Lumbar Spine

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Lumbar Spine

• Todd McCall, M.D.
• Assistant Professor of Neurosurgery

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Introduction

• Symptoms
• Back pain
• Degenerative disc disease
• Facet arthropathy
• Compression fracture
• Radiculopathy
• Herniated disc
• Synovial cyst

• Radiographic findings
• Stenosis
• Spondylolisthesis

Red flags
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Back pain

• 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

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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

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Degenerative disc disease
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Bone scan

• text

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Facet arthropathy
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Compression fx (osteoporotic)

• Increasing incidence with aging population
• Pain worse with axial loading
• Treatments
• Watch
• Bracing
• PT
• Kyphoplasty
• Important to treat underlying osteoporosis

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Compression fx (osteoporotic)

• Imaging studies
• X-rays
• Good for screening
• CT
• MRI
• contrast
• Bone scan

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Radiculopathy

• Due to nerve irritation or compression
• Symptoms
• Pain / tingling
• Numbness
• Weakness
• L4/5 ADF, foot drop
• L5/S1 APF

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Radiculopathy herniated disc

• Treatment
• Meds (steroid)
• PT
• ESI
• Surgery

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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
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Cauda equina syndrome
normal
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Radiculopathy synovial cyst
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Stenosis

• Due to
• Disc bulging
• Lig. flavum hypertrophy
• Facet arthropathy
• Spondylolisthesis
• Synovial cysts

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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

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Spondylolisthesis

• Symptoms
• Back pain
• Neurogenic claudication
• central canal stenosis
• Radiculopathy
• lateral recess stenosis
• neuroforaminal stenosis

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