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Neurology > Lower Back Pain Lecture Powerpoint > Flashcards

Lower Back Pain Lecture Powerpoint Flashcards

1
Q

Lower back pain is the ___ most common reason to visit healthcare providers, up to __% of people experience it during their lifetime. The same percent of those seen in primary care will have ____ type lower back pain

A
  • 2nd
  • 80%
  • nonspecific
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2
Q

Nonspecific back pain definition

A

Back pain in the absence of an underlying cause that is mostly musculoskeletal pain (mechanical cause) and does not warrant diagnostic testing and improves in a few weeks

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3
Q

The C and L spine should have a ___ curvature while the T should have ___

A

Lordosis, kyphosis

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4
Q

When documenting, don’t need to cite specific muscle but describe location using anatomic clues example

A

Ex) paraspinal tenderness (important to differentiate between on the spinous process and on the muscle

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5
Q

As we age, ligaments of the back can lose elasticity becoming…

A

…hypertrophic which can result in compression of the spinal cord on the thecal sac or a slip of the disks

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6
Q

Sciatic nerve is formed from…

A

…L4 to S3

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7
Q

Herniated disks can heal on their own because…

A

….the nucleus pulposis will dry and shrink over time after being herniated

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8
Q

Classification of back pain based on duration

A

Acute - <4 weeks
Subacute - 4-12 weeks
Chronic - >12 weeks
Recurring - intermittent episodes with pain free periods

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9
Q

3 broad categories of back pain

A

1) nonspecific low back pain
2) serious systemic etiologies (spinal cord compression/cauda equina, metastatic cancer, epidural abscess, vertebral osteomyellitis)
3) less serious specific etiologies (vertebral compression fracture, radiculopathy, spinal stenosis)

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10
Q

Some other common etiologies of back pain (5)

A
  • ankylosing spondylitis
  • osteoarthritis
  • scoliosis
  • psychological
  • pancreatitis/nephrolithiasis/pyelonephritis/herpes zoster
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11
Q

Mechanical risk factors for back pain (5)

A
  • heavy physical work
  • heavy lifting
  • twisting and vibration
  • posture
  • obesity
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12
Q

Serious systemic etiologies for back pain (3)

A
  • spinal cord compression/cauda equina syndrome
  • metastatic cancer
  • spinal epidural abscess or other infection
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13
Q

Suspected musculoskeletal back pain lasting over ___ should raise concern and confirm need to complete diagnostic studies

A

4 weeks

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14
Q

Cauda equina syndrome and symptoms (1 big one and 3 others)

A

Compromised canal of the spinal cord beneath L1 that needs emergent referral to neurosurgery to prevent permanent loss of function

  • Urinary retention***
  • perianal anesthesia
  • decreased anal sphincter (late finding)
  • herniated nucleus pulposis
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15
Q

Radiculopathy

A

Dysfunction of the nerve root causing pain, sensory impairment, weakness, decreased DTR in a nerve root distribution including things such as sciatica

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16
Q

Vertebral compression fracture and 3 risk factors and a key treatment

A
  • Collapse of the vertebral body most often nonemergent concern that self limits
  • older age, osteoporosis, steroid use
  • kyphoplasty
17
Q

Piriformis syndrome

A

Thickened piriformis muscle that puts pressure on sciatic nerve seen often in those that sit a lot on a bike or even some runners that can be a source of sciatica

18
Q

Spinal stenosis

A

Narrowing of spinal canal that results in bony constriction of the cauda equina in patients greater than 65 from neurogenic claudication resulting in pain walking or standing that decreases when sitting or in spinal flexion

19
Q

Ankylosing spondylitis

A

Inflammatory arthritis of spine causing chronic back pain most common in men under 40 characterized by morning stiffness that is improved with exercise and worsened (often awakening) in the night

20
Q

Waddells sign

A

Psychologic distress contributing to back pain symptoms and display associated and inappropriate physical signs (overreaction during physical exam, superficial tenderness, improvement upon distraction, nondermatomal distribution of sensory loss)

21
Q

Differential diagnosis of back pain without radiculopathy (6)

A
  • musculoskeletal pain
  • retroperitoneal neoplasm
  • ankylosing spondylitis
  • depression
  • epidural abscess
  • malingering
22
Q

Differential diagnosis of back pain with radiculopathy (4)

A
  • herniated nucleus pulposis
  • spinal stenosis
  • compression fracture
  • malingering
23
Q

Constitutional red flags of lower back pain (5)

A
  • unintentional weight loss
  • fever/night sweats
  • night pain
  • history of malignancy
  • IV drug use
24
Q

Bowel/bladder red flags of lower back pain (2)

A

-retention
-incontinence
(these are LATE findings!)

25
Q

Patrick’s FABER test and what 2 things does it test?

A

A test of flexion, abduction, and external rotation of the hips and SI joints

26
Q

Straight leg raising

A

A test of keeping the knee straight while lifting leg up, if decreased on one side indicative of nerve root irritation in sciatica

27
Q

Physical exam red flag findings for lower back pain (7)

A
  • saddle anesthesia
  • loss of anal sphincter tone (late finding)
  • major motor weakness
  • elevated temp
  • vertebral tenderness
  • extremely limited range of motion
  • pain not reproducible by exam
28
Q

Musculogiamentous strain and treatment options (5)

A
  • Usually brought on by a precipitating event that causes sensation of giving way of back associated with severe pain, radiation is rare
  • Rest and moderate activity, ice, NSAIDs, muscle relaxants (make drowsy and can’t drive), PT
29
Q

Contraindications to NSAIDs for lower back pain (4)

A
  • peptic ulcer disease
  • bleeding
  • anticoags
  • renal dysfunction
30
Q

NSAID medication options for lower back pain (5)

A
  • ibuprofen
  • naprosyn
  • relafen
  • meloxicam
  • celebrex
31
Q

Opioids and systemic steroids provide no better benefit than ___

A

NSAIDs

32
Q

Lumbar disc herniation classic presentation

A

Radiculopathy, burning pain along distribution of affected nerve root

33
Q

Lumbar disc herniation treatments (3)

A
  • 80% self resolve
  • NSAIDS
  • epidural steroid injections
34
Q

Spinal stenosis is worsened with what motion?

A

Increased spinal extension

35
Q

Pharmacologic treatment options for spinal stenosis (3)

A
  • NSAIDs
  • Acetaminophen if cannot tolerate them
  • tramadol
36
Q

Spondylosis vs spondylolysis vs spondylolisthesis

A
  • Spondylosis is osteoarthritis of the spine causing wear and tear
  • Spondylolysis is a defeect or stress fracture in the pars interarticularis (young athlete) giving scotty dog appearance on oblique film
  • spondylolisthesis is a defect or fracture of bilateral pars resulting in slippage graded 1-5 needed to be stabilized with rods
37
Q

Imaging for lower back pain

A
  • not indicated for mechanical or acute pain less than 4 weeks
  • if red flag (under 18 over 50) or fever
  • plain x ray first
  • MRI test of choice
  • CT for fractures

Neurology (23 decks)

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