Management of spinal issues Flashcards
Back pain is what number reason for clinic visits?
2
What are the three initial concerns with LBP?
- Systemic disease
- Neurologic compromise
- Social/psychological stress
Duration of pain greater than what amount of time is a red flag?
more than one month
Over what age is a red flag?
50 years
What percent of LBP may be due to SDs?
70%
What are the landmarks of the OSE?
Shoulder heights
Crest heights
Greater trochanter heights
Standing and seated flexion
True or false: most patients with LBP without other symptoms usually improve rapidly
True
Is imaging indicated for nonspecific LBP
No
What are the four types of red flag conditions that warrant imaging?
Fracture
Infection
Neoplasms
Severe neurologic deficit
(FINS)
When should plain x-rays be obtained for LBP?
not improved for 4-6 weeks
When is MRI indicated for back pain?
If persists longer than 12 weeks
Why are labs good for evaluation of back pain?
Systemic disease evaluation
True or false: manipulation treatment is as effective as conventional medical therapy
True
What is the biomechanical perspective of LBP?
Address SDs to allow MS to operate more efficiently
What are the main benefits of OMT?
Reduced time and money on surgery and other treatments
How many treatments are considered a trial of OMT?
3-4
Is bed rest indicated for LBP?
Nope
What are interventional treatments for LBP? Is this diagnostic or therapeutic?
fluoroscope guided injection
Both diagnostic and therapeutic
What are the specialist for LBP?
Physiatrist/neurologist
What are the three things that a physician spine specialist looks for?
Disc disease
Facet disease
Referred pain
When should surgery be considered? (3)
- Spinal neurological pathology
- Spinal instability
- Conservative treatments fail
What are the two types of spine surgeons?
Neurosurgeons
Ortho
What are the three diseases that need a surgical consult?
- Cauda equina
- Suspected spinal cor dcompression
- Progressive neuro deficit
Who would you refer a radiculopathy to: a neurosurgeon, or ortho?
Either
Who would you refer a myelopathy to: a neurosurgeon, or ortho?
Neuro
Who would you refer a spinal instability to: a neurosurgeon, or ortho?
Ortho
What are the three reasons for treating OMT with LBP?
Effective
Decreases med needs
Decrease needs for other treatments
What are the areas of the body that should be assessed with an osteopathic structural exam for LBP? (6)
- Innominates
- Sacrum
- Pubic symphysis
- Lumbar spine segments
- Fascial patterns at transitional areas
- Major muscles related to the low back
What are the two general rules for ordering imaging for LBP?
- Severe progressive neuro deficits
- Ssx that suggest underlying condition
What are the general components of conservative treatment of LBP?
Activity modification
OMT
Injections
Neuromotor deficits that do not improve with conservative therapy in what timeframe should be referred to a neurologist?
4-6 weeks of conservative therapy
