Lumbar Spine Quiz
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Questions and Answers

What is the purpose of the straight leg test in the lumbar spine examination?

  • To test for lumbar sprains and strains
  • To determine if the patient has a previous history of cancer
  • To elicit radicular pain (correct)
  • To test for neoplastic pain

    • Which region is often described as the location of simple sprains and strains in the lumbar spine?

  • Upper back
  • Paravertebral or super gluteal region (correct)
  • Lower abdomen
  • Neck

    • What is a positive sign in the FABER test, also known as Patrick's Test?

  • Pain in the groin
  • Pain that radiates down both legs
  • Pain in the lower back
  • Pain in the SI joint only (correct)

    • Which type of pain in the lumbar spine tends to be severe, constant, and persists at night?

    <p>Neoplastic or infectious pain</p> Signup and view all the answers

    What are NOT red flag symptoms of lumbar pain that may indicate serious underlying conditions?

    <p>Age greater than 30 years, early morning pain, and rash</p> Signup and view all the answers

    What is a positive sign for a herniated nucleus pulposus in the cross straight leg test?

    <p>Radicular pain on the ipsilateral side</p> Signup and view all the answers

    In the lumbar spine, the nerve root exits at the level BELOW the named vertebrae

    <p>True</p> Signup and view all the answers

    Which nerve root is responsible for ankle dorsiflexion?

    <p>L4</p> Signup and view all the answers

    Which nerve root is the sensory nerve for the medial ankle/foot?

    <p>L4</p> Signup and view all the answers

    What is controlled by nerve root L3?

    <p>Knee extension</p> Signup and view all the answers

    Which nerve root DOESNT control the patellar deep tendon reflex?

    <p>S1</p> Signup and view all the answers

    What does the Babinski reflex indicate?

    <p>Spinal cord injury</p> Signup and view all the answers

    The lumbar and sacral nerve innervative the lower extremities and bowel/bladder function

    <p>True</p> Signup and view all the answers

    Ankle clonus after sudden ankle plantarflexion is indicative of stroke or multiple scleroma

    <p>False</p> Signup and view all the answers

    Waddell sign are non-organic physical signs in lowr back pain that are out of proportion from exam findings

    <p>True</p> Signup and view all the answers

    What is the first line pharmaceutical therapy for acute low back pain?

    <p>NSAIDs</p> Signup and view all the answers

    How long is chronic low back pain defined as lasting?

    <p>More than 3 months</p> Signup and view all the answers

    What type of symptoms should prompt the use of oral steroids instead of NSAIDs in acute low back pain?

    <p>Radicular symptoms</p> Signup and view all the answers

    In chronic low back pain, what type of activity usually aggravates the pain?

    <p>Physical activity or movement</p> Signup and view all the answers

    What is the most predominant symptom experienced by patients with chronic low back pain?

    <p>Pain into one or both buttocks</p> Signup and view all the answers

    If a patient presents with chronic low back pain, it is important to rule out causes such as cancer, stenosis, deformities, infections and osteoporosis by referring the patient to orthopedics

    <p>True</p> Signup and view all the answers

    Acute low back pain tends to resolve on its own in 4-6 weeks

    <p>True</p> Signup and view all the answers

    Chronic low back pain is the most common cause of lost work time and disability in patients less than 45 years of age

    <p>False</p> Signup and view all the answers

    What is a key finding in patients with herniated nucleus pulposus?

    <p>Worsened pain with spinal flexion</p> Signup and view all the answers

    Which diagnostic tool is considered the best for evaluating herniated nucleus pulposus?

    <p>MRI</p> Signup and view all the answers

    What is a common sign of cauda equina syndrome?

    <p>Saddle paresthesia</p> Signup and view all the answers

    What is the initial recommended management for a patient with suspected cauda equina syndrome?

    <p>Immediate emergency department visit for emergent MRI</p> Signup and view all the answers

    While cauda equina syndrome is not common, it is a medical emergency and must be ruled out if suspected

    <p>True</p> Signup and view all the answers

    If the MRI confirms cauda equina syndrome, the treatment is emergent surgical decompression

    <p>True</p> Signup and view all the answers

    A herniated nucleus pulposus can be treated conservatively with NSAIDs, muscle relaxers and physical therapy

    <p>True</p> Signup and view all the answers

    What is the characteristic pain location reported by patients with sacroiliitis?

    <p>Posterior hip pain</p> Signup and view all the answers

    What term is used to describe the pain over the SI joints in a patient with sacroiliitis?

    <p>Fortin point pain</p> Signup and view all the answers

    Which special test is likely to be positive in a patient with sacroiliitis?

    <p>FABER test</p> Signup and view all the answers

    What is a common finding on x-ray for a patient with degenerative disc disease?

    <p>Joint narrowing, sclerosis, osteophytes</p> Signup and view all the answers

    Which patient demographic is more commonly affected by sacroiliitis?

    <p>Females and obese individuals</p> Signup and view all the answers

    A patient with degenerative disk disease often report stiffness in the morning that is brief as the main complaint

    <p>True</p> Signup and view all the answers

    Which condition is most common in younger athletes such as dancers, gymnasts, and lifters?

    <p>Spondylolysis</p> Signup and view all the answers

    Which type of spondylolisthesis is more common in females above the age of 40 years?

    <p>Degenerative spondylolisthesis</p> Signup and view all the answers

    What clinical finding on an oblique x-ray is characteristic of spondylolysis?

    <p>Scotty dog collar</p> Signup and view all the answers

    Which region will a lateral film x-ray show the slipped vertebrae in spondylolisthesis?

    <p>L5-S1</p> Signup and view all the answers

    What is the main treatment approach for a patient with spondylolysis?

    <p>Physical therapy and modified activity</p> Signup and view all the answers

    What is the most common cause of spondylolysis?

    <p>Repetitive extension of the lower back</p> Signup and view all the answers

    What is the key clinical finding for spondylolisthesis on imaging?

    <p>Slipped vertebrae anteriorly</p> Signup and view all the answers

    What is the major difference between isthmic and degenerative spondylolisthesis?

    <p>Cause</p> Signup and view all the answers

    How is spondylolysis typically managed?

    <p>Physical therapy and modified activity</p> Signup and view all the answers

    Which test is used to diagnose piriformis syndrome?

    <p>Piriformis test</p> Signup and view all the answers

    What is a common symptom reported by patients with lumbar spinal stenosis?

    <p>Improvement of symptoms with spinal flexion and walking</p> Signup and view all the answers

    What imaging modality is preferred for demonstrating lumbar spinal stenosis?

    <p>MRI</p> Signup and view all the answers

    Which activity is likely to worsen symptoms of lumbar spinal stenosis?

    <p>Standing for prolonged periods</p> Signup and view all the answers

    What is the most appropriate initial treatment for piriformis syndrome?

    <p>NSAIDs and rest</p> Signup and view all the answers

    Which physical exam finding may be observed in patients with lumbar spinal stenosis?

    <p>Changes in sensory nerve patterns</p> Signup and view all the answers

    Patients with lumbar spinal stenosis report pain relief with spinal flexion or walking with a more flexed spine, so these patients may present with walking stooped over

    <p>True</p> Signup and view all the answers

    Patients with spondylolisthesis often report buttocks pain that comes with tingling along the back of the leg into the foot due to the sciatic nerve spasms

    <p>False</p> Signup and view all the answers

    Around 10 percent of patients with solid tumors will develop mets to the spine

    <p>False</p> Signup and view all the answers

    Study Notes

    Anatomy of Lumbar Spine

    • Nerve roots exit at the level below the named vertebrae
    • Important to ask about previous cancers in regards to lower back pain

    Lumbar Pain Presentation

    • Simple sprains and strains: often described as lower back pain in the paravertebral or super gluteal region
    • Nerve root pain: presents as sharp, shooting pain, but may not be present in the back due to referred pain
    • Neoplastic or infectious pain: severe, constant pain persisting at night

    Red Flag Symptoms of Lumbar Pain

    • Age greater than 50 years
    • Children
    • Night pain
    • Fever, malaise, weight loss, bladder or bowel dysfunction
    • Progressive deficits
    • Previous history of cancer

    Special Tests of the Lumbar Spine

    • Straight leg test: performed by gradually raising the patient's straight leg while supine to illicit radicular pain
    • Cross straight leg test: performed by raising the contralateral leg, positive sign for a herniated nucleus pulposus would be radicular pain on the ipsilateral side
    • FABER test (Patrick's Test): flexion, abduction, and external rotation of the hips to illicit pain, positive sign is pain in the SI joint only

    Lumbar Spinal Stenosis

    • Progressive degeneration of the vertebral discs and facet joints
    • Leads to narrowing of the spinal canal and compression of nerve roots
    • Patients report neurogenic claudication with radicular symptoms that worsen with standing or spinal extension
    • Patients report pain relief with spinal flexion or walking with a more flexed spine
    • Physical exam findings: changes to sensory nerve patterns and decreased deep tendon reflexes that progress with the disease process
    • MRI is the test of choice to demonstrate lumbar spinal stenosis
    • Managed with physical therapy, core strengthening, NSAIDs

    Piriformis Syndrome

    • Occurs when the piriformis muscle in the buttocks spasms
    • Patients report buttocks pain that comes with tingling along the back of the leg into the foot due to the sciatic nerve spasms
    • Diagnosis made with the piriformis test
    • Treatment: NSAIDs, rest, and stretching

    Nerve Roots in the Lumbar Spine

    • L4: causes ankle dorsiflexion and is the sensory nerve for the medial ankle/foot
    • L3: extends the knee and is the sensory nerve for the mid-thigh region above the knee
    • L2, L3, L4: control the patellar deep tendon reflex
    • S1: controls the achilles deep tendon reflex
    • The Babinski reflex: looks for great toe extension with fanning of the lesser toes, which is a sign of spinal cord injury
    • Ankle clonus: after sudden ankle dorsiflexion, indicative of stroke or multiple sclerosis

    Acute Low Back Pain (ALBP)

    • Most common cause of lost work time and disability in patients less than 45 years of age
    • Tends to resolve on its own in 4-6 weeks
    • First line pharmaceutical therapy: NSAIDs
    • If radicular symptoms present, a short burst of oral steroids should be used instead of NSAIDs

    Chronic Low Back Pain

    • Defined as greater than 3 months
    • Important to rule out causes such as cancer, stenosis, deformities, infections, and osteoporosis by referring to orthopedics
    • Patients often complain of pain that is aggravated by activity but relieved with rest
    • Most predominant symptom: pain into one or both buttocks

    Herniated Nucleus Pulposus

    • Presents as "radiating pain, numbness, and weakness to the unilateral lower extremity"
    • A patient with a herniated nucleus pulposus will have a positive straight leg test
    • Key finding: worsened pain with spinal flexion
    • Best diagnostic tool: MRI
    • Can be treated conservatively with NSAIDs, muscle relaxers, and physical therapy

    Cauda Equina Syndrome

    • Medical emergency that must be ruled out if suspected
    • Signs: loss of bladder and bowel function with saddle paresthesia
    • Patient with suspected cauda equina syndrome must go to the emergency department for emergent MRI
    • If MRI confirms, treatment is emergent surgical decompression

    Sacroiliitis

    • More common in females and obese patients
    • Patient will likely report pain over one or both SI joints with posterior hip pain that may radiate down the leg
    • Pain over the SI joints is referred to as "fortin point" pain
    • Special tests: FABER and Fortin finger test
    • Can be treated with conservative measures

    Degenerative Disc Disease

    • Due to the loss of articular cartilage and growth of new bone around the facet joints
    • Patient often reports stiffness in the morning that is brief as the main complaint
    • X-ray findings: joint narrowing, sclerosis, osteophytes

    Spondylolysis

    • Most common in younger athletes such as dancers, gymnasts, and lifters
    • Pars interarticular stress fracture most commonly due to repetitive extension of the lower back
    • Most cases occur at the L5 vertebrae
    • Key clinical finding: "scotty dog collar" on an oblique x-ray
    • Can be treated with modified activity, physical therapy, and gradual return to practice

    Spondylolisthesis

    • Due to vertebral sliding from repetitive extension
    • Most common to occur in the L5-S1 region
    • Two types: isthmic (more common in younger athletes and children from pars defect) and degenerative (more common in females above the age of 40 years)
    • Lateral film x-ray will show the slipped vertebrae

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    Description

    Test your knowledge on lumbar spine anatomy including nerve root exits, lower back pain, and pain presentation patterns. Explore concepts related to nerve root pain, lower back pain causes, and clinical considerations for patients with lumbar spine issues.

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