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Assessment of Dorso-Lumbar Spine: Low Back Pain
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Assessment of Dorso-Lumbar Spine: Low Back Pain

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Questions and Answers

What is the definition of low back pain?

  • Pain and discomfort localized below the inferior gluteals folds and above the costal margins
  • Pain and discomfort localized below the costal margins and above the inferior gluteals folds (correct)
  • Pain and discomfort localized in the thoracic region
  • Pain and discomfort localized above the costal margins and below the lumbar spine
  • What is radicular syndrome?

  • A type of osteoporosis that affects the spine
  • A type of infection that affects the spine
  • A type of cancer that affects the spine
  • Pain that arises from compression or irritation of the nerve roots (correct)
  • What is a red flag for low back pain?

  • History of cancer (correct)
  • Age over 60
  • Previous back injury
  • Family history of low back pain
  • What is the estimated sensitivity of the sacroiliac joint pain tests?

    <p>93.8%</p> Signup and view all the answers

    What is the percentage of patients with low back pain who have discogenic pain?

    <p>26%-42%</p> Signup and view all the answers

    What is centralization of symptoms?

    <p>Progressive resolution, reduction or retreat of pain toward midline</p> Signup and view all the answers

    What is the name of the test that suggests sacroiliac joint pain when 3 or more of 6 positive tests are present?

    <p>None of the above</p> Signup and view all the answers

    What is the definition of neuropathic pain?

    <p>Pain arising from injury or disease directly affecting the nerve roots</p> Signup and view all the answers

    Which of the following is a characteristic of mechanical low back pain?

    <p>Pain not attributable to a objectively recognisable, known specific pathology</p> Signup and view all the answers

    What is a key feature of discogenic pain?

    <p>Annular disruption and inflammatory response</p> Signup and view all the answers

    Which of the following is NOT a red flag for low back pain?

    <p>Muscle sprain</p> Signup and view all the answers

    What is the significance of centralization of symptoms in low back pain?

    <p>Progressive resolution, reduction or retreat of pain toward midline</p> Signup and view all the answers

    Which of the following tests is used to suggest sacroiliac joint pain?

    <p>Gaenslen’s left and right, thigh thrust, sacral thrust, distraction and iliac compression</p> Signup and view all the answers

    What is the estimated specificity of the sacroiliac joint pain tests?

    <p>78.1%</p> Signup and view all the answers

    Which of the following is a characteristic of radicular syndrome?

    <p>Pain arising from injury or disease directly affecting the nerve roots</p> Signup and view all the answers

    What is the significance of nerve roots disorders in low back pain?

    <p>Pain worsened by flexion of head and relieved by extension</p> Signup and view all the answers

    What is a characteristic of myofascial pain?

    <p>Presence of trigger points</p> Signup and view all the answers

    What is the result of clinical instability in the spine?

    <p>Clinical signs and symptoms created by dysfunction of one or more of the stabilizing subsystems</p> Signup and view all the answers

    Which of the following is associated with functional instability?

    <p>Altered intervertebral discs and ligament out support of the spine</p> Signup and view all the answers

    What is the purpose of the positive passive lumbar extension test?

    <p>To assess lumbopelvic instability</p> Signup and view all the answers

    What is the result of centralization in low back pain?

    <p>Abolishment of pain or migration of symptoms to a location more proximal to midline of the lumbar spine</p> Signup and view all the answers

    What is a contributing factor to other sources of low back pain or a primary cause by itself?

    <p>Myofascial pain</p> Signup and view all the answers

    What is the definition of clinical instability?

    <p>The clinical signs and symptoms created by dysfunction of or more of the stabilising subsystems of the spine</p> Signup and view all the answers

    What type of pain is characterized by the presence of trigger points?

    <p>Myofascial pain</p> Signup and view all the answers

    What is the purpose of the positive passive lumbar extension test?

    <p>To assess for lumbopelvic instability</p> Signup and view all the answers

    What is associated with an increase in the size of the neutral zone?

    <p>Lumbopelvic instability</p> Signup and view all the answers

    Study Notes

    Low Back Pain

    • Pain and discomfort localized below the costal margins and above the inferior gluteal folds, with or without referred leg pain.

    Global Diagnostic Triage (International Guidelines)

    • Serious pathology (red flags) prioritized over radicular syndrome and non-specific/mechanical low back pain.

    Non-Specific/Mechanical Low Back Pain

    • Not attributable to a objectively recognizable, known specific pathology (e.g., infection, tumor, osteoporosis).
    • Different underlying causes, including:
      • Myofascial
      • Discogenic
      • Sacroiliac

    Red Flags

    Spinal Fractures

    • Major trauma
    • Osteoporotic fracture
    • Osteoporosis

    Cancer

    • History of cancer
    • Multiple cancer risk factors
    • Strong clinical suspicion

    Infection

    • Immunocompromised status
    • Urinary tract infection
    • Intravenous drug use

    Neurophatic Pain

    • Pain arising from injury or disease directly affecting the nerve roots that innervate the spine and lower limbs.
    • No gold-standard approach for diagnosis.
    • Distribution of pain and associated sensory or motor signs, including:
      • Sensory loss
      • Hyperalgesia, allodynia
      • Weakness
      • Numbness, tingling, electricity type pain

    Nerve Roots Disorders

    • Dorsal flexion worsens pain, plantar flexion makes it better.
    • Flexion of head worsens pain, extension relieves it.

    Mechanical Low Back Pain

    • Sacroiliac joint pain suggested when 3 or more of 6 positive tests (Gaenslen's left and right, thigh thrust, sacral thrust, distraction, and iliac compression).
    • Estimated sensitivity of 93.8%, specificity of 78.1%.
    • Discogenic pain:
      • 26%-42% of patients with low back pain
      • Annular disruption and inflammatory response
      • Centralization of symptoms: progressive resolution, reduction, or retreat of pain toward midline

    Low Back Pain

    • Pain and discomfort localized below the costal margins and above the inferior gluteal folds, with or without referred leg pain.

    Global Diagnostic Triage (International Guidelines)

    • Serious pathology (red flags) prioritized over radicular syndrome and non-specific/mechanical low back pain.

    Non-Specific/Mechanical Low Back Pain

    • Not attributable to a objectively recognizable, known specific pathology (e.g., infection, tumor, osteoporosis).
    • Different underlying causes, including:
      • Myofascial
      • Discogenic
      • Sacroiliac

    Red Flags

    Spinal Fractures

    • Major trauma
    • Osteoporotic fracture
    • Osteoporosis

    Cancer

    • History of cancer
    • Multiple cancer risk factors
    • Strong clinical suspicion

    Infection

    • Immunocompromised status
    • Urinary tract infection
    • Intravenous drug use

    Neurophatic Pain

    • Pain arising from injury or disease directly affecting the nerve roots that innervate the spine and lower limbs.
    • No gold-standard approach for diagnosis.
    • Distribution of pain and associated sensory or motor signs, including:
      • Sensory loss
      • Hyperalgesia, allodynia
      • Weakness
      • Numbness, tingling, electricity type pain

    Nerve Roots Disorders

    • Dorsal flexion worsens pain, plantar flexion makes it better.
    • Flexion of head worsens pain, extension relieves it.

    Mechanical Low Back Pain

    • Sacroiliac joint pain suggested when 3 or more of 6 positive tests (Gaenslen's left and right, thigh thrust, sacral thrust, distraction, and iliac compression).
    • Estimated sensitivity of 93.8%, specificity of 78.1%.
    • Discogenic pain:
      • 26%-42% of patients with low back pain
      • Annular disruption and inflammatory response
      • Centralization of symptoms: progressive resolution, reduction, or retreat of pain toward midline

    Centralization

    • Defined as the phenomenon where a movement or position leads to the abolition of pain or the migration of symptoms from a more distal or lateral area in the buttocks and lower extremity to a more proximal location near the midline of the lumbar spine.
    • Indicates a good prognosis.

    Myofascial Pain

    • Can be a contributing factor to other sources of low back pain (LBP) or a primary cause in itself.
    • No gold standard for evaluating myofascial pain.
    • Characterized by the presence of trigger points.

    Lumbopelvic Instability

    • Results from dysfunction in one or more of the stabilizing subsystems, leading to an increase in the size of the neutral zone.
    • Comprises three subsystems:
      • Passive subsystem
      • Active subsystem
    • Clinical instability is defined as the clinical signs and symptoms created by dysfunction of one or more of the stabilizing subsystems of the spine.

    Functional Instability

    • Associated with altered intervertebral discs and ligamentous support of the spine.
    • Can be identified using the positive passive lumbar extension test (also known as the Prone instability test).

    Centralization

    • Defined as the phenomenon where a movement or position leads to the abolition of pain or the migration of symptoms from a more distal or lateral area in the buttocks and lower extremity to a more proximal location near the midline of the lumbar spine.
    • Indicates a good prognosis.

    Myofascial Pain

    • Can be a contributing factor to other sources of low back pain (LBP) or a primary cause in itself.
    • No gold standard for evaluating myofascial pain.
    • Characterized by the presence of trigger points.

    Lumbopelvic Instability

    • Results from dysfunction in one or more of the stabilizing subsystems, leading to an increase in the size of the neutral zone.
    • Comprises three subsystems:
      • Passive subsystem
      • Active subsystem
    • Clinical instability is defined as the clinical signs and symptoms created by dysfunction of one or more of the stabilizing subsystems of the spine.

    Functional Instability

    • Associated with altered intervertebral discs and ligamentous support of the spine.
    • Can be identified using the positive passive lumbar extension test (also known as the Prone instability test).

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    Description

    This quiz assesses knowledge of the dorso-lumbar spine and low back pain, including global diagnostic triage, serious pathology, and mechanical low back pain.

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