Lumbar Spine Classification/Diagnoses Flashcards
DDD profile
55-60
DJD profile
55-60
Disc (IDD, EDD) profile
young (20-40)
Difference in body chart/location of symptoms for DDD vs. DJD
- DDD = the disc can present with bilateral LBP symptoms (one side can be greater); can refer to buttock
- DJD = facet can be local pain & refer to buttock, posterior thigh, groin
Body chart/location of symptoms difference between EDD & IDD
- IDD = local unilateral pain, spreads with progression; referral to buttock
- EDD = bilateral paravertebral pain
Pain difference between ProT & PPL
- ProT = bilateral paravertebral with buttock/leg pain in partial or complete dermatomal line
- PPL = little to no lumbar pain, posterior leg pain
Prolapse body chart/location of symptoms
-leg pain is greater than back pain; dermatomal pattern
Extrusion body chart/location of symptoms
-leg pain is greater than back pain; poly-segmental (radicular & non-radicular pain)
IDD body chart
EDD body chart
Facet body chart
Protrusion body chart
Prolapse Body Chart
Extrusion body chart
Lateral Stenosis Body Chart
central stenosis body chart
DDD/DJD Body Chart
Differences of pain between ProL & Ext
- ProL: leg pain > back pain; dermatomal pattern
- ExT: leg pain > back pain; poly-segmental (radicular & non-radicular pain)
Difference of pain between chronic lateral spinal stenosis and DRG with lateral spinal stenosis
- chronic: proximal worse than distal
- DRG: paresthesia & radicular lancinating pain
Lateral Spinal Stenosis Profile
40-60
Central Stenosis Profile
60-70
Facet profile
chronic > 55-60
What kinds of things might a patient who has instability complain of?
- catching, unilateral pain, deep dull ache
- back feels weak or feels as if it will “give way” with certain movements
- sharp pain with sudden or unexpected movement of the trunk
Agg factor difference between stenosis and disc involvement?
Flexion is an agg factor for disc involvement and extension is an agg factor for stenosis
History of DDD/DJD (spondylosis)
Episodic; repeated annular tearing
History differences with ProT and ProL
ProL: typical fast onset
ProT: recurrent history
Which lumbar spine disorder produces disabling pain with minor provocations?
Instability
OE Exam tests to rule in facet lumbar disorder
quadrant, ROM
Which parts of the OE help you to differentiate between stenosis and DDD/DJD (spondylosis)
- BOTH will be painful with side bending
- flexion will hurt for DDD/DJD (spondylosis)
- extension will be painful & limited for stenosis
Agg factors of facet joint dysfunction?
more pain with standing vs. sitting; 3-D motion extension (cartilage) vs. flexion (capsule)
Instability agg factors
-prolonged postures (sitting, standing, bending, semi-flexed postures), forward bending, sudden unexpected movements, return to erect posture after FB, lifting, loading in extension. Night: possible clunking with position change. AM: ache usually worsens as day progresses
If a patient had a disc with nerve root involvement, how would you tell (based off of agg factors) which is affecting the patient more, the disc or the nerve root involvement?
- flexion, sitting = disc
- standing, walking = nerve root involvement
- sneezing would hurt with both
Acute disc activity limitations
- cough/sneeze
- repeated bending, sitting, lifting, stooping
Chronic disc activity limitations
- sitting in lordosis
- carrying in extension
- pain with stooping
Activity limitation complaints if there is adverse neurodynamic component involved with LS disorders
- getting in/out of a car, taking a bath, kicking a football, prolonged sitting (slump)
- any activity that includes leg extended (gait, kicking) - SLR
- any activity in which knee is bent toward buttocks, such as hurdling (PKB)
- 24 hour pattern: symptoms may be worse at night (posture). symptoms may be worse in AM due to night position. Worse at end of day - latent effect from sustained posture or repetitive activity
lateral spinal stenosis ease factors
flexing spine (sitting or squatting, walking uphill)
Instability history
- gradual or episodic
- history of recurrent dysfunction that becomes more pronounced with each successive episode
- minor provocations produce disabling pain
Potential findings if adverse neurodynamic component is involved during neurodynamic testing
- knee flexed in standing
- compensatory movements that fit with a neurodynamic dysfunction during active movement testing
- increase tension to active movements (lumbar flexion + neck flexion/extension, etc.)
- palpate nerve & find reproduction of symptoms with nerve palpation
- reproduce symptoms with neurodynamic tests
T/F: neurodynamic testing with IDD would be negative
true
T/F: neurodynamic testing with EDD would be negative
false
neurological exam findings with protrusion
negative or mild neurological signs
axillary lesion
if bulge is medial to nerve root, the patient shifts to the same side
increased pain with contralateral sidebending; slump pain is > SLR
neurological exam findings with central ProL
negative segmental; possible reduced DTRs
neurological exam findings with PLL ProL
positive
neurological exam findings with ExT
positive
lateral spinal stenosis neurological exam findings
- dorsal & ventral: hypo or a-reflexia
- dorsal: sensation
- ventral: motor loss (segmental paresis)
shoulder lesion
if bulge is lateral to nerve root, the patient shifts to the opposite side (most common)
increased pain with ipsilateral sidebending; slump pain > SLR pain
avulsion fracture profile
younger population, traumatic history, spontaneous resolution of symptoms
transverse radial fissures
annulus splits from inside to out; seen in acute disc related disorders
rim lesion
transverse annular tear; partial detachment of annulus to the rim of vertebral body; starts mid & goes to post/sup portion of the disc
concentric delamination
circumferential tear; nucleus loses water, annulus buckles & layers separate all around
Similarities & differences in IDD & EDD
- Similarities: young, non-capsular pattern
- Differences: IDD will present with negative tension signs & EDD will have positive tension signs
Reasons/causes of lateral stenosis
facet joint hypertrophy, loss of IVD height, IVD bulging, & spondylolisthesis
Potential causes for central stenosis
facet joint arthrosis, thickening & bulging of the ligamentum flavum, bulging of the IVD, and spondylolisthesis
Which portion of spine anatomy is spondylolysis a defect of?
pars interarticularis
T/F: spondylolysis occurs unilaterally
F - occurs both unilaterally and bilaterally
Which view on an x-ray is best to image spondylolisthesis?
oblique view of an x-ray
definition of spondylolisthesis
anterior slippage & inability to resist shear forces relative to the vertebra below
Where is the most common site for spondylolisthesis to occur?
L5-S1
Which spine disorder can spondylolisthesis progress to?
instability
Potential causes of spondylolisthesis?
-congenital, isthmus, degenerative, traumatic or pathologic
extraneural
movement in relation to mechanical interface
Examples of interface tissue (extraneural)
-soft tissue, tunnels, nervous system relatively fixed
intraneural
involving connective tissue and/or neural tissue
Potential causes/examples of intraneural adverse neurodynamics
-edema within nerve, fibrosis within dura, etc.
altered axoplasmic flow
-an alteration in the pressure gradients that exist within the fluids, tissues & surrounding structures of the nervous system. if the alteration is significant enough it can affect changes in blood flow and axonal transport. The nerve then becomes more susceptible to being compromised & the target tissue is more susceptible to trophic changes
double crush injury (altered axoplasmic flow)
-injury at a distal site along the nerve could have an additive effect leading to injury to a proximal site along the nerve
reversed crush injury (altered axoplasmic flow)
-injury at a proximal site along the nerve could have an additive effect leading to injury to a distal site along the nerve
Other potential causes of lumbar spine pain?
- pediatric considerations [non-specific low back pain]
- back-related tumor
- back-related infection
- spinal fracture
Profile of pt with back-related tumor
-age > 50; history of cancer; unexplained weight loss; failure-conservative therapy
profile of pt with back-related infection (spinal osteomyelitis)
-recent infection; intravenous drug user; concurrent immunosuppressive disorder
spinal fracture profile/presentation
-history of trauma; prolonged use of steroids; age > 70 yrs
L1 refers to:
(Non-radicular)
Groin
Upper Lumbar (or T9) Refers to:
(non-radicular)
Lower Lumbar Pain
(L4/L5-Bilat or unilat)
L3 Refers to:
(Non radicular)
“L3 in the knee”
L4 Refers to:
(Non radicular)
“in the ankle: (band around ankle and gr trochanter)
Lower abdominal symptoms, testicular pain
L5/S1 refers to:
(Non-radicular)
coccyx symptoms
L5 refers to:
(Non-radicular)
upper lumbar pain
Discogenic Referral
(Non-radicular)
vague ache to buttock/LE
Deep spot of pain in buttock
Lower Lumbar disc: ant thigh pain/groin
