Management of spinal issues

Question 1

Back pain is what number reason for clinic visits?

Answer 1

2

Question 2

What are the three initial concerns with LBP?

Answer 2

1. Systemic disease
2. Neurologic compromise
3. Social/psychological stress

Question 3

Duration of pain greater than what amount of time is a red flag?

Answer 3

more than one month

Question 4

Over what age is a red flag?

Answer 4

50 years

Question 5

What percent of LBP may be due to SDs?

Answer 5

70%

Question 6

What are the landmarks of the OSE?

Answer 6

Shoulder heights
Crest heights
Greater trochanter heights
Standing and seated flexion

Question 7

True or false: most patients with LBP without other symptoms usually improve rapidly

Answer 7

True

Question 8

Is imaging indicated for nonspecific LBP

Answer 8

No

Question 9

What are the four types of red flag conditions that warrant imaging?

Answer 9

Fracture
Infection
Neoplasms
Severe neurologic deficit

(FINS)

Question 10

When should plain x-rays be obtained for LBP?

Answer 10

not improved for 4-6 weeks

Question 11

When is MRI indicated for back pain?

Answer 11

If persists longer than 12 weeks

Question 12

Why are labs good for evaluation of back pain?

Answer 12

Systemic disease evaluation

Question 13

True or false: manipulation treatment is as effective as conventional medical therapy

Answer 13

True

Question 14

What is the biomechanical perspective of LBP?

Answer 14

Address SDs to allow MS to operate more efficiently

Question 15

What are the main benefits of OMT?

Answer 15

Reduced time and money on surgery and other treatments

Question 16

How many treatments are considered a trial of OMT?

Answer 16

3-4

Question 17

Is bed rest indicated for LBP?

Answer 17

Nope

Question 18

What are interventional treatments for LBP? Is this diagnostic or therapeutic?

Answer 18

fluoroscope guided injection

Both diagnostic and therapeutic

Question 19

What are the specialist for LBP?

Answer 19

Physiatrist/neurologist

Question 20

What are the three things that a physician spine specialist looks for?

Answer 20

Disc disease
Facet disease
Referred pain

Question 21

When should surgery be considered? (3)

Answer 21

• Spinal neurological pathology
• Spinal instability
• Conservative treatments fail

Question 22

What are the two types of spine surgeons?

Answer 22

Neurosurgeons

Ortho

Question 23

What are the three diseases that need a surgical consult?

Answer 23

1. Cauda equina
2. Suspected spinal cor dcompression
3. Progressive neuro deficit

Question 24

Who would you refer a radiculopathy to: a neurosurgeon, or ortho?

Answer 24

Either

Question 25

Who would you refer a myelopathy to: a neurosurgeon, or ortho?

Answer 25

Neuro

Question 26

Who would you refer a spinal instability to: a neurosurgeon, or ortho?

Answer 26

Ortho

Question 27

What are the three reasons for treating OMT with LBP?

Answer 27

Effective
Decreases med needs
Decrease needs for other treatments

Question 28

What are the areas of the body that should be assessed with an osteopathic structural exam for LBP? (6)

Answer 28

• Innominates
• Sacrum
• Pubic symphysis
• Lumbar spine segments
• Fascial patterns at transitional areas
• Major muscles related to the low back

Question 29

What are the two general rules for ordering imaging for LBP?

Answer 29

• Severe progressive neuro deficits

- Ssx that suggest underlying condition

Question 30

What are the general components of conservative treatment of LBP?

Answer 30

Activity modification
OMT
Injections

Question 31

Neuromotor deficits that do not improve with conservative therapy in what timeframe should be referred to a neurologist?

Answer 31

4-6 weeks of conservative therapy