Examination and Treatment of the Lumbar Spine - PowerPoint PPT Presentation

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Examination and Treatment of the Lumbar Spine

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Advanced imaging. MRI. CT. Bone scan. Aging Disc. Boden study ... Diagnostic dilemma. Radial tearing in annulus fibrosis. Advanced imaging. MRI. Discogram ... – PowerPoint PPT presentation

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Title: Examination and Treatment of the Lumbar Spine


1
Examination and Treatment of the Lumbar Spine
  • William L. Tontz, Jr., MD

2
Physical Examination
  • History
  • Mechanism onset of symptoms
  • PQRST
  • Family History (Genetic Twin Studies)
  • Smoking

3
Physical Examination
  • Range of motion
  • Muscle strength
  • Atrophy
  • Sensory exam
  • Specialized tests

4
Imaging Studies
  • Upright radiographs
  • Flexion/Extension views
  • Advanced imaging
  • MRI
  • CT
  • Bone scan

5
Aging Disc
  • Boden study
  • Disc Herniation
  • Spinal Stenosis
  • Segmental Instability
  • Discogenic

6
Herniated Disc
  • Annular tear
  • Posteriolateral herniation nucleus pulposus
  • Pain
  • Neurologic deficit
  • Improvement

7
Spinal Stenosis
  • Pathophysiology
  • Symptoms
  • Low back pain
  • Claudication
  • Leg pain
  • Weakness
  • Co-existent cervical stenosis

8
Segmental Instability
  • Abnormal motion two vertebral segments
  • Retrolisthesis, spondylolisthesis
  • 3-4 mm translation
  • 10-15 degrees angular displacement
  • Chronic and repetitive nerve root irritation

9
Discogenic
  • Internal disc disruption
  • Diagnostic dilemma
  • Radial tearing in annulus fibrosis
  • Advanced imaging
  • MRI
  • Discogram

10
Spinal Fractures
  • Denis column classification
  • Vacarro/Anderson classification
  • Compression fractures
  • Traumatic
  • Pre-existing
  • Pathologic
  • Burst Fractures

11
Treatment
  • Non-operative
  • Calendar
  • Medications
  • Physical therapy
  • Injections
  • Epidurals

12
Operative Treatment
  • 3 general indications
  • Persistent or progressive neurological deficit
  • Functional
  • Segmental Instability
  • Intractable pain despite 3-6 month
    non-operative care

13
Case Studies
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