Lumbar Spine Conditions Flashcards
3 Categories of LBP
- Serious Spinal Pathologies (tumors, infection, fx, cauda equina syndrome)
- Sciatica
- Nonspecific LBP (dysfunctions of msk tissues
Term: Back-related LE symptoms caused by back (nerve/nerve root) conditions
Sciatica
Distributions of LBP
- Serious Spinal Pathologies
- Sciatica
- Nonspecific LBP
- ~10%
- ~40%
- ~50(+)%
Term: narrowing of the central canal or lateral intervertebral foramina
Spinal Stenosis
Condition
- Male > Female
- 60+ yo
- Congenital or age related degeneration
Spinal Stenosis
Term: Type of spinal stenosis most often due to degeneration
Lateral Spinal Stenosis
Boundaries of the lateral foramen
- Anterior
- Posterior
- Superior
A: Vertebral body and disc
P: Ligamentum flavum
S: Facet joints
Term: Neural compromise due to obstruction of blood flow to the nerve, nerve root, or dural sleeve
Neurogenic Claudication
Condition: Symptoms
- Localized vauge pain
- Back and leg pain (can be bilateral)
- Presence of N/T and weakness in LEs
- Cramping
Spinal Stenosis
Conditon: Aggravating Factors
- Extension
- Prolonged standing or walking
- Walking downhill
- Lying flat
** Anything that loads the posterior column **
Spinal Stenosis
Condition: Easing Factors
- Flexion
- Sitting or squatting
- Walking uphill
- Bike riding
Spinal Stenosis
Condition: Objective Exam
- Flat lumbar posture
- Painful/limited extension
- Pain with SB on involved side
Spinal Stenosis
Flat back posture unload the posterior column
Term: Compromised ciculatory system due to PVD
Vascular Cluadication
Condition: Pain worse with incline walking but improved with decline walking
Vascular Claudication
Condition: Symptoms
- Flexion does not ease symtpoms
- Rarely have back sx
Vascular Claudication
Condition: Objective Exam
- Skin color or temperature changes
- Hair loss
- Peripheral pulses absent
- LE cramping/tightness
Vascular Claudication
Describe how the lumbar facet joints project the discs
Because they are oriented to prevent rotation
Describe what motions cause facet compression
Lateral flexion and rotation
Nerve: Innervates the lumbar facet joints
Medial branch of the dorsal primary ramus
Describe the connection between LBP and mutlifidus atrophy
The medial branch of the dorsal primary ramus innervates the facet joints as well as multifidus.
The facet joint capsules are highly innervate and are a large source of LBP
When the facet joints are aggravated the body avoids activities that would worsen the pain, less firing of those nerves means less activity in multifidus leading to atrophy
Structure: Synovial fold within facet joints
Meniscoid
2 Functions of the Meniscoid
- Provide smooth gliding motion
- Prevent excess motion
Cause of Acute Facet Joint
Mechanical block from meniscoid
Condition: Symptoms
- Unilateral pain, sharp over facet
- Increased pain with stretch/compression of joint
- Limitation in SB and extension
Acute Facet Joint
Condition: MOI of sudden unguarded movement (i.e. flexion or rotation)
Acute Facet Joint
5 Causes of Chronic Facet Joint
- Degerenation
- Hypertrophy
- Osteophytes
- Inflammation
- Microfracture
Condition: Symptoms
- Unilateral pain
- Less sharpt over the joint
- Rarely radiates down leg
Chronic Facet Joint
Condition: Symptoms
- Stiffness and pain in AM
- Increased pain with stretch of joint
Chronic Facet Joint
Condition: History
- Past Acute Facet Joint
- Never entirely symptom free
- Trauma
- Degeneration
Chronic Facet Joint
Condition: Objective
- Localized pain but can refer to larger area
- Local tenderness with palpation, stiff, thick
- Initially hypomoble
Chronic Facet Joints
3 Things to Know about Facet Joints and Referred Pain
- Facet joint have a referral pattern
- The referral pattern becomes broad with facet joint pathology
- The referral pattern is similar to many other LBP referrals
Condition: Irritation/Inflammation, compression, or tension to the nerve root
Acute Nerve Root (ANR)
3 Possible Causes of ANR
- Disc pathologies
- Degenerative changes
- Other medical conditions
Describe the progression of pain with ANR
Can begin as a proximal ache and them move distally
Condition: Symptoms
- More distal than proximal signs i.e. radiating
- Limited ROM and activity
- Muscloskeletal involement is central/local
ANR
Condition: Chronic irritation of nerve root/adhesion
Chornic Nerve Root (CNR)
4 Possible Causes of CNR
- Hx of disc pathology
- NR injury
- Degenerative changes
- Spinal surgery/scaring
Condition: Symptoms
- More proximal than distal
- Minimal limitation of activity
CNR
Condition: Objective
- Localized thickness in tissues
- Stiff segmentally
- May report pain with OP
CNR
