Management Of Low Back Pain - Week 2 Neuro

Front 1

Broad classification of low back pain into three types

Back 1

mechanical, neuropathic, and secondary to another cause

Front 2

What type of back pain is typically worsened with movement/improved by rest?

Back 2

mechanical

Front 3

What types of movement would aggravate disc disorders?

Back 3

prolonged sitting or forward flexion

Front 4

What type of lower back pain is classically relieved by forward flexion and worsened with extension?

Back 4

spinal stenosis

Front 5

Which type of low back pain is often associated with a traumatic event such as a fall/motor MVA?

Back 5

sacroiliac joint pain

Front 6

History of heavy work predisposes to...

Back 6

degenerative disk disease

Front 7

Low back-pain, right greater than left, localizes to the...

Back 7

lumbosacral region

Front 8

Compression of the spinal cord is called...

Back 8

myelopathy

Front 9

Compression of the nerve root is called...

Back 9

radiculopathy

Front 10

When pain is present in back pain, which part of nerve is more likely to be involved?

Back 10

nerve root

Front 11

Back pain that is worse with Valsalve maneuver suggests...

Back 11

nerve root compression due to disk herniation

Front 12

Positional exacerbation of pain suggests...

Back 12

nonsystemic etiology

Front 13

Focal musculoskeletal strain and spasm are constant? or poisitional?

Back 13

Constant, not usually positional

Front 14

Nerve or nerve-root compression: constant or positional?

Back 14

can be either

Front 15

Nerve or nerve-root compression exacerbated by?

Back 15

twisting of the back, prlonged sitting, forward flexion with legs extended, and Valsalva

Front 16

Intermittent sharp pain radiating from the low back down the leg in a patient with hx. of acute onset of pain while lifting is c/s with?

Back 16

radiculopathy due to disk hernation

Front 17

Pain radiating from the low back down the right lateral leg to the lateral foot suggests which dermatome?

Back 17

S1, likely due to compressive lesion of S1 nerve root

Hint 17

`

Front 18

When symptoms improve with leg flexion, it suggests which nerve involvement?

Back 18

L5, S1

Front 19

Why does lex flexion improve sciatica?

Back 19

leg flexion relaxes sciatic nerve tension

Front 20

What are the 4 different ways that cancer can have neurologic complications?

Back 20

local spread, metastasis, neoplastic meningitis, and paraneoplastic syndrome

Front 21

Postmenopausal- at risk of what vertebral etiology?

Back 21

osteoporosis; predisposes to vertebral compression fracture

Front 22

Spinous process tenderness suggests which possible etiologies?

Back 22

compression fracture, osteomyelitis, neoplasm

Front 23

Decreased sensation of the lateral right foot localizes to what dermatome?

Back 23

S1

Front 24

Ankle reflex involves which nerves?

Back 24

S1, S2

Front 25

Decreased DTR indicates what type of nervous system dysfunction?

Back 25

peripheral nervous system

Front 26

Positive straight leg raise implies?

Back 26

L5 or S1 radiculopathy

Front 27

Absent ankle reflex suggests what type of lesion?

Back 27

S1 or S2

Front 28

Positive straight leg test implies what type of lesion?

Back 28

L5 or S1

Front 29

In radiculopathies, sensory and reflex changes happen before?

Back 29

motor changes

Front 30

Injury to which nerve root affects knee extension?

Back 30

L3

Front 31

Injury to which nerve root affects knee extension and ankle dorsiflexion?

Back 31

L4

Front 32

Injury to which nerve root affects foot eversion and big toe dorsiflexion?

Back 32

L5

Front 33

Injury to which nerve root affects foot inversion, ankle plantar flexion?-

Back 33

S1- *I think that S1 is plantar flexion but that L5 is more inversion

Front 34

90% of radiculopathies occur where?

Back 34

Either L4-L5 or L5-S1

Front 35

Sciatic nerve is composed of nerve fibers from which nerve roots?

Back 35

L4-S3

Front 36

Symptoms of sciatic nerve compression

Back 36

Buttock pain radiating to leg without back pain, sensory symptoms in L5 and S1 dermatomes, weakness in both L5/S1 distribution

Front 37

What is position-related claudication (hurts when standing with legs straight) caused by?

Back 37

neurogenic claudication

Front 38

What are the symptoms of cauda equina syndrome?

Back 38

saddle anesthesia, bilateral leg weakness, bladder, bowel, and sexual dysfunction

Front 39

At what level does the spinal cord end?

Back 39

L1-L2

Front 40

Compression of which nerve roots causes cauda equina syndrome?

Back 40

S3, 4, 5

Front 41

What causes neurogenic claudication?

Back 41

lumbar spinal stenosis

Front 42

Why do you get pain when standing with cauda equina?

Back 42

possibly because of engorgement of the epidural venous plexus

Front 43

Is lateral or central herniation of discs more common?

Back 43

Lateral, which compresses nerve roots

Front 44

What is osteoarthritis of hte spine called?

Back 44

spondylosis

Front 45

Five types of tumor that commonly metastasize to bone

Back 45

breast, lung, thyroid, renal, prostate

Front 46

What shoud you suspect when multiple progressive mononeuropathies occur that are seemingly random and unrelated?

Back 46

chronic meningitis

Front 47

Indications for evaluation of radiculopathy are?

Back 47

Presence of motor symptoms/signs, chronic symptoms refractory to conservation therapy, possibility of serious cause, bowel, bladder, sexual dysfunction

Front 48

Evaluation of back pain is not necessary if what three things are true?

Back 48

Sensory symptoms only, recent onset of symptoms, history consistent with herniated disk

Front 49

If symptoms don't respond to conversative therapy, what tests should you get?

Back 49

MRI of lumbosacral spine, EMG/NCV

Front 50

If cancer is suspected, what test should you get?

Back 50

spinal x-rays (along with MRI, I think)

Front 51

If chronic meningitis is suspected, what test should you get?

Back 51

lumbar puncture

Front 52

What should patient's activity be after acute onset low-back pain?

Back 52

- rest the back using proper low-back positioning and hygiene, for 1-2 days, then slowly resume activities (walk a few mins. each hour)

Front 53

What is the evidence for epidural steroid injections for treatment?

Back 53

mixed results in clinical trials

Front 54

What type of pain are muscle relaxants indicated for?

Back 54

acute muscle spasm, NOT inflammation/nerve-root compression

Front 55

________ is more likely than spinal stenosis to be associated with an abrupt onset and specific inciting event

Back 55

herniated disk

Front 56

Acute is defined of (in terms of back pain)

Back 56

less than four weeks

Front 57

Chronic low back pain persists for more than...

Back 57

three months

Front 58

Sensory loss, clear neurological weakness, diminished/asymmetrical knee and ankle reflexes may indicate involvement of what part of the anatomy?

Back 58

nerve root involvement

Front 59

Rectal exam is indicated in patients with serious or progressive neurological findings to evaluate...

Back 59

possible cauda equina syndrome or conus medullaris dysfunction

Front 60

What is the most sensitive sign for radiculopathy?

Back 60

straight leg raise, though it's not very specific?

Front 61

Why is diagnostic utility of imaging limited?

Back 61

because many pain free adults have degenerative disorders

Front 62

Three cases when you might get imaging in a patient with low back pain

Back 62

1) severe or progressive neurological deficits
2) serious underlying condition is suspected
3) evaluating patients for surgery or epidural steroid injections

Front 63

What imaging modality is the best for evluating disc disorders or neurological syndrome, or ruling out vertebral fractures or metastases?

Back 63

MRI without contrast

Front 64

What plays a greater role than anatomical pathology in predicting future or persistent low back pain?

Back 64

psychological factors (depression, anxiety, coping mechanisms/attitudes, work stress, health, etc.)

Front 65

Concominant psychopathology is better at predicted chronic pain in patients with acute symptoms than it is at predicting...

Back 65

new episodes of low back pain

Front 66

Injection therapy should be reserved for patients with what?

Back 66

-radicular symptoms (steroids)
-chronic pain and injection confirmed disease (radiofrequency denervation for facet/sacroiliac joint pain)

Front 67

What would you use to treat patients with persistent pain with or without radiculopathy?

Back 67

multimodal treatment regimen- regular exercise program, weight loss, psychotherapy, injections, and meds.

Front 68

Strong evidence supports the use of what type of drugs for non-neuropathic low back pain?

Back 68

NSAIDs- treatment effect is small, though

Front 69

Minimal evidence exists that NSAIDs are effective for what?

Back 69

radiculopathy