Examination and Treatment of the Lumbar Spine

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Examination and Treatment of the Lumbar Spine

• William L. Tontz, Jr., MD

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Physical Examination

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

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Physical Examination

• Range of motion
• Muscle strength
• Atrophy
• Sensory exam
• Specialized tests

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Imaging Studies

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

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Aging Disc

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

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Herniated Disc

• Annular tear
• Posteriolateral herniation nucleus pulposus
• Pain
• Neurologic deficit
• Improvement

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Spinal Stenosis

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

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Segmental Instability

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

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Discogenic

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

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Spinal Fractures

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

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Treatment

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

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Operative Treatment

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

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Case Studies