Lower Back Pain

Waddell's Signs: 1. superficial tenderness 2. nonanatomic tenderness 3. axial loading 4. pain on simulated rotation 5. distracted straight leg raise 6. regional sensory change 7. regional weakness 8. overreaction

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Two surgical approaches to spondylolisthesis?

1. Decompression 2. Decompression with Fusion

In females, the leading risk factor increasing the likelihood of osteoporosis is (_). Men can sometimes be due to (_)

menopause, or estrogen deficiency testosterone deficiency

In cases of spondylolysis, there will seem to be a fracture accross the (_) of the Scotty Dog

neck

Nigh and Rest Pain are hallmarks of (_) or (_) disorders

neoplastic infectious

The main risk factor leading to an increased frequency of lumbar compression fractures is (_)

osteoporosis

What is the most common symptom of spondylolisthesis?

pain

The mainstay of treatment for herniated disks is an initial period of (_) with pain and anti-inflammatory medications, followed by (_)

rest PT

In most cases, (_) of the lumbar canal may be attributed to acquired degenerative or arthritic changes of the intervertebral discs, ligaments and facet joints surrounding the lumbar canal. These changes include cartilaginous hypertrophy of the articulations surrounding the canal, intervertebral disc herniations or bulges, hypertrophy of the ligamentum flavum and osteophyte formation

stenosis

A (_) fracture may require a thoracolumbar corset along with doing an aerobic walking program.

transverse process fracture

In younger patients, fractures are usually due to (_) while in older patients, the cause is usually (_) or from an external trauma such as a fall.

violent trauma nontraumatic

Onset is usually under 35 years of age. Pain persists for more than 3 months (i.e. it is chronic). The back pain and stiffness worsen with immobility, especially at night and early morning

Ankylosing Spondylitis

Some patients have eye inflammation, and more severe cases must be observed for heart valve involvement.

Ankylosing Spondylitis

a form of chronic inflammation of the spine and the sacroiliac joints that can lead to complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis

Ankylosing Spondylitis

Treatment goals for spinal fractures include protecting nerve function and restoring alignment and stability of the spine. T or F?

True

indicators of a non-organic or psychological component to pain. Historically they have been used to detect "malingering" patients with back pain.

Waddell's Signs

Genetic disorder, called HLA-B27 or sometimes in predisposed people after exposure to bowel or urinary tract infections?

Ankylosing Spondylitis

A dramatic loss of flexibility in the lumbar spine is an early sign of (_)

Ankylosing Spondylitis

This type of fracture is associated with work or sports

Axial Burst Fracture

You lose height on both the front and back of the vertebra in this type of fracture, often caused by a fall from height in which you land on your feet.

Axial Burst Fracture

What is used for MM to evaluate the number of myeloma cells, their activity in the BM and the extent of damage

BM biopsy

a. a loss of sensation and motor function (paralysis and ataxia) that is caused by the lateral hemisection (cutting) of the spinal cord

Brown-Sequard's Syndrome

A potential cause of this disorder includes surgery, spinal or epidural anesthesia, spinal manipulation

Cauda Equina Syndrome

This is a true surgical emergency

Cauda Equina Syndrome

a collection of signs and symptoms resulting from compression of the bundle of nerve roots emerging from the end of the spinal cord below the 1st lumbar vertebra

Cauda Equina Syndrome

severe LBP with bilateral sciatica associated with saddle anesthesia, urinary retention, and bowel dysfunction.

Cauda Equina Syndrome

(_) hemisection will cause pure Brown Sequard symptoms while a (_) hemisection will cause this plus other signs and symptoms. This one is more common.

Complete Incomplete

While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.

Compression Fracture

This type of fracture is associated with osteoperosis

Compression fracture

This type of spondylolisthesis is not usually associated with a defect in the pars interarticularis. It is more commonly seen in (_)

Congenital women

This surgical intervention is typically avoided in spondylolisthesis as it can lead to further slip and progressive problems?

Decompression

This type of spondylolisthesis is typically a result of a combination of disc degeneration and facet joint degeneration. It is more commonly seen in (_) older than 40

Degenerative women

What imaging can we get for HNP that will determine nerve roots involved?

EMG

Careful cervical spine/dorsal spine immobilization is necessary, with elimination of neck movement for this disease?

ER Treatment of BS Syndrome

What is the study of choice for Cauda Equina Syndrome?

Emergent MRI

The vertebra is literally pulled apart (distraction), such as in a head-on car crash in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt. - often associated with MVA

Flexion/Distraction (chance) fracture

This is an unstable injury involving bone and/or soft tissue in which one vertebra may move off the adjacent one (displaced).

Fracture-Dislocation

sudden, insidious pain that is made worse by coughing, straining or laughing?

HNP

What are the two lumbar disc syndromes?

HNP and Spondylosis

(_) tightness and a (_) gait are typically seen in patients with Spondylolisthesis?

Hamstring Waddling

Pure Brown-Séquard syndrome is associated with the following: 1. Interruption of the (_)l tracts 2. (_) paralysis below the level of the lesion 3. Babinski sign (_) to lesion 4. Abnormal reflexes and Babinski sign may not be present in acute injury.

Lateral Corticospinal Ipsilateral spastic ipsilateral

What is most effective for AS pain?

Indomethicin

What are the 3 phases of MM treatment + supportive therapy? 1. (_) phase- The efforts and treatment are focused on reducing the amount of the disease 2. (_) Phase- There is no current standard and no therapy is considered to be the accepted approach, however, biologic therapy, immune therapy or bone marrow transplantation could have a role. 3. (_) Phase- is reserved for the treatment of patients in whom all know effective therapy with acceptable toxicity has failed.

Induction Maintenance Salvage

C/L loss of pin and temp. sensation that occurs 2-3 segments below lesion?

Interruption of lateral spinothalamic tracts associated with BS Syndrome

What are the four types of spondylolisthesis?

Isthmic Congenital Degenerative Pathologic

This type of spondylolisthesis is commonly caused by fatigue or stress fracture of the pars interarticularis. It is more common in (_)

Isthmic men

In the lumbar area, > 80% of disk ruptures affect (_) nerve roots

L-5 or S-1

A stretching injury to the ligaments, tendons, and/or muscles of the low back after exertional twisting/lifting /Pulling forces. One of the most common causes of lower back pain?

Lumbar Strain/Weightlifter's Back

This is classified as "acute" if it has been present for days to weeks. If the strain lasts longer than 3 months, it is referred to as "chronic."

Lumbar Strain/Weightlifter's Back

i. an exaggerated lumbar lordosis ii. a forward-tipped pelvis iii. inflexible and weak paraspinal muscles iv. tight inflexible hamstrings v. weak abdominal muscles vi. an intrinsically weak lumbar structure The above are RF for what condition?

Lumbar Strain/Weightlifter's Back

iii. Position of comfort will tend to be the fetal position

Lumbar Strain/Weightlifter's Back

localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues.

Lumbar Strain/Weightlifter's Back

Decreased energy level flu symptoms back pain bone pain

MM

The diagnosis is established by: 1. the demonstration of the abnormal protein in the serum and/or the urine - Bence Jones Protein 2. the presence of abnormal plasma cells (myeloma cells) in the bone marrow

MM

What are the two causes of primary spinal tumors?

MM Plasmacytoma

patients who have been involved in the agricultural, chemical, or radiology industries are at higher risk of developing which disease ?

MM or Plasma Cell Dyscrasia

This type of imaging is best at diagnosis as well as determining the degree of nerve compression

MRI

(_) is the most sensitive study available. It can usually discriminate between an infection and tumor versus a degenerative process. The most notable exception to this is the (_) fracture that cannot easily be distinguished from a neoplastic process during the first six to eight weeks

MRI acute compression

Neoplasms involving the spine typically are metastatic lesions from distant primary tumors. Lung, prostate, breast, renal, and thyroid tumors can all spread to the spine

Multiple Myeloma

What imaging can we get for HNP that will define the size and location of herniation?

Myelogram

Can you diagnose an HNP by XR alone? What do we need?

NO MRI or CT

What GU disorders can cause lower back pain?

Nepholithiasis Acute Bacterial Prostatitis

colicky, nauseous costovertebral pain often referred to the lower abdomen and groin with positive occult blood

Nephrolithiasis

A loss of calcium and phosphate salts causing the bones to become porous, brittle, and easily broken

Osteoperosis

The first signal is often a sharp pain in the lower back while lifting or bending, which usually indicates the collapse of a vertebra.

Osteoperosis

What abdominal disorders can cause lower back pain?

Pancreatitis Posterior Duodenal Ulcers Renal issues- CVA tenderness AAA rupture, erosion of adjacent structures or dissection

This type of spondylolisthesis results of problems such as severe osteoporosis or tumors of the bone (usually metastatic).

Pathologic

What is the treatment for Lumbar Strain/Weightlifter's Back?

RICE Exercises include 1. strengthen core 2. stretch back muscles 3. remain active

"Can't Pee, Can't See, Can't Climb a Tree"

Reiter's Syndrome (arthritis) associated Ankylosing Spondylitis

The hallmark of AS is involvement of the (_) joint

SI

Two types of pain associated with spondylolisthesis?

Sciatic- radiation to butt. back, thigh, and calf Claudication-improves with rest

Lab Findings with Ankylosing Spondylitis: 1. Elevated (_) 2. (_) 3. Positive (_) assay

Sed Rate Anemia HLA B27

Patients with a true positive straight leg raising sign complain of excruciating sciatica-like pain in the elevated leg at 30 to 40 degrees of elevation. This sign is usually absent in patients with lumbar stenosis. T or F?

True

Moderate to severe back pain made worse by movement. In some cases when the spinal cord is also involved, numbness, tingling, weakness or bowel/bladder dysfunction.

Spinal Fracture

Decompressive Lumbar Laminectomy is a treatment option for what disorder? Although extensive, most patients including the elderly are medically capable of tolerating this procedure.

Spinal Stenosis

Pain is relieved by flexing back or by sitting?

Spinal Stenosis

Signs may include patches of hair, nevi, hemangiomas or dimples on the lower back in the midline. Rare in the adult population- just because of abnormal curvature

Spinal Stenosis

Walking uphill is less painful than walking downhill?

Spinal Stenosis

narrowing of the spinal canal? This may be related to (_)

Spinal Stenosis OA

Straight Leg Raising Test or Lasegue's Sign?

Spinal Stenosis- performed by raising the straight lower extremity and dorsiflexing the foot,

Symptoms, when they occur, often begin with the growth spurt

Spondylolisthesis

What is the most common cause of back pain in adolescents ?

Spondylolisthesis

a forward slip of one vertebra relative to another

Spondylolisthesis

"Scott Dog" seen on posterior oblique XR views?

Spondylolisthesis.

What does the Meyerding's Classification System have to do with?

Spondylolisthesis. Measures percentage of vertebral slip forward over the body beneath.

The use of growth factors, immunoglobulins, and antibiotics play a crucial role in the management of the disease.

Supportive Therapy - part of MM treatment

What is the only effective treatment of CES?

Surgical Decompression

This type of fracture results from rotation or extreme sideways (lateral) bending and usually does not affect stability. It is often due to severe impact

Transverse Process Fracture

Spondylolisthesis usually occurs towards the (_) of the spine

base of the spine. (L4-L5 or L5-S1)

Brown Sequard Syndrome requires evaluation for other injuries: i. (_) dysfunction in some cases. ii. (_) tube insertion and subsequent low-wall suction may help to prevent aspiration. Additionally, these patients are prone to developing ileus in the acute stage. iii. (_)spine immobilization, or lower dorsal vertebra immobilization, is required with trauma or suspicion of an unstable spine.

bladder NG Cervical

A simple (_) fracture requires a hyperextension brace for sitting and standing activities for 6-12 weeks --If you cannot trust patient, then they will have to have surgery

compression fracture

spinal infections usually begin in the (_) and spread tot he (_) or (_)

disc space vertebral body epidural space

Surgery for metastatic disease is reserved for those cases where there is: 1. Spinal (_) 2. (_) compromise 3. At least a three to six month life expectancy.

instability neurologic

I/L loss of tactile discrimination, vibratory, and position sensation below lesion

interruption of posterior white column associated with Brown Sequard Syndrome

With spinal fractures, we may see a (_) posture that cannot be corrected as well as (_) contractures due to iliopsoas shortening

kyphotic hip flexor