Revision- Lumbar Spine Conditions

Question 1

What are the specific pathoanatomical diagnosis

Answer 1

Fractures #
​ VB wedge or endplate
​ Spondylolysis (PI stress #)

Spondylolisthesis
​ Bilateral PI# with anterior VB slippage
​
Disc prolapse with radicular pain ​ AKA ‘radiculopathy’
​ Spinal canal stenosis

Type 1 Modic changes
​ Vascularisation of VB with findings of inflammation and edema, but no trabecular damage or marrow changes

Will all show​ constant LBP, with little change

Question 2

Where can lumbar spine pain originate?

Answer 2

Disc
Z Joints (aka facet joint)
SI Joints
Ligaments
Muscles
Nerves: NR/SC/CE

Red flags:
Visceral referred pain (e.g. kidney, liver)
Tumour (??)
Infection (??)

Question 3

What are serious pathologies?

Answer 3

Malignancies
Systemic inflammatory disorders
Infections
Cauda equina syndrome

Question 4

What are some common signs of spinal tumours?

Answer 4

• Pain (back and/or neck pain, arm and/or leg pain)
• Muscle weakness or numbness in the legs (or arms depending on location).
• Difficulty walking.
• General loss of sensation.
• Difficulty with urination (incontinence)
• Change in bowel habits (retention)
• Paralysis to varying degrees

Question 5

Possible indicators of serious (spinal) pathology

Answer 5

– Unremitting pain/night pain
– Thoracic pain (without obvious cause)
– Fever and unexplained weight loss
– Bladder or bowel dysfunction
– History of carcinoma
– Ill health or presence of other medical illness
– Progressive neurological deficit
– Disturbed gait, saddle anaesthesia
– Age of onset <20 years or >55 years

Question 6

What are signs of a spinal infection?

Answer 6

-Fever
-Chills
-Headache (depending where)
-Pain
-Stiffness
-Motor Impairments
^Weakness
^Bladder/bowel impairments
-Sensory Impairments
^Numbness/tingling

Question 7

What is Ankylosing Spondylitis (AS)?

Answer 7

• pain and stiffness in the back (Lx‐Tx), buttocks (SIJ) or neck
• symptoms worse after rest (for example, in the early morning >30 min‐1hr) and relieved with exercise
• pain in tendons and ligaments, often felt as pain at the front of the chest, back of the heel or underneath the foot.

Question 8

What is cauda equina syndrome?

Answer 8

• Compression of the cauda equina
• LBP
• Bladder and bowel disorders
• Motor Impairments (bilateral)
• Weakness
• Bladder/bowel impairments
• Sensory Impairments (bilateral, non-dermatomal)
• Numbness/tingling/loss of sensation (glove-stocking)
• Altered reflexes

Question 9

What is Spondylolysis – pars defect?