Week 1- L-spine Common Clinical Presentations Flashcards
Classifications of LBP.
- Acute or Subacute LBP with Mobility Deficits
- Acute, Subacute, or Chronic LBP with Movement Coordination Impairments
- Acute LBP with Related (Referred) Radiating LE Pain
- Acute, Subacute, or Chronic LBP with Radiating Pain
- Acute or Subacute LBP with Related Cognitive or Affective Tendencies
- Chronic LBP with Related Generalized Pain
What are (3) prognostic indicators for development of recurrent LBP?
- Hx previous episodes.
- Excessive spine mobility.
- Excessive mobility in other joints.
What are the (5) prognostic indicators for development of chronic LBP?
- Presence of symptoms below the knee.
- Psychosocial distress or depression.
- Fear of pain, movement, and re-injury or low expectations of recovery.
- Pain of high intensity.
- Passive coping style.
- ______ _____ Pain: Area bordered by transverse line from T12 – S1.
- ______ _____ Pain: Area bordered by vertical lines through PSISs and horizontal lines through S1 and sacrococcygeal joints .
- Lumbar Spine Pain
- Sacral Spine Pain
LBP Prevalence:
- Mechanical = ___%
- Non-mechanical spinal conditions = ___%
- Visceral = ___%
- Mechanical = 97%
- Non-mechanical spinal conditions = ~1%
- Visceral = 2%
Common Clinical Presentations List, (11)
- Neoplasms
- Infection
- Spondyloarthropathies
- Vertebral Body Fracture
- Spondylolysis & Spondylolysthesis
- Discogenic Pain (discitis and internal disc disruption)
- Radicular pain/ radiculopathy
- Lumbar Stenosis
- Zygapophysial Joint Pain
- Muscle Pain
- L-Spine Surgeries
Neoplasms:
- What is the presenting complaint in 90% of neoplasm patients?
- What are the (4) most common sites of metastasis?
- Back pain
- Breast, Lung, Prostate, Kidney
What may be found during a patient interview/Hx with Neoplasms? (6)
- PMH includes cancer
- Progressive
- Fatigue
- Weight Loss
- Smoking
- Pain Complaints
Common pain complaints found with patients with Neoplasms:
- Persistent
- Not alleviated with “________”
- Worse at _______
- _________ symptoms
- Persistent
- NOT alleviated with “bed rest”
- night
- Neurological
Neoplasm Physical Examination:
- ____-_______ presentation
- Age > ___
- Anemia
- Neurological signs
- non-mechanical
- Age > 50`
Infection:
- Vertebral osteomyelitis is misdiagnosed in ____% of cases and has an average delay of _____ months in diagnosis.
- _______ ________ is a hematogenous spread of bacteria into epidural space that occurs in 10% of spine infections. Misdiagnosis rate is estimated at 50%.
- 33.7%, 2.6 months
- Epidural Abscess
What may be found during a patient interview/Hx with Infection (Vertebral Osteomyelitis)? (6)
- Often traced to other sources of infection (bladder most common)
- At risk patients (immunocompromised or DM)
- Weight loss
- Fatigue
- Fever
- Neurological Symptoms
Patients with Vertebral Osteomyelitis often complain of local, focal back pain that is worse with _________ loading and improves with __________ position.
- mechanical
- recumbent
Vertebral Osteomyelitis Physical Examination:
- Fever
- ______ tenderness
- Aggravated with local __________
- __________ signs
- Lab tests important for Dx
- local
- percussion
- Neurological
Epidural Abscess is often concomitant with vertebral osteomyelitis and can present similar to mechanical _________ pain.
-radicular
Fractures:
- What are the (3) divisions of fracture classifications.
- Vertebral fractures increase mortality and is a predictor for subsequent vertebral fractures (__-__x) and hip fracture (__x).
- Anterior Column, Middle Column, Posterior Column
- vertebral fracture (4-5x), hip fracture (3x)
What are the (3) Types of Fractures in the TLICS Classification System?
- Compression
- Translation
- Distraction
Compression Fractures (“Traditional”):
- Stable injury involving the ______ column.
- Common mechanism is axial loading in what position?
- A compression ______ fracture involves the anterior and middle columns and makes up 15-20% of all major vertebral body fractures.
- Where is a compression burst fracture most common? What is of concern with burst fractures?
- Compression burst fractures come from high axial force in what position?
- anterior
- flexed position
- burst
- T/L Junction, neural involvement
- flexed
Translation/Rotation Fractures:
- Associated with what common MOIs?
- Involves ________ and _____ forces.
- Horizontal displacement of one T/L vertebral body on another.
- Facet joints are intact but __________.
- Fall from height or heavy object falling on body with bent trunk.
- torsion and shear forces
- dislocated
Distraction Fractures:
- Separation in the ________ axis.
- Anterior & posterior ligaments, anterior & posterior bony structures, both.
- Potential Frx to __________ elements.
- vertical
- posterior
What are some red flags for vertebral fracture? (4)
- Older age
- Significant trauma
- Corticosteroid use
- Contusion/abrasion
Henschke Cluster Items for Vertebral Frx. (4)
- Age > 70 years
- Significant trauma
- Prolonged corticosteroid use
- Sensory alterations from the trunk down
Roman Cluster Items for Vertebral Frx. (5)
- Age >52
- No presence of leg pain
- BMI = 22
- Does not exercise regularly
- Female
Spondylolysis:
- Fatigue fracture of ____________.
- What are the (3) proposed mechanisms?
- What is a flail segment?
- 90% of Spondylolysis at ___ level.
- pars interarticularis
- Acquired (repetitive microtrauma), Congenital, Developmental
- Bilateral pars defect with attached multifidi.
- L5 level
Spondylolisthesis:
- Anterior slip of the vertebrae following bilateral __________.
- What are the grades?
- Greatest slippage occurs between __-__ years old. Why?
- Often reduced ______ observed with flex/ext radiographs (rather than instability).
- spondylosis
- Grade 1=0-25%, Grade 2=25-50%, Grade 3=50-75%, Grade 4=75-100%
- 10-15 years old, bone is not ossified
- ROM
What populations are at increased risk for Spondylolysis and Spondylolisthesis? (3)
- Athletes (repetitive extension)
- girls (2x), women (4x)
- Adolescents
