, irritating the nerve root below
L5-top of foot and big toe, S1 pinky toe and heel, L4 midline calf
Describe how acute disc herniation occurs and who it normally effects.
24-45, often occurs in healthy discs
usually occurs as the posterolateral corner of the disc buckles and the nucleus protrudes through the annulus, irritating the nerve root below
L5-top of foot and big toe, S1 pinky toe and heel, L4 midline calf
What are the symptoms of an acute disc herniation?
back pain begins first and then leg pain follows
associated dermatome radiation
patients will list away from the side of herniation, straight leg raise will cause irritation and pain
patients will often have muscle spasm or inability to flex
What are the symptoms of an acute disc herniation? Will x-ray reveal the defect?
back pain begins first and then leg pain follows
associated dermatome radiation
patients will list away from the side of herniation, straight leg raise will cause irritation and pain
patients will often have muscle spasm or inability to flex
X-ray is often completely normal, MRI is diagnostic
How do you treat acute disc herniation?
80% resolve spontaneously in 6-10 weeks, begin physical therapy at time of diagnosis
encourage walking for exercise
meds: NSAIDs, gabapentin, maybe medal dose pack; epidural steroid injection are an option to calm the inflammation (buys time for disc to resolve on its own)
consider surgical discectomy at 2-3 mo if no pain relief, nerve root deficits are present or there is severe functional limitation
absolute surgical indications if cauda equine syndrome is present (with saddle anesthesia- usually large central herniated) or if there is advancing neurologic deficits (ie. foot drop)
Describe the procedure of microdiscetomy.
performed under regional anesthesia with a 1inch incision
surgery to remove herniated disc pieces only
allows patients to return home in 2-3 hours and to work within 1 week (light) and/or return to athletics
