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12 Cards in this Set
- Front
- Back
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Straight leg raise (SLR) versus femoral stretch tests identify HNPs at which levels?
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Femoral stretch: L2-3 (hip flexors), L3-4 (quads, TA [tibalis anterior])
SLR: L4-5, L5-S1 |
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What is the most specific clinical exam for HNP? Especially true in what situation?
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Contralateral SLR
Especially for axillary herniation |
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What body position results in the lowest intradiskal pressure? Highest?
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Lowest: supine
Highest: sitting, flexed with weights in hands |
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Lumbar disk herniations occur most commonly at which location (on axial imaging)?
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Paracentral
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How can referred pain be differentiated from lumbar radicular pain?
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Referred pain usually above knee
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How does the orientation of the upper lumbar nerve roots differ from that of the lower roots?
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Upper roots have more direct takeoff (less room to manipulate)
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What is the natural history motor recovery, pain, resolution, and sensory deficits in HNP?
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Motor generally recovers
Pain generally resolves 30% of sensory deficits persist |
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Pediatric herniations are not generally disk material; they consist of what?
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Avulsion of ring apophysis of vertebral body
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Is there a proven benefit to epidural steroids for HNP?
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No
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What patients are especially likely to have recurrent postoperative pain? What percentage of patients?
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Large annular defect
Up to 15 to 20% have long-term backache |
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What is the reported re-herniation rate? What is the imaging study of choice to identify re-herniation?
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10%
MRI with gadolinium |
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What are the three componenets of the treatment algorithm for postoperative infection after lumbar diskectomy? When should surgery be performed?
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MRI with gadolinium
Percutaneous biopsy and culture IV antibiotics Surgery for failure of antibiotic treatment |
