Ortho - Back Pain

Front 1

Most common sites of lumbar disk herniation

Back 1

L4-L5

L5-S1

Front 2

Most common pattern of lumbar disk herniation

Back 2

Posterolateral disk herniation causing asymmetrical nerve root symptoms

Front 3

Spondylolithesis

Back 3

Slippage of one vertebral body relative to another

Front 4

Spondylolysis

Back 4

Bilateral pars interarticularis defect
Can lead to vertebral slippage

Front 5

Spondylytis

Back 5

Osteomyelitis of the axial skeleton

Front 6

Malignancies most likely for bony metastisis

Back 6

Breast

Lung

Prostate

Thyroid

Kidney

Lymphoma

Front 7

Roses recommended back pain Questions

Back 7

Front 8

Red flag back pain diagnosis

Back 8

Cauda equina

Spinal fractures

Spinal malignancy

Spinal infection

Front 9

L3 Radiculopathy

Stress test

Sensation

Reflex

Strength

Back 9

Stress test: Reverse Straight leg raise

Sensation: Medial thigh

Reflex: -

Strength: Hip flexion

Front 10

L4 Radiculopathy

Stress test
Sensation
Reflex
Strength

Back 10

Stress test: Reverse Straight leg raise
Sensation: Medial foot
Reflex: Patellar
Strength: Knee extension

Front 11

L5 Radiculopathy

Stress test

Sensation

Reflex

Strength

Back 11

Stress test: Straight leg raise

Sensation: Between 1st and 2nd web space

Reflex: -

Strength: Big toe/ankle dorsiflexion

Front 12

S1 Radiculopathy

Stress test

Sensation

Reflex

Strength

Back 12

Stress test: Straight leg raise

Sensation: Lateral foot

Reflex: Achilles

Strength: Ankle plantar flexion

Front 13

Spinal stenosis/pesudoclaudication

Back 13

Chronic low back pain and leg radiculopathy

Occurs with walking (especially downhill) and relieved by rest and sitting forward after about 15 minutes

Front 14

Anklyosing spondylitis

Back 14

Consider in younger patients with back pain, morning stiffness that improves with exercise

Front 15

At risk of cauda equina syndrome

Back 15

- bilateral radicular pain

- bilateral sensory disturbance

- bilateral motor weakness

- bilateral loss of reflexes

Front 16

Incomplete cauda equina syndrome

Back 16

- subjective and/or objective evidence
of neurological losses such as impaired bladder sensation

- impaired urethral sensation, impaired rectal sensation

- objective genital/peri-anal (S3–S5) sensory
disturbance and/or reduction in anal tone

- must still have normal bladder function

Front 17

Complete cauda equina syndrome

Back 17

bladder becomes paralysed and this leads to painless retention of urine with overflow incontinence

Front 18

Most consistent physical exam finding in cauda equina syndrom

Back 18

Urinary retention (PVR >100 ml)

Front 19

Patients at risk for spinal infections

Back 19

IVDU
Alcoholics

Immunocompromised

Elderly

Hx of blunt trauma to back

Indwelling Foley catheter

Recent dental GI/GU/Spinal instrumentation

Front 20

Most common organism for spinal infection

Back 20

S Aureus

GNB, TB, and pseudomonas and IVDU also possibilities

Front 21

Risk factors for malignancy back pain

Back 21

Older than 50

Worse at night

Known history of cancer

elevated ESR

Hematocrit <30

Clincal gestalt

Front 22

Grading spondyolithesis

Back 22

I: 0-25%

II: 25-50%

III: 50-75%

IV: >75%

Front 23

Indications for plain films in patients with low back paon

Back 23

• Age younger than 18 or older than 50 years

• Any history of malignancy or unexplained weight loss

• Any history of fever, immunocompromised state, or injection drug use

• Recent trauma, other than simple lifting

• Progressive neurologic deficits or other findings consistent with cauda equina syndrome

• Prolonged duration of symptoms beyond 4 to 6 weeks

Front 24

Plain film findings of spondylitis

Back 24

erosion of contiguous vertebral endplates and a shortened disk space height, best seen on the lateral view

Front 25

Bladder volume estimation on U/S

Back 25

Length X Width X Height X 0.52

Front 26

Rosens DDx Low Back Pain

Back 26

Front 27

Spinal stenosis - potential surgical indications

Back 27

- progressive neurologic deficit

- progressive reduction in ability to walk secondary to pseudoclaudication

- evidence of cauda equina syndrome

- intractable pain

Front 28

Approach to w/u query vertebral malignancy

Back 28

Front 29

DDx of thoracic back pain

Back 29

• Uncomplicated musculoskeletal back pain
• Spinal cord and nerve root pathology (e.g., disk herniation, tumor, hematoma)
• Vertebral column disease (e.g., primary or metastatic malignancy, osteomyelitis)
• Disk infection
• Primary neurologic disease
• Degenerative and autoimmune arthropathies
• Herpes zoster
• Vascular disease (e.g., thoracic aortic dissection, acute coronary syndrome, pulmonary embolism)
• Thoracic cavity pathology (e.g., pleuritis, pericarditis, pneumonia, esophageal pathology)
• Intraperitoneal and retroperitoneal abdominal pathology (e.g., peptic ulcer disease, pancreatitis, hepatobiliary disease)

Front 30

Hall Back pain syndromes

Back 30

1: Back pain dominant, flexion exacerbated
2: Back dominant, no flexion component, extension worsens
3: Leg dominant, worse with flexion "sciatica"
4: Leg dominant, worse with extension/walking better with flexion "claudication"