Mss-Spine Disorders And Low Back Pain: “Back” To Basics

Front 1

What is the second most common clinic visit cause?

Back 1

lower back pain (LBP)

Front 2

What risk factor is one of the most important in LBP?

Back 2

genetics

Front 3

What ligament accounts for up to 80% of LBP?

Back 3

iliolumbar ligament

Front 4

Gluteus maximus, medius, and minimus all originate where?

Back 4

ilium-medial to lateral

Front 5

Gluteus maximus, medius, and minimus attach where?

Back 5

maximus: gluteal tuberosity
medius: superior posterior greater trochanter
minimus: anterior inferior greater trochanter

Front 6

What are the 3 patterns of back pain:

Back 6

axial-pain in back/buttocks (non-nerve)
radicular-source of pain in back/buttocks; travels (nerve irritation)
pseudoradicular-pain from back that travels to legs (originates from tendons, joints, and ligaments)

Front 7

T or F: leg pain>back pain in radicular pattern

Back 7

true

Front 8

When should people seek medical attention for back pain?

Back 8

leg pain>back pain; balance/bladder/bowel problems; sudden weight loss; after trauma; progressively worsening; and pain>6 weeks

Front 9

When is back pain emergent?

Back 9

1. weakness in legs-spinal cord problems
2. bowel or bladder-conus medullaris syndrome
3. "saddle anesthesia"-cauda equina syndrome
4. acute back pain with tearing sensation-dissecting aortic aneurysm

Front 10

Patients with functional deficits should be sent to what specialist?

Back 10

physiatrist

Front 11

What specialist performs spinal injections under fluoroscopic guidance?

Back 11

interventional pain specialist

Front 12

When would you refer to an interventional pain specialist?

Back 12

localized pain without profound neurologic deficits

Front 13

Patients with systemic pain, joint pain, rash, and abnormal labs should be referred to whom?

Back 13

rheumatologist

Front 14

Neurological abnormalities that can not be localized or identified should be referred to whom?

Back 14

neurologist

Front 15

Profound and/or emergent neurologic deficits should be referred to whom?

Back 15

neurosurgeon

Front 16

What are the most important tools that can be used in diagnosing back pain?

Back 16

history and physical

Front 17

X-ray lumbar views should include what?

Back 17

flexed and extended l-spine

Front 18

MRI is useful in viewing what tissues?

Back 18

bones, discs, joints, nerves, soft tissue

Front 19

CT is useful in viewing what?

Back 19

bony anatomy

Front 20

What imaging is excellent for bone metabolism?

Back 20

nuclear bone scan

Front 21

What imaging is useful in spondylolisthesis?

Back 21

SPECT

Front 22

What is useful in imaging vascular problems?

Back 22

angiogram

Front 23

What treatments for LBP were discussed in this lecture?

Back 23

interventional spine injections; radiofrequency ablation-burns nerves; vertebroplasty or kyphoplasty-cements vertebrae; surgery

Front 24

How can a differential diagnosis be approached?

Back 24

tissue-based approach

Front 25

A nerve root impingement is also called what?

Back 25

radiculopathy

Front 26

Facet arthropathy and spondylolisthesis are possible causes of what?

Back 26

LBP

Front 27

Deep pain and tenderness over ischial tuberosity is indicative of what?

Back 27

ischial bursitis

Front 28

What is narrowing of the spinal canal referred to as? Where can pain be referred?

Back 28

spinal stenosis; legs

Front 29

Difference between spondlyosis, spondylolysis, and spondylolisthesis:

Back 29

1. spondylosis-arthritis in spine
2. spondylolysis-breakdown of vertebral structure
3. spondylolithesis-forward slipping of one vertebra on one below it

Front 30

Discogenic pain:

Back 30

pain cannot be reproduced with surface palpation; provocative discography

Front 31

Discitis:

Back 31

Severe pain out of proportion to physical exam

Front 32

Spondylolisthesis:

Back 32

(“Scottie dog” neck broken) and flexion/extension views

Front 33

Sacroiliac ligament enthesopathy

Back 33

negative sacroiliac provocative maneuvers

Front 34

Sacral or pelvic occult fracture:

Back 34

false positive hip exam

Front 35

Often compensatory from SI ligament injury:

Back 35

Gluteal bursitis/ tendinopathy

Front 36

Hip intraarticular pathology:

Back 36

labral tear; scour test

Front 37

Pain at rest, history of cancer, pain out of proportion to exam:

Back 37

tumor

Front 38

Lumbosacral plexopathy:

Back 38

non-radicular distribution; not consistent with single dermatome or myotome

Front 39

Neuroclaudication seen in:

Back 39

spinal stenosis

Front 40

Cauda equina syndrome: lower motor neuron lesion:

Back 40

saddle anesthesia

Front 41

Conus medullaris syndrome: upper motor neuron lesion:

Back 41

perianal anesthesia; hyperreflexia

Front 42

Tumor diagnostics:

Back 42

nuclear bone scan

Front 43

Hip intraarticular pathology diagnostics:

Back 43

arthrogram of labrum