spine

• LUMBAR DISC HERNIATION 

  SX= at L5/S1, pain

  DX= image w MRI

  TX= might not need surgery. Neuro issues get neurology/orthopedic surgery. Get PT, ice, water therapy/injections. Leminectomy/discectomy for surgery
• MUSC BACK STRAIN

  SX= low back pain. Palpation of vertebrae doesn’t cause bony tenderness.

  PE= straighten lumbar spine. Pain along para spinal muscles, ROM causes pain/difficulty. strength/reflexes/skin sensation/DTRs/straight leg raise all normal

  TX= ice 1-2wks→heat, NSAIDs, muscle relaxants, stretch, image if no improvement in 4-6wks. PT
• SPONDYLOLYSIS/SPONDYLOLISTHESIS

  PATHO= defect/stress fracture in pars interarticularis of vertebral arch, hyperextension at L4-L5/L5-S1

  SX= pain

  DX RADIOLOGY= XR shows “collared scotty dog”
• ANKYLOSING SPONDYLITIS

  PATHO= inflam arthritis of the spine that can be disabling due to fusion of the spine

  SX= <40 yo(15-35yo). Uveitis, psoriasis, IBD, aortic regurg, pulm fibrosis. Involved spine/sacroiliac joints. Pain radiates to the buttocks. Low back pain (stiff/pain in AM, better w exercise, pain at night, dec mobility if fusion starts)

  DX RADIOLOGY= “bamboo spine and dagger sign” on XR. Pt has HLA-B27 gene, elevated CRP/ESR

  TX= NSAIDs, DMARDs, methotrexate, TNF
• EPIDURAL ABSCESS

  SX= fever w non-traumatic back pain. Ask abt IVDA. focal/severe back pain. Nerve root/radicular sx. Motor weakness, sens changes. bladder/bowel dysf. Paralysis.

  DX= MRI

  TX= surgical and abx URGENT
• CAUDA EQUINA SYN (lower part) aka SPINAL CORD COMPRESSION (whole spine)

  SX= pain, motor weakness, sensory findings, late bowel/bladder findings. Can be asym/bilateral. Weak plantar flexion of feet w loss of ankle jerks w mid-cauda equina lesion of S1/S2 roots. S3-S5 involvement means bladder/rectal sphincter paralysis.

  • Requires urgent attention to decompress nerves and will have sx for life if not addressed fast

  TX= laminectomy, discectomy, spinal fusion
• SPINAL STENOSIS

  SX= 60 yo+ narrowing of spinal canal from something pushing posteriorly (osteoarthritis changes, herniated disk, trauma, spondylolisthesis), bending forward/sitting eases pain. Neurogenic claudication and LE pain in weight bearing/walking.

  • Gradual sx onset, numb/tingle/weak in foot/leg. pain/cramp in one/both legs with prolonged standing.

  DX RADIOLOGY= MRI or CT myelogram

  TX= PT, epidural injections, water therapy, surgery to decompress spine
• THORACIC OUTLET SYN

  SX= Neuro=pain, dysesthesia, numb, weak, hand atrophy, 

  • Venous=forearm fatigue quick, pain and cyanosis, 
  • Arterial= hand ischemia w pain, pallor, paresthesia, cold

  NOTES= scalene triangle is predominantly involved and there is brachial plexus compression and the subclavian artery. Example is pt cannot hold golf club
• 1. Describe the “red flags” that indicate the need for early imaging for a patient with back pain.

  Fever w back pain, severe/progressive neurologic deficit (bowel/bladder dysf (saddle paresthesia), minor osteoporotic pts, major trauma in older pts/acute bony tenderness, hx of cancer/WL, recent bacterial inf, IVDU, fever/night sweats, immune suppression, extremes of age, hx of recent spinal instrumentation.
• appropriate imaging for a patient with a suspected spinal infection or abscess. 

  MRI
• 1. patient presentation that does not require immediate radiographic imaging. 

  Muscle strain w no pain radiating or loss of sensation anywhere