spine conditions Flashcards
how is lower back pain defined?
- pain and discomfort, localised below the costal margin and above the inferior gluteal folds **with or without **leg pain
define acute LBP
- usually defined as the duration of an episode of low back pain** persisting for less than 6 weeks **
define sub-acute LBP
- episode of low back pain between 6 - 12 weeks
define chronic LBP
lower back pain for longer than 12 weeks
what other pain might lower back pain also present with?
- with or without **sciatica/leg pain **
describe the** epidemiology **of LBP
- back pain affects up to 85% of the population at some time in their lives
- **leading cause of disability **world wide
- 10-15% proceed to become chronic, high recurrence rates
- most LBP is classified in non-specific LBP
what are the 3 groups that LBP can be classfied into?
- specific spinal pathology (less than 1%)
- radicular symptoms (5-10%)
- non specific low back pain (90-95%)
what are other situations that may cause LBP that arent the classified groups?
- hip pathology
- referred visceral pain
- viral syndrome
- vascular causes
what important mental factor can be associated with lower back pain?
- psychosocial factor - eg fear of movement, catastrophising, stress etc
when is it important to refer a patient with LBP for a medical opinion / ie to see a doctor?
- if there is a** suspicion of serious underlying condition**
- if the pain meds that the patient is taking arent working well for him
* if they dont respond or improve after conservative physio treatment for longer than 4-6 weeks - if they have** severe or progressive neurological deficit**
what are examples of specific causes of LBP?
ie anything that isnt non specific lbp
- fracture
- osteoporosis
- inflammatory rheumatology condition
- tumour - spine is common site for secondary bony metastases
- infection
- cauda equina syndrome
- structural changes radicular pain
what are red flags?
- clinical findings that increase the level of suspicion that there is a **serious medical condition **presenting as common, non serious, MSK conditions
what are examples of red flags for lower back pain?
- thoracic pain
- fever
- unexplained weight loss
- history of cancer
- ill health or presence of medical illness
- bladder or bowel dysfunction
- progressive neurological deficit, especially bilateral (abnormal neurological function )
- saddle anaesthesia (altered sensation in perineal area)
- history of steroid use
- history of osteoporosis
what is cauda equina syndrome?
NB
- compression and paralysis of nerve roots in the lumbar spinal canal
what are some examples of symptoms of cauda equina syndrome?
- bladder or bowel dysfunction
- progressive neurological deficit- esp bilateral
- saddle anaesthesia **- altered sensation in perineal area **
- disturbed (ataxic gait)- poor coordination of gait
what should you do if you suspect a patient may have cauda equina syndrome?
- you should send them to A&E for further investigation
- if patient does have CES - then they will get an urgent decompression surgery - otherwise permenant damage will occur
what is degeneration of the spinal column?
- age related change to the spinal column
- by the age of 50 years, 85-95% of adults show evidence of **degenerative disc disease **at autopsy including disc bulge/ prolapsed disc
what** 2 types of joints in the spine **can suffer from osteoarthritis?
- central intervertebral joints
- facet joints
what is spondylosis?
- a term used to describe a group of degenerative conditions that affect the intervertebral discs, vertebral bodies and associated joints in the spine
- eg lumbar or cervical spondylosis
if there is osteoporosis of the IV discs and also the facet joint, what is this condition called?
- degenerative disc disease (DDD)
what are the clinical features of osteoporosis in the spine?
- LBP that may or may not accompany referred pain in the buttock/leg
- bilateral or unilateral LBP
- stiffness - eg in the morning
- there may or may not be symptoms of nerve root compresion eg P&N’s, numbness, weakness
after examining a patient with suspected osteoarthritis in the spine, what can be noticed?
- reduced spinal ROM
- stiffness on accessory glides of spinal vertebrae
- may or may not be signs of nerve root compression
what can be seen on x ray with osteoarthritis of the spine?
- narrowing intervertebral disc space
- osteophyte formation - ‘spurs’
- narrowing of inter vertebral foramen
how does** spinal stenosis** occur?
- spinal stenosis happens when the space inside the spinal canal is too small
- this puts pressure on the spinal cord and or the nerves
at what age can spinal stenosis occur?
over the age of 50 years old
what are the** signs/symptoms** of spinal stenosis?
- flexed spinal posture
- limited spinal extension
- pain & symptoms worsen with extension and are better/relieved with flexion
- treadmill test may reproduce leg symptoms
what are the 3 options for surgery for spinal stenosis?
- spinal decompression
- laminectomy
- urgent decompression surgery if cauda equina syndrome
what is spondylolisthesis?
- the slippage one 1 vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms of pain
what are the causes of spondyloisthesis?
- traumatic spondylolisthesis - L5/S1 - most common
- degenerative changes - L4/L5 - more common
- graded I-IV in severity, with IV being the worst
what is spondylolysis?
- a condition involing a bony defect or stress fracture in the pars interarticularis
- can be unilateral or bilateral
- may predispose to slip - spondylothesis
- can be congenital or acquired
what kind of activities is spondylolysis associated with?
- associated with hyperextension activities eg gymnastics, high jump and throwing sports
what are clinical features of spondylolysis?
- may be asymptomatic if grade I
- may present with unilateral LBP and +/- buttock pain
- pain worsens with extension movements like walking
- rest usually relieves the symptoms
- localised tenderness
- localised protective muscle spasm
what are clinical features of spondyloisthesis?
hint: similiar to spondylolysis symptoms
- patients have low back pain
- pain is made worse by extension movements
- pain decreases as the patient goes into a flexed posture
- localised tenderness
what does the treatment for grade I-II spondylolisthesis involve?
- relative rest from aggregating movements & activities
- exercise
- no manual therapy at level of slip
- anti-lordotic brace
what does the treatment for a grade III-IV for spondylolisthesis involve?
- no contact sport
- same as grade I&II
- may require spinal fusion (fusion of 2 or more unstable vertebrae into 1 to relieve pain)
what is lumbrosacral radiculopathy?
- disorder that causes pain in the lower back and radiates down the back of the thigh into the leg (sciatica)
- very common cause of back pain
- patient will present with symptoms related to nerve root compression or irritation to a nerve
what is sciatica?
- pain going down the leg from the lower back
where do the lumbar nerve roots exit the spinal column?
- **below **the corresponding vertebra
what are examples of pathologies can cause radicular back pain?
- disc prolapse or herniation
- OA
- stenosis in older patient
what is a prolapsed intervertebral disc?
example of cause for radicular back pain
- protrusion of nucleus pulposus through the outer layer - annulus fibrosis
- varying degrees of severity
what discs are most common for prolapsed intervertebral discs?
- l5/S1
- L4/L5
in which direction does the nucleus protrude?
posterolaterally or posteriorly
what are the symptoms of radiculopathy related to disc pathology?
- age 20-50 years
- males > females
- trivial event involing flexion and possibly +/- rotation
- acute severe pain, unable to move
- pain - central or unilateral LBP, may have buttock pain, may have leg pain
- aggravated by coughing, sneezing, flexion movements and positions eg sitting, driving etc
- eased by **lying and short periods of walking **
what is the ASIA scale?
- the american spinal injury association impairment scale
- describes a patients functional impairment as a result of a spinal cord injury
describe** non specific lower back pain**
- lower back pain that is not due to a recogniziable, known specific pathology
- several structures in the back including joints, discs and connective tissues may contribute to symptoms
