Lumbar Spine
Todd McCall, M.D.
Assistant Professor of Neurosurgery
Introduction
• Symptoms
– Back pain
• Degenerative disc
disease
• Facet arthropathy
• Compression
fracture
– Radiculopathy
• Herniated disc
• Synovial cyst
• Radiographic
findings
– Stenosis
– Spondylolisthesis
Red flags
Back pain
• Common causes
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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
• 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
Degenerative disc disease
Bone scan
•text
Facet arthropathy
Compression fx (osteoporotic)
• Increasing incidence with
aging population
• Pain worse with axial loading
• Treatments:
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Watch
Bracing
PT
Kyphoplasty
Important to treat underlying
osteoporosis
Compression fx (osteoporotic)
• Imaging studies
– X-rays
• Good for screening
– CT
– MRI
• contrast
– Bone scan
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
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Urinary retention (most sensitive)
Incontinence (overflow)
Saddle anesthesia (anus, genitals, perineum)
Weakness (often multiple myotomes)
Pain
SURGICAL EMERGENCY
Cauda equina syndrome
normal
Radiculopathy: synovial cyst
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
Spondylolisthesis
• Symptoms
– Back pain
– Neurogenic
claudication
• central canal
stenosis
– Radiculopathy
• lateral recess
stenosis
• neuroforaminal
stenosis