Rheum: Low Back Pain

Front 1

disc degeneration/herniation most common at what level?

Back 1

L4/5 > L5/S1

Front 2

prevalence of low back pain?

Back 2

affects 85% of population during lifetime
26% occurrence per year

Front 3

causes of low back pain?

Back 3

>90% caused by degenerative changes, traumatic fractures, soft tissue injuries

rest are infection, osteopenia, tumor, etc

Front 4

low back pain Tx rationale?

Back 4

look for red flags
do imaging for - fracture, infection, tumor, nerve injury, age
if no red flag - conservative Tx

Front 5

when to do imaging?

Back 5

red flag!
if no red flag, Tx, and then if persists, image

however, 29% aSx pts over 40 have radiographic nerve root compression

Front 6

how good are following modalities?
plain x ray
supine x ray
oblique x ray
standing x ray
flexion/extension xray

Back 6

plain x ray - low yield
supine x ray - not good
oblique x ray - low yield, "scotty dog sign"
standing x ray - help w/ spondylolisthesis
flexion/extension xray - help w/ spondylolisthesis

Front 7

conservative tx in low back pain?

Back 7

NSAIDs
muscle relaxants
narcotic analgesics
oral steroids
back exercises

Front 8

low back Dx treatable by all modalities?

Back 8

mechanical low back pain
radiculopathy
spinal stenosis
spondylolisthesis

Front 9

low back Dx where surgery is exclusive Tx?

Back 9

cauda equina syndrome (this is urgent!)

Front 10

central disc herniation of L45 level causes what radiculopathy?

Back 10

L5

Front 11

far lateral disc herniation of L45 causes what radiculopathy?

Back 11

L4

Front 12

Sx of cauda equina syndrome?

Back 12

severe bilateral leg pain and distal weakness. urinary retention or incontinence.
urgent workup necessary!

Front 13

pathophysiology of cauda equina syndrome?

Back 13

large disc herniation

Front 14

neurological findings of cauda equina syndrome?

Back 14

true motor weakness. increased post void residual

Front 15

Tx of cauda equina syndrome?

Back 15

urgent surgery

Front 16

Sx of lumbar stenosis?

Back 16

tiredness of legs w/ standing or activity relieved quickly by leaning foward or sitting down

Front 17

how to differentiate neurogenic claudication vs vascular claudication?

Back 17

vascular - distal leg more, long rest
neurogenic - proximal leg more, shorter resting time

Front 18

what muscle movement relieves lumbar stenosis?

Back 18

flexion
"shopping cart" test

Front 19

Sx of spondylolisthesis?

Back 19

mixture of Sx of radiculopathy, stenosis, and mechanical back pain

Front 20

define following terms of spondylolisthesis
spondylosys
spondylolysis
spondylolisthesis
spondyloptosis
pars interarticularis

Back 20

spondylosis - arthritic degenerative changes of spine
spondylolysis - defect in pars interarticularis
spondylolisthesis - pathological displacement of a vertebra in relationship to the vertebra below. ** there are different grades (I-IV) to describe how far the vertebra has slipped
spondyloptosis - severe spondylolisthesis
pars interarticularis - means "the part between the facets"

Front 21

imaging appreance of spondylolysis?

Back 21

"scotty dog"
best seen on oblique plain films

Front 22

spondylolisthesis grading criteria?

Back 22

degree of slipping
grade
I - 0-25 %
II - 25-50%
III - 50-75%
IV - 75 - 100%
more than 100% - spondyloptosis