Lumbar Spine Classification Flashcards by Tim Schonhoff

DDD/DJD (profile)

55-60 y/o

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Disc (profile)

Young (20-40 y/o)

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Disc w/ nerve root irritation

40-45 (central proL/proT)
30-45 (exT)
18-35 (PPL proT/proL)

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Spinal Stenosis (profile)

40-60 y/o

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Central Stenosis (profile)

60-70 y/o

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Facet (profile)

chronic > 55-60 y/o

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Instability (profile)

young, older if degenerative

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DDD>DJD (body chart)

Disc can present with bilateral low back symptoms (one side can be greater); can refeer to butt

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DJD>DDD (body chart)

facet can be local pain and refer to butt, posterior thigh, groin

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IDD (body chart)

local unilateral pain, spreads with progression, referral to butt

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EDD (body chart)

bilateral Paraverterbral

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Disc ProT (body chart)

ilateral paravertebral with butt/leg pain in partial or complete dermatomal line

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Disc PPL (body chart)

little to no lumbar pain, posterior leg pain

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Disc ProL (body chart)

leg pain> back pain; dermatomal pattern

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Disc ExT (body chart)

leg pain> back pain, poly segmental (radicular and non radicular)

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Spinal Stenosis (lateral) (body chart)

Leg pain with patchy, dermatomal, multi segmental

Acute: distal worse than proximal
Chronic: proximal worse than distal
DRG: paraesthesia and radicular pain

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Central Stenosis (body chart)

back and leg pain, bilateral, extra segmental

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Facet (body chart)

Local unilateral pain

facet can refer to butt, posterior thighs, and groin

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Instability (body chart)

Highly variable

Catching, unilateral pain, deep dull ache

The Back feels weak or feels as if it will “give way” with certain movements

Also sharp pain with sudden or unexpected movements of the trunk

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DDD/DJD (Agg factors)

Acute disc: cough/ sneeze, repeated bending, sitting, lifting, stooping

Chronic Disc: sitting in lordosis, carrying in extension, pain with stooping

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Disc (IDD, EDD) (Agg factors)

Acute disc: cough/ sneeze, repeated bending, sitting, lifting, stooping

Chronic Disc: sitting in lordosis, carrying in extension, pain with stooping

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Disc w? nerve root invlovement (Agg factors)

Flexion, sitting (disc)

Standing, walking (nerve root involvement)

Sneezing

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Spinal Stenosis (lateral) (Agg Factors)

Extension postures, prolonged standing and walking, lying flat, walking downhill

Central Stenosis (Agg factors)

Extension postures, prolonged standing and walking, lying flat, walking downhill

Facet (Agg Factors)

More pain with standing vs sitting, 3-D motion (quadrant) Extension (cartilage) and flexion (capsule)

DDD/DJD (Ease factors)

lying down, unloading

Disc (IDD, EDD) (Ease factors)

lying down, unloading

Disc w/ nerve root involvement (Ease factors)

lying down, unloading

Spinal Stenosis (lateral) (Ease factors)

flexing spine (sitting or squatting, walking uphill)

Cental Stenosis (Ease factors)

flexing spine (sitting or squatting, walking uphill)

facet (ease factors)

variable

DDD/DJD (History)

episodic, repeated annular tearing

Disc w/ nerve root involvement (history)

ProT: recurrent history ProL: typical fast onset Bending, lifting Episodic

Central Stenosis (history)

gradual

Facet (history)

gradual or sudden unguarded movement

Instability (history)

Gradual or episodic. History of recurrent dysfunction that becomes more pronounced with each successive episode. Minor provocations produce disabling pain

DDD/DJD (Neurodynamic Testing)

Disc (IDD, EDD) (neurodynamic testing)

IDD: negative EDD: positive

Disc w/ nerve root involvement (neurodynamic testing)

Positive: SLR/Slump, PKB

Spinal Stenosis (neurodynamic testing)

Positive: SLR/Slump, PKB

Central Stenosis (neurodynamic testing)

positive

Facet (neurodynamic testing)

negative

Instability (neurodynamic testing)

Variable adverse mechanical tension findings SLR>91 degrees

DDD/DJD (Neuro Exam)

Negative

Disc (IDD,EDD) (Neuro Exam)

Negative

Disc w/ nerve root involvement (Neuro Exam)

ProT: negative or mild neurological signs Central ProL: negative segmental; possible reduced DTRs PPL ProL: positive ExT: positve

Spinal Stenosis (lateral) (Neuro Exam)

Dorsal and Ventral: Hypo or a-reflexia Dorsal: sensation Ventral: motor loss (segmental paresis)

Central Stenosis (Neuro Exam)

Dorsal and Ventral: diminished reflexes Dorsal: sensation Ventral: motor loss

Facet (Neuro Exam)

negative

Instability (Neuro Exam)

Negative

DDD/DJD (palpation)

Central PA> unilateral PA | Stiff/pain if in acute episode

Disc (IDD, EDD) (palpation)

Central Pa> unilateral PA | Stiff and pain

Disc w/ nerve root involvement (palpation)

Central PA and Unilateral PA stiff and painful

Spinal Stenosis (lateral) (palpation)

Unilateral PA may be stiff/painful

Central Stenosis (palpation)

Central PA, Unilateral PA stiff and painful

Facet (palpation)

Unilateral PA stiff/painful

Instability (palpation)

Pain/ spasm with central PA pressure Excessive PPIVM and PAIVM findings