Lumbar spine

Question 1

List four principles of managing low back pain

Answer 1

1. making a diagnosis
2. educating the patient
3. involving the patient in active lifestyle changes
4. initiating a step-wise treatment plan from simple and non-invasive to procedural if necessary.

Question 2

How is acute lumbar strain managed?

Answer 2

rest, heat, ice, NSAIDs, PT only after pain has subsiced

Question 3

How is chronic muscular low back pain managed?

Answer 3

weight loss, core strengthening, aerobic activity

Question 4

How are disc herniations managed?

Answer 4

NSAIDs, aerobic exercise, PT, NOT narcotics

Question 5

When is surgery indicated for herniated discs?

Answer 5

no pain relief after 2-3 months
cauda equina syndrome
worsening neuro deficit

Question 6

What is the surgical approach to disc herniation?

Answer 6

microdiscectomy- simple outpatient procedure

Question 7

Spinal stenosis is notable in that pain is worsened by ______ and relieved by _____

Answer 7

worsened by standing or walking

relieved by leaning forward

Question 8

What is the most common cause of spinal stenosis?

Answer 8

facet joints and discs degenerate–> osteophytes, joint capsules and ligamentum flavum thicken

–> the neural space gets crowded out, subluxation can occur

Question 9

What is the most common cause of spinal stenosis?

Answer 9

facet joints and discs degenerate–> osteophytes, joint capsules and ligamentum flavum thicken

–> the neural space gets crowded out, subluxation can occur

Question 10

Describe treatment for spinal stenosis

Answer 10

NSAIDs, weight loss, PT for core strenghtening
epidural steroid injections might help
surgery if symptoms refractory and impacting QoL

surgery: laminectomy, decompression, spinal fusion

Question 11

What is spondylolisthesis?

Answer 11

bony defect in the pars interarticularis allowing for splitting and subluxation of the vertebrae

Question 12

Spondylolisthesis most commonly occurs at L5 and is most likely a result of a _____

Answer 12

stress fracture, could have occurred during childhood

Question 13

Describe exam findings that indicate spondylolisthesis

Answer 13

pain worse with extension, better with flexion
notable step off in lumbar spine
negative straight leg test

Question 14

How is spondylolisthesis treated?

Answer 14

NSAIDs, core strengthening, bracing

surgery indicated for severe or worsening pain- involves fusion from L5-sacrum

Question 15

How is spondylolisthesis treated?

Answer 15

NSAIDs, core strengthening, bracing

surgery indicated for severe or worsening pain- involves fusion from L5-sacrum

Question 16

When is it appropriate to order imaging in the workup of low back pain

Answer 16

> 6 weeks

red flag symptoms- neuro deficit etc