Week 5

Question 1

what is radiculopathy

Answer 1

injury or damage to nerve roots in the area they leave the spine that may result in pain, loss of sensation and/or motor function depending on the severity of symptoms

Question 2

what is acute low back pain

Answer 2

up to 12 weeks

Question 3

chronic LBP

Answer 3

3 months or greater

Question 4

what is lumbago

Answer 4

refers to acute back pain or a strain

Question 5

what is sciatica

Answer 5

often used to describe lumbosacral radiculopathy, pain distributed along the sciatic nerve (L4-S3)

Question 6

constructing a differential diagnosis of acute LBP

Answer 6

1. LBP due to disorders of the musculoskeletal structures
2. LBP due to systemic disease affecting the spine
3. LBP due to visceral disease

Question 7

what are some red flag findings for acute LBP?

Answer 7

• loss of bowel control
• loss of bladder control
• unexplained fever or weight loss
• focal neurological deficit

Question 8

what is cauda equina syndrome

Answer 8

compression and disruption of function to cauda equina (L3-L5 nerve roots), most commonly due to lumbar disc herniation

Question 9

what are the classical symptoms of cauda equina syndrome?

Answer 9

• new urinary retention or overflow incontinence, fecal incontinence
• saddle anesthesia

Question 10

what is the diagnostic gold standard for cauda equina syndrome

Answer 10

MRI

Question 11

T or F: Cauda equina syndrome is a urgent ER referral; requires surgical decompression within 24-48 hours

Answer 11

True

Question 12

what is the most common tumor of the spine called

Answer 12

metastases

Question 13

what’s a big indicator of metastases?

Answer 13

unexplained weight loss

Question 14

T or F: metastases is a condition that you need an urgent referral

Answer 14

true

Question 15

what is a vertebral fracture

Answer 15

a break in one or more spinal vertebrae that can result from trauma and metastatic disease but, in most cases, are the result of osteoporosis (at T11-L2)

Question 16

what is the most common vertebral infection?

Answer 16

Osteomyelitis

Question 17

what is the most common cause of osteomyelitis

Answer 17

staphylococcus aureus

Question 18

what spines is the most susceptible to injury

Answer 18

L4-L5 (L5 nerve root) and L5-S1 (S1 nerve root)

Question 19

what is the single most common lumbar radiculopathy

Answer 19

L5 radiculopathy

Question 20

what is usually described from the patient experiencing LBP with radiculopathy

Answer 20

tingling, electric, burning or sharp

Question 21

what is disc herniation

Answer 21

displacement of intervertebral disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space

Question 22

what are the patterns of disc herniation

Answer 22

• bulging disc
• herniated disc - protrusion
• herniated disc - extrusion
• herniated disc - sequestration

Question 23

explain bulging disc

Answer 23

loss/damage of annular fibers allows the nucleus pulposus to shift without herniation, associated with trauma

Question 24

explain herniated disc - protrusion

Answer 24

focal distension of the disc, annulus fibrosis remains intact

Question 25

explain herniated disc - extrusion

Answer 25

nucleus pulposus breaks through the annulus fibrosis but remains in the disc

Question 26

explain herniated disc - sequestration

Answer 26

nucleus pulposus breaks through the annulus fibrosis and is displaced from the site of extrusion, considered a subtype of extruded disc

Question 27

explain the hancock rule

Answer 27

if at least 3 of 4 findings are in concordance with a specific nerve root:
- dermatomal pain location
- sensory deficit
- reduced reflex
- motor weakness

Question 28

an acute injury in the distribution of L2, L3, and L4 will most commonly present with

Answer 28

radiating back pain to the anterior aspect of the thigh, which may progress into their knee, and possibly radiate to the medial aspect of the lower leg, into the foot

Question 29

what has the highest LR positive for L2, L3, L4 radiculopathy

Answer 29

asymmetric quad reflex

Question 30

with L5 radiculopathy, patient will often complain about what

Answer 30

acute back pain, which radiates down the lateral leg into the foot

Question 31

what has the highest LR positive for L5 radiculopathy

Answer 31

asymmetric medial hamstring reflex

Question 32

with S1 radiculopathy, patient will often complain about what

Answer 32

radiation of sacral or buttock pain into the posterior aspect of the patient’s leg into the foot

Question 33

what has the highest LR positive for S1 radiculopathy

Answer 33

asymmetric achilles reflex (absent ankle reflex)

Question 34

what is spondylosis

Answer 34

an umbrella term for age-related degeneration of the spinal column

Question 35

what is spinal stenosis

Answer 35

narrowing of the spinal canal which can lead to compression of the nerve roots (most commonly due to spinal OA)

Question 36

what is spondylolysis

Answer 36

weakness or stress fracture through the pars interarticularis

Question 37

what is spondylolisthesis

Answer 37

the slippage of one vertebral body with respect to the adjacent vertebral body

Question 38

what are the grades of spondylolisthesis

Answer 38

Healthy spine
Grade 1: < 25%
Grade 2 : 25-50%
Grade 3: 50-75%
Grade 4: > 75%

Question 39

what are the 3 categories of radicular symptoms and signs

Answer 39

mild radiculopathy is consider a sensory loss and pain without motor deficits
moderate radiculopathy is the sensory loss or pain with mild motor deficits
severe radiculopathy is considered sensory loss and pain with marked motor deficits

Question 40

T or F: most cases of lumbosacral radiculopathy are self-limited. Spontaneous improvement is very common without treatment

Answer 40

true