The Lumbar Spine

Question 1

Up to ___% of all people experience LBP at some point in their lifetime.

Answer 1

80%

Question 2

List 7 questions to ask a patient experiencing LBP.

Answer 2

1. Has the patient experienced low back pain in the past? If so, was it the same type of LBP that the patient is currently experiencing?
2. What was the result of intervention for any previous incidences of back pain?
3. How did the injury occur? Lifting? Insidious onset?
4. What is the patient’s occupation? Is the patient currently working?
5. Where is the pain located?
6. Is the pain constant or intermittent?
7. Is the patient experiencing sxs of numbness/tingling or problems with bowel/ bladder?

Question 3

Pain radiating below the ____ is an indication that there could be a disc injury

Answer 3

KNEE

Question 4

Radiating pain that is greater in the buttock and/or leg than in the low back is also an indication of a _____.

Answer 4

Disc herniation

Question 5

List 5 common medical diagnoses that can cause LPB (red flags).

Answer 5

1. Spinal fractures
2. Spinal infection
3. Neoplasm
4. Cauda Equina Syndrome
5. Ankylosing Spondylitis

Question 6

List 2 indications that may suggest the presence of a fracture.

Answer 6

1. History of trauma

2. Point tenderness over the area of the fracture

Question 7

Compression fractures are common in patients with _____ and with a history of ______.

Answer 7

Osteoporosis (age >50, Asian/Caucasian, female)

History of steroid use

Question 8

List 3 risk factors for neoplasms.

Answer 8

1. Hx of cancer
2. Cancers that metastasize to the spine (breast, lung, prostate)
3. Age > 50 years

Question 9

List 5 signs and symptoms of neoplasm.

Answer 9

1. Unexplained weight loss
2. Constant pain
3. No relief with bed rest
4. Night pain
5. Symptoms do not improve with PT

Question 10

List 4 characteristics of cauda equina syndrome.

Answer 10

1. MEDICAL EMERGENCY
2. Saddle anesthesia
3. Recent onset of bladder dysfunction
4. Progressive lower extremity symptoms

Question 11

List 5 characteristics of ankylosing spondylitis.

Answer 11

1. Male gender
2. Age < 35 years
3. Night pain
4. Morning stiffness
5. Reduction in symptoms with exercise and activity

Question 12

List 4 risk factors for spinal infection.

Answer 12

History of

1. Recent bacterial infection
2. Recent spinal surgery
3. IV drug abuse
4. Immunosuppression

Question 13

List 3 characteristics of a spinal infection.

Answer 13

1. Fever
2. Deep constant pain
3. Spinal rigidity

Question 14

List 4 things to observe, in addition to the usual items, in patients with back pain.

Answer 14

1. Posture
2. Gait
3. Willingness to move (transfer out of chair)
4. Inconsistent movement patterns

Question 15

List 3 things to palpate when examining patients with low back pain.

Answer 15

1. Soft tissue integrity
2. Bony landmarks in lumbar spine and SI joint
3. Bony landmarks in the pelvis and LE for leg length discrepancy

Question 16

Tightness in what 7 muscle groups can contribute to back problems?

Answer 16

1. Gastrocsoleus
2. Quadriceps
3. Hamstrings
4. Hip flexors
5. Glut maximus
6. Hip adductors
7. Hip rotators

Question 17

Most of the motion in the lumbar spine in to forward bending occurs at ____ and _____, and only a small amount of ____ occurs in the lumbar spine.

Answer 17

L4-L5 and L5-S1

Small amount of ROTATION at the lumbar spine

Question 18

How is range of motion into forward bending measured at the lumbar spine? Normal values?

Answer 18

1. With the patient in a neutral position, put one end of the tape measure on T12, and stretch the tape measure down the lumbar spine to S1.
2. Instruct the patient to bend forward as far as possible before pain.
3. Normal: 5cm difference
4. Abnormal: Less than 3cm

Question 19

Strength of the ____, ____ and _____ should be assessed in patients with back pain.

Answer 19

Abdominals
Back extensors
LE muscles

Question 20

______ testing is not performed in the lumbar spine because it is difficult to eliminate motion in joints.

Answer 20

Resistive Isometric Testing

Question 21

L5 nerve root is usually affected by the ____, and the S1 nerve root is usually affected by the ____ disc.

Answer 21

L5 nerve root = L4/5 disc

S1 nerve root = L5/S1 disc

Question 22

Spondylosis is _____ at the lumbar spine, and it includes _____ disease and _____.

Answer 22

Osteoarthritis
Degenerative disc disease
Stenosis

Question 23

What is the prevalence, etiology, and prognosis of lumbar radiculopathy? What segments are more most commonly effected?

Answer 23

1. Prevalence: ~5% of all patients with low back pain
2. Etiology: more common among patients aged < 55
3. Prognosis favorable, recovery could take longer than simple nonspecific LBP
4. Most common at L4/L5 and L5/S1

Question 24

List 5 signs and symptoms of lumbar radiculopathy.

Answer 24

1. Pain radiating below the knee
2. Pain that is worse in the buttocks and/or leg than in the low back
3. Pain that is worse with sitting than most other positions (causes posterior migration of disk)
4. Nerve root signs (sensory deficits, motor deficits, deep tendon reflex changes) that are consistent with one nerve root level
5. Positive SLR, with pain limiting range to no more than approximately 40 degrees of hip flexion

Question 25

List 3 interventions used to treat lumbar radiculopathy.

Answer 25

1. Extension exercises 2. Activity regulation 3. Maintaining a lordosis with ADLs

Question 26

What is the difference between spondylosis and spondylolisthesis?

Answer 26

1. Spondylosis: presence of a fracture in the pars intraarticularis. 2. Spondylolisthesis: presence of a vertebra that has slipped forward due to the presence of bilateral fractures in the pars intraarticularis.

Question 27

List 2 possible causes of spondylosis and spondylolisthesis.

Answer 27

1. Failure of the neural arch (surrounding the spinal cord) at the pars intraarticularis to unite during growth (more common) 2. Fracture of the pars intraarticularis.

Question 28

What are 2 onsets of pain for spondylosis and spondylolisthesis?

Answer 28

1. Sudden quick movement into extension | 2. Repetitive movements into extension

Question 29

What kinds of pain should be monitored for in patients with spondylosis and spondylolisthesis? (2)

Answer 29

1. Pain with positions/ activities that entail extension (increases tendency for vertebra to slip anteriorly) 2. Pain is better with positions that entail flexion

Question 30

The presence of a _____ on X-ray is a sign of the presence of a fracture

Answer 30

'Scotty dog collar'

Question 31

List the 4 grades of slippage as determined by an xray for spondylosis and spondylolisthesis.

Answer 31

1. Grade I if up to 1/4 of the vertebral body has slipped forward in relation to the vertebral body below 2. Grade II if up to 1/2 of the vertebral body has slipped forward in relation to the vertebral body below 3. Grade III if up to 3/4 of the vertebral body has slipped forward in relation to the vertebral body below 4. Grade IV if more than 3/4 of the vertebral body has slipped forward in relation to the vertebral body below

Question 32

How is spondylosis/OA of the spine diagnosed?

Answer 32

via X-ray and MRI

Question 33

___ exercises and ___ mobilization have been shown to reduce symptoms in patients with spondylosis/OA.

Answer 33

Stabilization exercises | Hip Mobilizations

Question 34

What is the cause of spinal stenosis?

Answer 34

Bony encroachment into the spinal canal (central stenosis) and/or intervertebral foramen (lateral stenosis) secondary to degenerative changes

Question 35

Stenosis is characterized by a pain pattern in which symptoms increase with ___ and decrease with ____.

Answer 35

Increases with extension | Decreases with flexion

Question 36

List 2 symptoms that stenosis can cause.

Answer 36

1. Sxs attributable to a nerve root compression | 2. Neurogenic claudication sxs (nerve root ischemia causing poorly localized leg pain, parasthesia and cramping)

Question 37

Stenosis pain can be described as resembling ____ pain, and often increases with ____.

Answer 37

Ischemic pain | Walking

Question 38

How can one distinguish between spinal stenosis and LE claudication? (3)

Answer 38

1. Place patient on stationary bike 2. If sxs increase with biking- intermittenet claudication 3. If sxs remain the same = stenosis

Question 39

What are 5 diagnosis criteria for spinal stenosis?

Answer 39

4/5 must be positive: 1. Bilateral symptoms 2. Leg pain greater than back pain 3. Pain during walking/standing 4. Pain relief when sitting 5. Age > 48 years

Question 40

What is ankylosing spondylitis? (3)

Answer 40

1. Rheumatic, sero-negative condition 2. Characterized by ossification of spinal ligaments and joint capsules 3. Spinal mobility gradually decreases over time

Question 41

Patients with signs of _____ and _____ or a positive _____are likely to benefit from lumbar traction.

Answer 41

1. Nerve root compression 2. Peripheralization of sxs 3. Positive crossed leg raise test

Question 42

List 4 advantages of using lumbar bracing.

Answer 42

1. Controls lordotic positioning 2. Reminds patient to maintain lordosis 3. Reduces stress on spine by increase intra-abdominal pressure 4. Reduces stress on the spine by decreasing lever arm created by abdomen to bring abdominal contents towards the spine

Question 43

List 3 disadvantages of using lumbar bracing.

Answer 43

1. Atrophy of trunk muscles 2. Skin breakdown 3. Cosmetic issues