Spinal Conditions Management Quiz
48 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common symptom of a lumbar disc herniation?

  • Leg pain with back pain
  • Diminished sensation in lower extremities
  • Leg pain without back pain (correct)
  • Severe back pain

In which demographic are Schmorl's nodes most commonly found?

  • Older adults with degenerative conditions
  • Young adults
  • Children after injury (correct)
  • Elderly patients

What is the typical treatment approach for Schmorl's nodes?

  • Medication for inflammation
  • Physical therapy focusing on strength training
  • Conservative care including bracing (correct)
  • Immediate surgical intervention

What imaging technique is often used to diagnose discal pathology?

<p>MRI (B)</p> Signup and view all the answers

Which of the following statements about cervical myelopathy is true?

<p>It is typically seen in individuals over 60 years old. (A)</p> Signup and view all the answers

Which type of degenerative changes is considered noninflammatory?

<p>Disc degeneration (B)</p> Signup and view all the answers

What is a critical consideration in children regarding disc herniations?

<p>They usually occur spontaneously. (A)</p> Signup and view all the answers

What common symptom may accompany severe pain in spinal conditions?

<p>Limitations in range of motion (B)</p> Signup and view all the answers

What is the most significant reason for considering conservative care over surgical intervention for low back pain?

<p>The majority of patients are not candidates for surgery (C)</p> Signup and view all the answers

What does the term 'nonspecific diagnosis' imply in the context of conservative care for low back pain?

<p>There is a lack of clear guidelines for treatment based on the diagnosis (D)</p> Signup and view all the answers

What are the primary concerns that should guide the management of a patient with low back pain?

<p>Patient's symptoms, goals, and beliefs about their condition (A)</p> Signup and view all the answers

Which of the following is NOT considered a neurologic red flag in the evaluation of low back pain?

<p>Constitutional symptoms like weight loss (D)</p> Signup and view all the answers

Which imaging-related issue can lead to inadequate care for low back pain patients?

<p>Normal imaging results may lead to oversight of serious conditions (D)</p> Signup and view all the answers

What should be the immediate action taken if a patient exhibits symptoms of cauda equina syndrome?

<p>Send the patient straight to the emergency room (B)</p> Signup and view all the answers

Which of the following conditions is classified under the differential diagnosis of non-spinal issues related to low back pain?

<p>Piriformis syndrome (C)</p> Signup and view all the answers

What is a common misunderstanding regarding the relationship between imaging results and symptoms in low back pain management?

<p>Imaging results do not always correlate with patient symptoms (C)</p> Signup and view all the answers

What is a primary characteristic of corticosteroids when used for treatment?

<p>They act as membrane stabilizers and interfere with inflammatory mediators. (A)</p> Signup and view all the answers

Which type of fibers is associated with slow pain sensation?

<p>C fibers (D)</p> Signup and view all the answers

In the context of therapeutic injections, which statement is true?

<p>Anesthetic is employed to create a reversible conduction block. (B)</p> Signup and view all the answers

What is the recommended approach to the use of glucocorticoids?

<p>Short-term usage primarily to manage severe pain exacerbations. (A)</p> Signup and view all the answers

Which statement about trigger point injections is correct?

<p>The anesthetic is believed to be the primary method of action. (B)</p> Signup and view all the answers

Which area is most commonly targeted for injections in pain management?

<p>L4-L5-S1 level (C)</p> Signup and view all the answers

What is one of the significant side effects associated with long-term glucocorticoid usage?

<p>Numerous severe side effects and complications. (C)</p> Signup and view all the answers

What type of pain is most likely indicated for facet joint injections?

<p>Axial pain that worsens with standing. (C)</p> Signup and view all the answers

What distinguishes the analgesic effect of NSAIDs from their anti-inflammatory effect?

<p>Analgesic effect occurs at lower doses before affecting inflammation. (C)</p> Signup and view all the answers

Which of the following statements about the mechanism of action of NSAIDs is accurate?

<p>NSAIDs block the cyclooxygenase (COX) enzyme. (B)</p> Signup and view all the answers

For which type of pain is the ideal usage of short-acting opioids most justified?

<p>Severe acute pain relief. (A)</p> Signup and view all the answers

What is a common reason to consider using long-acting opioids like OxyContin?

<p>To address long-term pain when deemed absolutely necessary. (D)</p> Signup and view all the answers

Which of the following describes the primary effect of muscle relaxants used for pain management?

<p>They have a generalized effect due to central nervous system action. (B)</p> Signup and view all the answers

What is a major consideration when prescribing anticonvulsants for chronic neuropathic pain?

<p>Finding the correct dosage can be time-consuming and complex. (D)</p> Signup and view all the answers

In what scenario is the role of antidepressants particularly emphasized in pain management?

<p>When dealing with chronic pain, especially neuropathic pain. (D)</p> Signup and view all the answers

What best describes the role of concurrent medications when considering risk factors for pain management?

<p>They can complicate pain management due to potential interactions. (B)</p> Signup and view all the answers

What is a potential complication of vertebroplasty if bony fragments extend into the canal?

<p>Contraindication (C)</p> Signup and view all the answers

Which conservative management option is NOT typically used for acute vertebral compression fractures?

<p>Surgical stabilization (D)</p> Signup and view all the answers

What is a major goal of vertebroplasty in treating patients with osteoporotic vertebral compression fractures?

<p>Reduce pain and improve stability (D)</p> Signup and view all the answers

What procedure involves the percutaneous infusion of polymethylmetacrylate (PMMA) to provide analgesic effects?

<p>Vertebroplasty (B)</p> Signup and view all the answers

Which option is a consequence of increased pain post-procedure for vertebral compression fractures?

<p>Radicular pain (B)</p> Signup and view all the answers

What is a noted long-term outcome of vertebroplasty after one year?

<p>Maintained improvements in pain and function (C)</p> Signup and view all the answers

Which of the following is NOT a management approach for vertebral compression fractures?

<p>Physical aggression (C)</p> Signup and view all the answers

What is the purpose of using modalities in post-procedure management of vertebral compression fractures?

<p>To enhance patient comfort and recovery (A)</p> Signup and view all the answers

What is primarily a diagnostic procedure for Zygapophysial joint pain?

<p>Medial branch blocks (D)</p> Signup and view all the answers

What population is most at risk for non-traumatic sacral fractures?

<p>Post-menopausal osteoporotic women (C)</p> Signup and view all the answers

Which treatment is indicated for bladder issues resulting from compression fractures?

<p>Urinary retention management (D)</p> Signup and view all the answers

What is a significant consequence of medial branch radiofrequency neurotomy?

<p>Destruction of afferent supply to facet joints (A)</p> Signup and view all the answers

What increases the severity of anterior wedge fractures in the thoracic spine?

<p>Exaggerated kyphosis (D)</p> Signup and view all the answers

What symptoms are commonly associated with sacral fractures?

<p>Pain radiating to the hip or groin (C)</p> Signup and view all the answers

Which of the following statements about osteoporotic fractures is true?

<p>They can be classified as wedge, concave, or crush fractures. (D)</p> Signup and view all the answers

What is a common limitation in activities due to sacral fractures?

<p>Weightbearing activities (B)</p> Signup and view all the answers

Flashcards

Conservative LBP Management

Non-surgical approach for low back pain, trial for almost all surgical candidates.

Nonspecific LBP Diagnosis

When a specific cause of low back pain isn't found.

Low back pain history

Importance of patient's history, symptoms, and concerns to guide management.

Cauda Equina Syndrome

A true surgical emergency, affecting nerves in the lower back.

Signup and view all the flashcards

Red flags (LBP)

Warning signs for serious conditions, requiring immediate evaluation/treatment.

Signup and view all the flashcards

Neurologic Red Flags (LBP)

Symptoms concerning neurological issues, like bowel/bladder dysfunction, progressive weakness, sexual dysfunction.

Signup and view all the flashcards

Imaging Results (LBP)

Imaging doesn't always match symptoms. Normal studies can still indicate the need for care.

Signup and view all the flashcards

Differential Diagnosis (LBP)

Process of distinguishing between possible causes of low back pain, including spinal/non-spinal.

Signup and view all the flashcards

Neuromodulation Effect

Impact on the nervous system's function, not just treating masked depression.

Signup and view all the flashcards

Titration

Gradually adjusting medication dosage to find the optimal balance, based on the patient's response.

Signup and view all the flashcards

Side Effects as Advantages

Using potential side effects of drugs to benefit the patient, like sedation for sleep.

Signup and view all the flashcards

Glucocorticoid Usage

Short-term use of corticosteroid drugs like Prednisone to manage severe pain.

Signup and view all the flashcards

Short-Term Glucocorticoid Usage

Minimal risk associated with brief corticosteroid use, usually 1-2 weeks.

Signup and view all the flashcards

Fluoroscopically Guided Injections

Using X-ray imaging to guide injections precisely

Signup and view all the flashcards

Therapeutic Injections: Adjunct Treatment

Injections used as an addition to other treatment methods, not solely as a cure.

Signup and view all the flashcards

Trigger Point Injections: Needle Effect

Pain relief often attributed to the needle itself, not just the injected anesthetic or steroid.

Signup and view all the flashcards

Schmorl's Nodes

A vertical herniation where the disc protrudes through the endplate into the vertebral body.

Signup and view all the flashcards

Foraminal Disc Herniation

A disc herniation that occurs through the foramen, the opening where nerves exit the spinal canal.

Signup and view all the flashcards

Disc Herniation Location

The location and direction of a disc herniation determines the symptoms experienced.

Signup and view all the flashcards

Spontaneous Epidural Abscess

An infection in the space surrounding the spinal cord, occurring suddenly, usually in children.

Signup and view all the flashcards

Cervical Myelopathy

A condition affecting the spinal cord in the neck, causing symptoms like weakness, numbness, and difficulty walking.

Signup and view all the flashcards

Cervical Degeneration Stages

Cervical degeneration progresses through stages, starting with mild instability and progressing to more severe symptoms.

Signup and view all the flashcards

Cervical Radiculopathy

Pain, weakness, or numbness radiating down the arm, caused by nerve compression in the neck.

Signup and view all the flashcards

Cervical Myelopathy Hallmark Signs?

Long-tract signs, like weakness, numbness, and difficulty walking, are the hallmark of cervical myelopathy.

Signup and view all the flashcards

NSAID Mechanism

NSAIDS work by blocking the COX enzyme. This enzyme is responsible for producing substances that cause pain and inflammation.

Signup and view all the flashcards

Varied NSAID Response

Different people respond differently to specific NSAIDs. Trying multiple NSAIDs might be necessary to find the most effective one.

Signup and view all the flashcards

NSAID Dosing & Half-Life

The dosage and frequency of NSAID use depend on the drug's half-life. Shorter half-life drugs are suitable for episodic pain, while longer half-life drugs are better for chronic pain.

Signup and view all the flashcards

Opioid Role

Opioids are effective for cancer pain and severe acute pain, but their use in chronic non-malignant pain is controversial due to potential dependence or tolerance.

Signup and view all the flashcards

Opioid Efficacy

Improved function and decreased pain are clear signs of the effectiveness of opioid treatment.

Signup and view all the flashcards

Muscle Relaxant Effect

Muscle relaxants like Flexeril or Soma do not directly relax specific muscles but rather have a generalized effect by acting on the central nervous system.

Signup and view all the flashcards

Anticonvulsant Pain Relief

Anticonvulsants like Lyrica (pregabalin) or Neurontin (gabapentin) are often the preferred treatment for chronic neuropathic pain.

Signup and view all the flashcards

Antidepressant for Chronic Pain

Antidepressants are helpful for chronic pain, especially neuropathic pain.

Signup and view all the flashcards

Zygapophyseal Joint Pain Diagnosis

Identifying pain in the facet joints requires ruling out other potential causes. It's a process of elimination.

Signup and view all the flashcards

Medial Branch Blocks: Purpose

Medial branch blocks are primarily used to diagnose facet joint pain. They block the nerves that carry pain signals from the joint to the brain.

Signup and view all the flashcards

Medial Branch Neurotomy: Permanent Relief?

While destroying the nerves with radiofrequency neurotomy can provide pain relief, the nerves regenerate after about 9-12 months.

Signup and view all the flashcards

Sacral Fractures: Common Groups

Sacral fractures, often non-traumatic, are more prevalent in certain populations like military personnel, long-distance runners, post-menopausal women, and those who are pregnant or postpartum.

Signup and view all the flashcards

Sacral Fracture Symptoms

Pain over the sacrum, potentially radiating to the low back, hip, or groin, often worsens with weight-bearing and rotational movements.

Signup and view all the flashcards

Osteoporotic Compression Fractures: Types

Osteoporotic fractures in the spine can come in various forms like wedge-shaped, concave, or completely crushed.

Signup and view all the flashcards

Osteoporotic Fractures: T-Spine

Osteoporotic fractures in the thoracic spine show specific changes in the shape of the vertebrae, with increased severity of kyphosis (forward curvature) related to the occurrence of wedge-shaped fractures.

Signup and view all the flashcards

Compression Fractures: Complications

Acute complications of compression fractures include intestinal obstruction, inability to urinate, and serious spinal cord compression.

Signup and view all the flashcards

Vertebroplasty

A minimally invasive procedure to treat vertebral compression fractures by injecting bone cement (PMMA) into the fractured bone to stabilize it.

Signup and view all the flashcards

Kyphoplasty

Similar to vertebroplasty, but also involves inserting a balloon into the fracture site before injecting the cement to restore some vertebral height.

Signup and view all the flashcards

Kyphosis

An abnormal rounding of the upper back, often referred to as 'hunchback'.

Signup and view all the flashcards

Sacroiliac Joint Dysfunction

A condition characterized by pain and stiffness in the sacroiliac joint, a joint connecting the sacrum bone in the lower back to the ilium bone in the pelvis.

Signup and view all the flashcards

What are the symptoms of Sacroiliac Joint Dysfunction?

Symptoms often include unilateral (one-sided) pain localized to the buttock, groin, or lower back, often worse with hip loading or rotation.

Signup and view all the flashcards

Why is it important to consider anxiety/depression in managing vertebral compression fractures?

Patients with vertebral compression fractures can experience significant pain and functional limitations, leading to increased anxiety and depression. Addressing these mental health aspects is crucial for overall patient well-being and recovery.

Signup and view all the flashcards

What are some potential causes of increased pain after a vertebroplasty/kyphoplasty procedure?

Increased pain after the procedure could be due to a new compression fracture, collapse of an untreated vertebra, rib fracture, or even just the deformity itself.

Signup and view all the flashcards

Why is pain management crucial in patients with vertebral compression fractures?

Vertebral compression fractures can cause intense and debilitating pain, making it essential to address pain management to improve patient comfort, functionality, and quality of life.

Signup and view all the flashcards

Study Notes

Conservative Management of Spinal Conditions

  • Low back pain (LBP) affects most patients without needing surgery.
  • Conservative management is preferred over surgery.
  • Specific diagnoses are rarely given in back pain cases, leading to nonspecific treatments.
  • Diagnosis is a process combining history, physical exam, and imaging for best results.
  • Imaging results do not directly equate to symptoms, and normal imaging may lead to inappropriate care.

Differential Diagnosis of Low Back and Lower Extremity Pain

  • Spinal Issues:
    • Lumbar radiculopathy
    • Facet joint arthritis
    • Neurogenic claudication due to lumbar spinal stenosis
    • Fracture
    • Tumor
    • Infection
  • Non-spinal Issues:
    • Intrarticular hip pain
    • Piriformis syndrome
    • Peripheral neuropathy
    • Vascular claudication

Red Flags

  • Night pain
  • Relentless, constant pain not related to movement
  • Constitutional symptoms (weight loss, appetite changes, fever) indicate possible serious underlying conditions, warranting immediate medical attention.

Neurological Red Flags

  • Bowel/bladder dysfunction, particularly if accompanied by overflow incontinence, often indicates cauda equina syndrome, a true surgical emergency.
  • Progressive lower extremity weakness.
  • Sexual dysfunction.

Radiographic Red Flags

  • Compression fractures
  • Changes in pedicle appearance (look at AP x-ray)
  • New-onset spinal malalignment
  • Changes in disc height with vertebral body endplate erosions (infection)

Lumbar Disc Herniation

  • Common in young adults.
  • May or may not include leg pain.
  • Diagnosis differentiate herniation, bulge and degeneration.

Cervical Degenerative Disc Disease

  • Associated with neck pain.
  • Radicular symptoms like pain, weakness and numbness can occur.
  • Myelopathy, characterized by various clinical and imaging findings, can also be present.
  • Natural course of cervical degeneration typically starts with mild segmental instability, progressively impacting 10% at age 25 to 95% by age 65.

Cervical Myelopathy

  • Usually affects people over 60.
  • Characterized by long-tract signs (most commonly bilateral upper extremity symptoms).
  • Gradual onset of symptoms like weakness, clumsiness, and gait problems.
  • Some people may exhibit combined cervical and lumbar involvement.
  • Crucial to distinguish between myelopathy and other conditions.
  • Diagnosis often done through imaging and careful consideration of patient's clinical history

Injections (Diagnostic and Therapeutic)

  • Trigger point injections are often done with anesthetic, not steroids, to deliver relief.
  • Corticosteroids reduce inflammation, but are not intended for long-term treatment.
  • Facet injections can be both diagnostic and therapeutic, examining the source of axial pain, not necessarily isolated back pain.
  • Important to identify nerve, nerve root or disc issues.
  • Epidural steroid injections are given to treat radiculopathy, not necessarily isolated back pain, and it’s also used to diagnose pain
  • Specific considerations like side effects must be accounted for, especially long-term use.

Sacroiliac Joint Dysfunction

  • Pain often unilateral.
  • Can be present in the gluteal or posterior pelvic region.
  • May be accompanied by symptoms radiating down the leg.
  • Often occurs during transitional or high activity periods.

Physician Considerations regarding Spinal issues

  • Fluoroscopic-guided SI joint injections with local anesthesia are often used as a diagnostic standard
  • Diagnosis requires physical examination, imaging, and identifying underlying factors driving the patient’s symptoms.
  • Alternative therapies like acupuncture and biofeedback may be used in conjunction with other treatments.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Related Documents

Nonsurgical Mgmt of Spinal Conditions Notes PDF

Description

Test your knowledge on the conservative management of spinal conditions, focusing particularly on low back pain. This quiz will cover differential diagnoses, red flags, and the importance of proper imaging in treatment decisions. Enhance your understanding and skills in non-surgical approaches to spinal issues.

More Like This

Types of Low Back Pain
60 questions

Types of Low Back Pain

ExuberantGeranium avatar
ExuberantGeranium
Conservative Management of Spinal Conditions
24 questions

Conservative Management of Spinal Conditions

HighSpiritedEcoArt9378 avatar
HighSpiritedEcoArt9378
Conservative Management of Spinal Conditions
72 questions

Conservative Management of Spinal Conditions

HighSpiritedEcoArt9378 avatar
HighSpiritedEcoArt9378
Conservative Management of Spinal Conditions
81 questions

Conservative Management of Spinal Conditions

HighSpiritedEcoArt9378 avatar
HighSpiritedEcoArt9378
Use Quizgecko on...
Browser
Open
Browser
Browser