Pathologies Related to The Low Back I Flashcards
Spinal Malignancy: Incidence
-what is the primary malignant tumor and its location?
-typically seen in ______ ______
multiple myeloma; bone marrow
older adults
Spinal Metastases - secondary or primary?
________ MOST common tumors of the spine
secondary
2nd
Spinal Metastases is MOST often from ________,_______,______,________,______ and _________in that order.
breast, lung, prostate, kidney, GI, and thyroid tumors
(BL PK GT)
What is the 3rd MOST common area of metastasis, behind lung and liver
Bone
The ______ _________ is the MOST common structure for bone metastasis MOSTLY in the ________ portion leading to wedging
-_______ is rarely involved
vertebral body; anterior
disc
What is the most common region for spinal metatatsis?
thoracic 70% > lumbar
What is the most useful indicator of spinal malignancy?
PMH of cancer; 97% of spinal tumors are the result of metastasis
Pathogenesis of spinal metastasis is
healthy bone replaced by tumor
What is the common initial symptom of spinal malignancy?
spinal P!; unfamiliar or severe P! may become progressive
______________ S&S include possible myelopathy bony alteration, fxs, and joint instability unable to lie flat due to P!
-likely mechanical P! or no?
-stress test _____ for bone involvement
spinal malignancy
Yes
(+)
Spinal Malignancy referral?
urgent referral to MD unless cord S&S
Slow, gradual, and often progressive compression of the cord is known as
lumbar spinal cord myelopathy
What region is the 2nd most common area for spinal myelopathy?
lumbar
Spinal Myelopathy is most commonly due to
degenerative spinal changes
-lax and bulking ligamentum flavum
-age-related joint disease w/enlarging and encroaching arthritic bone (stenosis)
-age-related disc disease w/herniations
-vertebral body collapse/fx
-spondylolisthesis
Central disc herniation is rare? T or F
true
Lumbar spinal cord myelopathy S&S:
sensation
DTRs
Myotomes
Bowel/Bladder
Clonus/Babinksi
Superficial reflexes
hyposensitivity
hyperreflective
fatiguing
retentive/spastic
positive
hypoactive
Lumbar spinal myelopathy referral
immobilize emergency referral
What is cauda equina syndrome:
compression on some degree of the 20 spinal nn. that originate from the end of the spinal cord or conus medullaris in the vertebral canal
Where does the cauda equina begin?
Is cauda equina syndrome common?
below L1,L2 segment
no, rare 2% of lumbar age-related disc changes
Cauda equina is primarily due to:
-primary
-secondary
mid to lower lumbar age-related disc changes
secondarily due to other degenerative spinal changes and malignancy
Cauda equina syndrome risk factors:
mid to lower lumbar
persistent IDD, central > postlat IDD
central stenosis
Sx
<50 yrs.
Obesity
Clinical S&S of Cauda Equina Syndrome –Hx including:
LBP
Bowel and Bladder incontinence
Sexual dysfunction
Possible cancer S&S
Unilateral or Bilateral LE and patchy neuro S&S (not consistent)
Cauda Equina Syndrome:
sensation
DTRs
Myotomes
Dural Mobility
diminished/decreased
hypoactive
fatiguing
(+)
PT implications: cauda equina syndrome is _____ referral
_________is gold standard
emergency referral due to multiple spinal nn. involved
MRI
what is a spinal infection?
infectious disease of spinal structures
what is osteomyelitis? discitis?
bone infection
disc infection - more common in lumbar
how prevalent are spinal infections?
uncommon in wealthier countries - resurgence with longevity and IV drug use
what is the cause of spinal infections?
primarily from mycobacterium TB
staphylococcus aureus and brucella are also involved at times
what are risk factors for spinal infections?
immunosuppression
surgery, particularly of the spine and repeated procedures
IV drug use
social depravation
Hx of TB or another recent infection
how does spinal infections develop? where does it commonly spread to?
2-3 years after initial air droplet infection into lungs
spreads within the body through lymph and blood
as abscess grows, nerve root irritation, vertebral body collapses and cord compression may develop
spreads to disc more commonly in lumbar spine
what are early S&S of spinal infection? what are not common initially?
age related changes with back p!/stiffness is most common
constitutional symptoms NOT common initially
what are S&S of spinal infection?
localized and progressive pain that limits motion
likely mechanical P! for disc but possibly vertebral body involvement
stress tests (+) for disc
infection S&S
– abnormal fatigue
– fever since onset of back P!
unexplained weight loss of > 5-10% over a 3-6 month period
possible TTP, percussion, vibration
what S&S could show if spinal infections are left untreated?
neuro S&S influence the LEs, coordination, bowel and bladder dysfunction
loss of lumbar lordosis
what referral would a spinal infection be?
urgent unless cord S&S
what is the best imaging for a spinal infection?
MRI
otherwise can observe infection 3-5 days after onset
why would one order an x ray for a spinal infection?
if suspicious of TB
what is ankylosing spondylitis?
a type of spondyloarthropathy or spondyloarthritide
what are the two causes of ankylosing spondylitis?
genetics (90% (+) for HLA-B27 antigen)
environment
what condition is almost as common as RA?
ankylosing spondylitis
who has a higher prevalence of getting ankylosing spondylitis?
15-30 year olds
2-3x more likely males vs females
what region is ankylosing spondylitis most common in?
lumbosacral region
how does ankylosing spondylitis develop?
chronic inflammation at cartilage, tendon, ligament and synovium attachments to bone
erosive osteopenia and bony overgrowth
what does ankylosing spondylitis lead to?
fusion of involved joints (fibrotic changes spread)
appears bamboo like on x ray
S&S of ankylosing spondylitis
autoimmune S&S
multi-jt inflammation and P!
– > 30 min of P!/stiffness after prolonged positions
– improved P! w easy and regular movement
– chronic inflammation and P! of axial skeleton most often
– asymmetric or unilateral extremity involvement (typically smaller extremity joints and localized)
familial predisposition
extraarticular involvement of eyes, skin, GI tract and renal and cardiac systems
“hurts to see, pee and bend my knee”
what are signs you would find in the history of someone with ankylosing spondylitis?
progressive LBP primarily from greatest influence on SI > neck and lumbar regions
< 40 years
insidious lasting > 3 months
no change with rest
night pain from static positioning
buttock and hip P!
what would you observe in someone with ankylosing spondylitis?
hyperkyphosis
loss of lumbar lordosis
what would you find in a scan of someone with ankylosing spondylitis?
multiple directions of limited motion of involved joints
consistent block
stress tests - prolonged holds may be painful
what would you find in a biomechanical exam of someone with ankylosing spondylitis?
multiple directions of hypomobile accessory motion, possibly no motion
limited thorax excursion with manubrial and rib springs, possibly compromising breathing
positive Berlin and inflammatory back pain CPRs
what type of referral for ankylosing spondylitis?
urgent to rheumatologist
a “do not want to miss” condition in any young adult with low back pain
what two criteria are used for ankylosing spondylitis?
Berlin Criteria
IBP Criteria
PT Rx for ankylosing spondylitis
be sensitive to trauma in these patients
fall prevention
gentle ROM and exercise considering fragility
postural education
above also helps with bone pathologies
Ankylosing spondylitis may lead to:
osteoporosis
fractures
craniovertebral subluxations
stenosis
fusion in upright or MORE often forward bent position
extraarticular conditions –> IBS, uveitis
cardiopulmonary disorders
