lumbar spine pathologies

Question 1

What population is isthmic type spondylolisthesis commonly seen in?

Answer 1

Younger population (9-18 y/o)

often athletes with repetitive lumbar EXT combined with ROT

Question 2

A ___ fracture leads to anterior slippage of the vertebrae

Answer 2

pars

Question 3

What are the subjective findings of isthmic type spondylolisthesis?

Answer 3

• acute LBP
• bilateral radicular pain
• radiculopathy

Question 4

What are the objective findings of isthmic type spondylolisthesis?

Answer 4

• restricted/painful lumbar EXT
• (+) bilateral SLR for neural tension
• (+) neuro signs
• lumbar PA pain
• step off of spinous process during palpation

Question 5

What radiograph MRI view confirms a bilateral pars interarticularis fracture?

Answer 5

oblique view MRI

Question 6

What type of spondylolisthesis is known as the “scotty dog” sign?

Answer 6

isthmic type

Question 7

What population is degenerative type spondylolisthesis commonly seen in?

Answer 7

older population, females

Question 8

What is the most common level for isthmic type spondylolisthesis?

Answer 8

L5/S1

Question 9

What is the most common level for degenerative type spondylolisthesis?

Answer 9

L4/L5… followed by L3/L4

Question 10

What are the subjective findings for degenerative type spondylolisthesis?

Answer 10

• GRADUAL LBP
• bilateral buttock pain
• bilateral radicular pain
• radiculopathy
• pain agg w/ standing and walking
• pain relief with sitting

Question 11

What are the objective findings for degenerative type spondylolisthesis?

Answer 11

• restricted/painful lumbar EXT
• (+/-) SLR for bilateral neural tension
• (+) neuro signs
• Lumbar PA pain
• step off of spinous processes while palpating

Question 12

definition: pars fracture but with no anterior slippage

Answer 12

spondylolysis

Question 13

definition: pars fracture with anterior slippage

Answer 13

spondylolisthesis

Question 14

> ___% of spondylolisthesis cases can be treated conservatively

Answer 14

90%

Question 15

What are indications for surgical fusion surgery when treating spondylolisthesis?

Answer 15

• significant neuro symptoms (drop foot, progressive s/s, etc)
• unrelenting symptoms
• bowel/bladder symptoms

Question 16

What are the most common tumors in the spine?

Answer 16

spinal metastases

Question 17

What are the most common primary sites that metastasize to the spine?

Answer 17

1. breast
2. lung
3. prostate
4. renal
5. GI
6. thyroid

Question 18

(true/false) multiple myeloma can often manifest in lower thoracic/upper lumbar spine.

Answer 18

true

Question 19

(true/false) vertebral crush fractures can occur due to bone degradation

Answer 19

true

Question 20

LBP in what region should cause suspicion for spinal cancer?

Answer 20

L1/L2

Question 21

What is the highest predictor of spinal cancer?

Answer 21

PMH of Cancer

Question 22

What diagnostic imaging is the gold standard for identifying spinal tumors?

Answer 22

MRI

Question 23

definition: anterior vertebral body loses height due to degenerative conditions such as osteoporosis and can fracture under stress

MVAs/bone cancer

Answer 23

compression fractures

Question 24

What are the most common regions for compression fractures?

Answer 24

T11-L2

Question 25

definition: anterior and posterior aspects of the vertebral body are fractured. MOI: landing on feet after falling from a significant height.... MVA

Answer 25

axial burst fracture

Question 26

definition: less common fracture mostly caused by rotational or lateral flexion injuries - can hace avulsions Fx of psoas muscles in the upper lumbar spine

Answer 26

Transverse process fracture

Question 27

What is the most common level to experience a transverse process fracture?

Answer 27

L3

Question 28

definition: progressive bony fusion of spinal elements and the pelvis

Answer 28

ankylosing spondylitis

Question 29

What is the cause of ankylosing spondylitis?

Answer 29

autoimmune inflammatory conditions Genetics

Question 30

What are the s/s of ankylosing spondylitis?

Answer 30

- chronic/dull LBP or SIJ pain - loss of lumbar AROM - multi-level hypomobility with lumbar and thoracic PA glides - loss of rib cage expansion

Question 31

The spinal cord ends between levels __-___.

Answer 31

T12-L3

Question 32

What structures does the cauda equina provide innervation to?

Answer 32

- LE - bladder - anus - perineum

Question 33

What causes cauda equina syndrome?

Answer 33

1. herniation of lower lumbar disc (most common) 2. epidural hematoma 3. infections 4. neoplasms 5. trauma

Question 34

Herniations below T12 will have (UMN/LMN) signs.

Answer 34

LMN

Question 35

Herniations above T12 will have (UMN/LMN) signs.

Answer 35

UMN

Question 36

Cauda equina syndrome is most common in younger (males/females)

Answer 36

younger males

Question 37

What is the clinical presentation of cauda equina syndrome?

Answer 37

- severe LBP - bilateral lumbar radiculopathy symptoms - bladder/bowel dysfunction - saddle anesthesia or loss of sensation around the anus - sexual dysfunction

Question 38

What clinical signs should raise suspicion of cauda equina syndrome?

Answer 38

saddle anesthesia or loss of sensation around the anus AND bladder dysfunction

Question 39

Cauda equina lumbar radiculopathy symptoms normally follow the ____ pattern with weakness and paresthesia

Answer 39

L5/S1

Question 40

(LMN/UMN) symptom presentation is more common in cauda equina syndrome.

Answer 40

LMN (L3-S1 affected)

Question 41

(true/false) patients who present to PT with s/s of cauda equina syndrome do NOT need to be rushed to the ER.

Answer 41

FALSE

Question 42

Finding cauda equina syndrome and decompressing it <____ hours after onset is the window to prevent lasting damage.

Answer 42

< 48 hours

Question 43

What diagnostic imaging is the gold standard for detecting cauda equina syndrome?

Answer 43

MRI