Lumbar Spine. Todd McCall, M.D. Assistant Professor of Neurosurgery. Symptoms Back pain Degenerative disc disease Facet arthropathy Compression fracture Radiculopathy Herniated disc Synovial cyst. Radiographic findings Stenosis Spondylolisthesis. Introduction. Red flags.
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Lumbar Spine Todd McCall, M.D. Assistant Professor of Neurosurgery
Symptoms Back pain Degenerative disc disease Facet arthropathy Compression fracture Radiculopathy Herniated disc Synovial cyst Radiographic findings Stenosis Spondylolisthesis Introduction Red flags
Common causes Myofascial Hip arthritis SI joint Lumbar Spine Degenerative disc disease Facet arthropathy Compression fx (osteoporosis) Scoliosis Less common causes Metastasis History of cancer Unexplained weight loss Discitis / Osteomyelitis Recent infection or fever Traumatic injury Recent fall, etc Back pain
Back Pain • Typically start with 4-8 week course of PT (unless red flag present) • Water therapy for unloading • Useful clinical information • Core strengthening • Traction, TENS, etc. • Meds: NSAIDs (avoid narcotics) • If fail initial treatments, then get imaging studies
Bone scan • text
Increasing incidence with aging population Pain worse with axial loading Treatments: Watch Bracing PT Kyphoplasty Important to treat underlying osteoporosis Compression fx (osteoporotic)
Imaging studies X-rays Good for screening CT MRI contrast Bone scan Compression fx (osteoporotic)
Radiculopathy • Due to nerve irritation or compression • Symptoms • Pain / tingling • Numbness • Weakness • L4/5: ADF, foot drop • L5/S1: APF
Radiculopathy: herniated disc • Treatment • Meds (steroid) • PT • ESI • Surgery
Cauda equina syndrome • Usually due to massive disc herniation • L4/5 most common level • Often underlying stenosis • Symptoms • Urinary retention (most sensitive) • Incontinence (overflow) • Saddle anesthesia (anus, genitals, perineum) • Weakness (often multiple myotomes) • Pain SURGICAL EMERGENCY
Cauda equina syndrome normal
Stenosis • Due to: • Disc bulging • Lig. flavum hypertrophy • Facet arthropathy • Spondylolisthesis • Synovial cysts
Stenosis • Neurogenic claudication • Pain in legs worse with walking, alleviated with rest • Symptoms better with flexion (leaning over shopping cart) • Opens central canal • Treatment • PT (traction) • ESI • Surgical decompression
Symptoms Back pain Neurogenic claudication central canal stenosis Radiculopathy lateral recess stenosis neuroforaminal stenosis Spondylolisthesis