Operative treatment for common back conditions
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Presented by: Dr Paul Licina — Spine Surgeon Event: Mackay GP & Allied Health Education Day - 2014
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Operative treatment for common back conditions
Presented by:
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Event:
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Operative management for common back conditions
This document discusses common lumbar spine conditions like disc herniations and spinal stenosis. It provides 5 facts about disc herniations including what causes them, typical symptoms, and treatment options like steroid injections or surgery. It also outlines 5 facts about spinal stenosis including what it is, typical symptoms, and potential surgical treatment. The document seeks to address 3 common misconceptions about spinal fusion surgery, noting risks are low, it is often successful when combined with decompression, and adjacent level degeneration is usually due to preexisting conditions, not the fusion itself.
Common conditions of the lumbar spine
Common conditions of the lumbar spine include:
1. Degenerative disc disease, which occurs in nearly everyone over 50 due to disc degeneration and affects the lower lumbar spine the most.
2. Disc herniations, where a tear in the disc allows the nucleus to migrate and press on nerves, commonly causing leg pain.
3. Spinal stenosis, a narrowing of the spinal canal from bone spurs or thickened ligaments that compresses nerves and causes leg symptoms improved by sitting or bending forward.
4. Spondylolisthesis, the slipping of one vertebra over another, most often affecting L4 on L5 due to degeneration.
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Operative treatment for common back conditions
Presented by:
Dr Paul Licina — Spine Surgeon
Dr Adrian Nowitzke — Neurosurgeon
Event:
Bundaberg GP & Allied Health Education Day - 2015
Guidelines for return to sport after cervical trauma
The document discusses return to activity guidelines after various cervical injuries, including sprains/strains, burners/stingers, neuropathies, disc herniations, fractures, and surgery. It notes that there is no consensus between spinal surgeons on return to play. Generally, athletes can return when they have no symptoms or neurological deficits, full range of motion without pain, and adequate healing time from the injury, though risk of reinjury remains. The severity of the original injury and any subsequent surgery or abnormalities determine how quickly and safely athletes can safely return to their sport.
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Presented by:
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Presented by:
Dr David Lisle — Radiologist
Event:
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Presented by:
Dr David Lisle — Radiologist
Event:
Mackay GP & Allied Health Education Day - 2014
Surgery for degenerative stenosis and deformity
This document discusses surgical options for treating degenerative spinal conditions in elderly patients. It outlines procedures like decompression surgery to treat spinal stenosis which causes leg pain and nerve compression. For cases of stenosis accompanied by instability from issues like degenerative spondylolisthesis or scoliosis, fusion surgery may be added to address the instability and deformity in addition to decompressing the spine. The document provides overview information on the causes and treatments for common degenerative spinal conditions seen in elderly patients.
Operative management for common back conditions
This document discusses common lumbar spine conditions like disc herniations and spinal stenosis. It provides 5 facts about disc herniations including what causes them, typical symptoms, and treatment options like steroid injections or surgery. It also outlines 5 facts about spinal stenosis including what it is, typical symptoms, and potential surgical treatment. The document seeks to address 3 common misconceptions about spinal fusion surgery, noting risks are low, it is often successful when combined with decompression, and adjacent level degeneration is usually due to preexisting conditions, not the fusion itself.
Common conditions of the lumbar spine
Common conditions of the lumbar spine include:
1. Degenerative disc disease, which occurs in nearly everyone over 50 due to disc degeneration and affects the lower lumbar spine the most.
2. Disc herniations, where a tear in the disc allows the nucleus to migrate and press on nerves, commonly causing leg pain.
3. Spinal stenosis, a narrowing of the spinal canal from bone spurs or thickened ligaments that compresses nerves and causes leg symptoms improved by sitting or bending forward.
4. Spondylolisthesis, the slipping of one vertebra over another, most often affecting L4 on L5 due to degeneration.
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Surgery for back pain
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Event:
Mackay GP & Allied Health Education Day - 2014
Case Presentation
Dave, a 38-year old factory worker, sees a doctor for worsening back pain that radiates down his left leg. Imaging reveals chronic pars defects, grade 1 spondylolisthesis, and disc degeneration. He is referred to specialists, prescribed medications, and advised to file a workers compensation claim to receive treatment including epidural injections and physical rehabilitation with the goal of a gradual return to work.
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The document discusses common lumbar spine conditions including disc herniation, spinal stenosis, and chronic low back pain. It describes the causes, symptoms, treatments including surgery, and outcomes. For disc herniation, surgery in the form of discectomy is recommended for severe or unremitting leg pain and can provide relief in 90% of cases. Spinal stenosis is treated initially with physiotherapy or epidural injections, with surgery as an option for severe, unresolved symptoms. Fusion surgery is not usually indicated for chronic low back pain alone but may be used for instability or certain structural deformities.
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2) It categorizes back pain into 3 groups: nonspecific low back pain, back pain associated with radiculopathy, and back pain associated with a specific cause needing prompt evaluation.
3) Guidelines recommend triaging patients into these 3 categories and only imaging those with red flags, severe/progressive neurological symptoms, or if considering surgery/injections. Imaging is not recommended for nonspecific back pain.
Current concepts in management of lumbar disc prolapse
A discectomy is a last resort surgery for herniated discs that do not improve with more conservative treatments. The perfect indication for discectomy is a patient with a history of intolerable radicular pain for over six weeks, physical exam findings of nerve compression or tension, and an MRI confirming a large herniated disc. Earlier surgery may be considered for moderate nonradicular pain of less than six weeks if supported by physical exam findings and a small disc herniation is seen. Steroid nerve root blocks can help determine if surgery is needed by relieving radicular pain temporarily. A recent trial studied a Barricaid device implanted during discectomy to prevent reherniation.
Surgery for common lumbar conditions
This document discusses common degenerative conditions of the lumbar spine, including disc herniation, spinal stenosis, and spondylolisthesis. It provides details on symptoms, treatments like steroid injections or surgery, and outcomes. It aims to dispel misconceptions about spinal fusion surgery, noting that while risks exist, severe damage is rare and fusion is usually successful when performed for the right reasons. Fusion may not necessarily lead to more problems at adjacent levels in the future. The document includes examples of patients who had good outcomes from fusion surgery for conditions like isthmic spondylolisthesis and post-discectomy.
Approach to low back pain
Low back pain is one of the most common reasons for seeking medical attention. The majority of episodes are self-limited, but some suffer from chronic or recurrent courses. Almost any structure in the back can cause pain, most commonly the intervertebral discs and facet joints. A thorough history and physical exam are important to determine the likely cause and guide appropriate treatment. Imaging such as X-rays, CT, and MRI may help identify structural abnormalities but often are not needed for typical mechanical low back pain.
Myelopathy management
This document discusses cervical myelopathy, including its causes, symptoms, tests, treatment options, and surgical procedures. It provides details on:
- Common causes of cervical myelopathy like spinal stenosis, disc protrusions, and osteophyte formation.
- Typical symptoms like clumsy hands, leg stiffness, and gait imbalance and signs like hyperreflexia on examination.
- MRI as the best test to identify cord compression and changes, and CT myelogram as also useful.
- Surgical treatment options include anterior discectomy and fusion or corpectomy for one to two levels, and corpectomy with possible posterior fixation for three or more levels. Posterior laminectomy, laminectomy with fusion
Facet dislocation management
This document discusses the initial management and treatment of cervical spine facet dislocations. It provides guidelines for evaluation including imaging based on neurological status. Reduction techniques discussed include gradual traction, rapid reduction, and manipulation under general anesthesia. The role of MRI is debated, with most recommending MRI for incomplete neurological injuries before reduction. Anterior discectomy and fusion or posterior fusion are discussed as surgical stabilization options after reduction.
approach a patient with low back pain
Mr. B is a 37-year-old male who experienced acute lower back pain while working in his yard. He reports dull, burning pain localized to his lower back radiating into his left buttock. Physical examination reveals tenderness over the paraspinous muscles but normal range of motion, strength, and sensation in the lower extremities. Non-surgical management including medications, exercise, and lifestyle modifications is recommended. Further investigations are not needed unless symptoms fail to improve within 4-6 weeks.
My crook back
The document discusses the classification and management of chronic low back pain. It notes that 95% of back pain cases do not require surgery or radiology, and most patients need multidisciplinary care. While patients experience back pain, investigations and treatments directed at the back are often ineffective, suggesting the cause may involve neurological reorganization in the brain. The document provides tools to assess patients and strategies for clinicians, including explaining to patients that the cause is often not well understood, recommending evidence-based treatments like exercise over passive therapies, and avoiding factors that could worsen the condition like prolonged opioid use.
Initial Post Discectomy Programme
This document outlines an exercise program for patients who have undergone a lumbar discectomy. The goals within 3 weeks are to do 2-3 exercise sessions per day, walk for a total of 5km split into two sessions, and lift weights up to 5kg. The program focuses on core stabilization exercises using a transversus abdominis contraction to protect the low back during movements. Exercises progress from basic stretches and isometric contractions on the floor to movements with a ball and concluded with standing exercises.
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Surgery for low back pain
The document discusses different types of spine surgery for low back pain, including discectomy for disc herniation and fusion surgery. Discectomy has good outcomes, with patients typically able to return to sedentary duties in 3 weeks and sports in 6 weeks, and a 90-95% success rate. Fusion surgery results are not as good for low back pain compared to discectomy or when done for deformities or instability. Fusion may be suitable for patients with a specific diagnosis, clearly defined pain source, who are otherwise healthy candidates and have no psychosocial issues. The technique used should match the underlying pathology.
Neck pain case presentation - Cervical spondylosis
This document summarizes a case of a 55-year-old female tailor presenting with neck pain for 4 months. Her examination showed decreased range of motion of the neck without neurological deficits. Her comorbidities included diabetes mellitus. Differential diagnoses included cervical spondylosis, mechanical neck pain, and cervical disc herniation. She was managed with analgesics, a cervical collar, and physiotherapy. The discussion covered mechanical neck disorders, cervical spondylosis, and cervical disc herniation as potential causes and their typical presentations, investigations, and management approaches.
Surgery for back pain
Presented by:
Dr Paul Licina — Spine Surgeon
Event:
Mackay GP & Allied Health Education Day - 2014
Case Presentation
Dave, a 38-year old factory worker, sees a doctor for worsening back pain that radiates down his left leg. Imaging reveals chronic pars defects, grade 1 spondylolisthesis, and disc degeneration. He is referred to specialists, prescribed medications, and advised to file a workers compensation claim to receive treatment including epidural injections and physical rehabilitation with the goal of a gradual return to work.
Licina lumbar disc herniation
This document discusses disc herniation, including its causes, symptoms, signs, imaging, treatment options of observation, nerve root blocks, and surgery. It provides details on when surgery is appropriate and outcomes, which is typically relief of leg pain and satisfactory results in 90% of cases. However, surgery may not work when symptoms are primarily back pain rather than radicular pain or there are psychosocial issues. The document also includes examples of patients who may be candidates for surgery, nerve root blocks, or further observation and treatment.
Unifacet dislocation MRI
This document discusses treatment options for unilateral cervical facet fracture/dislocation. It presents 4 scenarios of a 55-year-old woman with this injury and discusses whether immediate closed reduction, MRI first, or surgery is most appropriate. The literature suggests that early decompression and reduction can improve outcomes with rare risk of neurological deterioration from closed reduction. MRI may not predict outcomes or guide treatment. The consensus is that MRI is only needed for late presentations, failed closed reductions, or if the patient's mental state prevents safe closed reduction. Otherwise, immediate closed reduction by experienced surgeons is recommended, especially for significant neurological deficits.
The role of surgery in common lumbar conditions
The document discusses common lumbar spine conditions including disc herniation, spinal stenosis, and chronic low back pain. It describes the causes, symptoms, treatments including surgery, and outcomes. For disc herniation, surgery in the form of discectomy is recommended for severe or unremitting leg pain and can provide relief in 90% of cases. Spinal stenosis is treated initially with physiotherapy or epidural injections, with surgery as an option for severe, unresolved symptoms. Fusion surgery is not usually indicated for chronic low back pain alone but may be used for instability or certain structural deformities.
Radiological assessment – Part 2
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Dr David Lisle — Radiologist
Event:
Bundaberg GP & Allied Health Education Day - 2015
Should I order an injection or let the specialist do it? – Part 1
Presented by:
Dr Brendan Moore – Pain Medicine Specialist Physician
Dr Greg Cowderoy – Radiologist
Event:
GP Education Day - 2015
Should I order an injection or let the specialist do it? – Part 2
Presented by:
Dr Brendan Moore – Pain Medicine Specialist Physician
Dr Greg Cowderoy – Radiologist
Event:
GP Education Day - 2015
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Presented by:
Dr Angus Forbes – Occupational Physician
Dr Paul Licina — Spine Surgeon
Event:
GP Education Day - 2015
Appropriate imaging for low back pain
1) The document discusses appropriate imaging for back pain, describing different imaging modalities like X-rays, CT scans, bone scans, and MRI.
2) It categorizes back pain into 3 groups: nonspecific low back pain, back pain associated with radiculopathy, and back pain associated with a specific cause needing prompt evaluation.
3) Guidelines recommend triaging patients into these 3 categories and only imaging those with red flags, severe/progressive neurological symptoms, or if considering surgery/injections. Imaging is not recommended for nonspecific back pain.
Current concepts in management of lumbar disc prolapse
A discectomy is a last resort surgery for herniated discs that do not improve with more conservative treatments. The perfect indication for discectomy is a patient with a history of intolerable radicular pain for over six weeks, physical exam findings of nerve compression or tension, and an MRI confirming a large herniated disc. Earlier surgery may be considered for moderate nonradicular pain of less than six weeks if supported by physical exam findings and a small disc herniation is seen. Steroid nerve root blocks can help determine if surgery is needed by relieving radicular pain temporarily. A recent trial studied a Barricaid device implanted during discectomy to prevent reherniation.
Surgery for common lumbar conditions
This document discusses common degenerative conditions of the lumbar spine, including disc herniation, spinal stenosis, and spondylolisthesis. It provides details on symptoms, treatments like steroid injections or surgery, and outcomes. It aims to dispel misconceptions about spinal fusion surgery, noting that while risks exist, severe damage is rare and fusion is usually successful when performed for the right reasons. Fusion may not necessarily lead to more problems at adjacent levels in the future. The document includes examples of patients who had good outcomes from fusion surgery for conditions like isthmic spondylolisthesis and post-discectomy.
Approach to low back pain
Low back pain is one of the most common reasons for seeking medical attention. The majority of episodes are self-limited, but some suffer from chronic or recurrent courses. Almost any structure in the back can cause pain, most commonly the intervertebral discs and facet joints. A thorough history and physical exam are important to determine the likely cause and guide appropriate treatment. Imaging such as X-rays, CT, and MRI may help identify structural abnormalities but often are not needed for typical mechanical low back pain.
Myelopathy management
This document discusses cervical myelopathy, including its causes, symptoms, tests, treatment options, and surgical procedures. It provides details on:
- Common causes of cervical myelopathy like spinal stenosis, disc protrusions, and osteophyte formation.
- Typical symptoms like clumsy hands, leg stiffness, and gait imbalance and signs like hyperreflexia on examination.
- MRI as the best test to identify cord compression and changes, and CT myelogram as also useful.
- Surgical treatment options include anterior discectomy and fusion or corpectomy for one to two levels, and corpectomy with possible posterior fixation for three or more levels. Posterior laminectomy, laminectomy with fusion
Facet dislocation management
This document discusses the initial management and treatment of cervical spine facet dislocations. It provides guidelines for evaluation including imaging based on neurological status. Reduction techniques discussed include gradual traction, rapid reduction, and manipulation under general anesthesia. The role of MRI is debated, with most recommending MRI for incomplete neurological injuries before reduction. Anterior discectomy and fusion or posterior fusion are discussed as surgical stabilization options after reduction.
approach a patient with low back pain
Mr. B is a 37-year-old male who experienced acute lower back pain while working in his yard. He reports dull, burning pain localized to his lower back radiating into his left buttock. Physical examination reveals tenderness over the paraspinous muscles but normal range of motion, strength, and sensation in the lower extremities. Non-surgical management including medications, exercise, and lifestyle modifications is recommended. Further investigations are not needed unless symptoms fail to improve within 4-6 weeks.
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Neck pain case presentation - Cervical spondylosis
Neck pain case presentation - Cervical spondylosis
Should I order an injection or let the specialist do it? – Part 1
Should I order an injection or let the specialist do it? – Part 1
Should I order an injection or let the specialist do it? – Part 2
Should I order an injection or let the specialist do it? – Part 2
How to avoid missing something serious in the spine
How to avoid missing something serious in the spine
Current concepts in management of lumbar disc prolapse
Current concepts in management of lumbar disc prolapse
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My crook back
The document discusses the classification and management of chronic low back pain. It notes that 95% of back pain cases do not require surgery or radiology, and most patients need multidisciplinary care. While patients experience back pain, investigations and treatments directed at the back are often ineffective, suggesting the cause may involve neurological reorganization in the brain. The document provides tools to assess patients and strategies for clinicians, including explaining to patients that the cause is often not well understood, recommending evidence-based treatments like exercise over passive therapies, and avoiding factors that could worsen the condition like prolonged opioid use.
Initial Post Discectomy Programme
This document outlines an exercise program for patients who have undergone a lumbar discectomy. The goals within 3 weeks are to do 2-3 exercise sessions per day, walk for a total of 5km split into two sessions, and lift weights up to 5kg. The program focuses on core stabilization exercises using a transversus abdominis contraction to protect the low back during movements. Exercises progress from basic stretches and isometric contractions on the floor to movements with a ball and concluded with standing exercises.
Surgery for low back pain
This document discusses spinal fusion surgery for low back pain. It begins by noting that fusion has caused "more tragic human wreckage" when performed incorrectly. It then outlines specific diagnoses that may warrant fusion, including facetogenic pain, discogenic pain, and spondylolisthesis. The document describes suitable and unsuitable surgery candidates. It details common fusion techniques like posterolateral fusion and interbody fusion. Finally, it states that fusion is appropriate when there is a clear diagnosis, identified pain source, suitable patient without psychosocial issues, and the technique matches the pathology.
Alternative therapies for low back pain
This document discusses evidence-based therapies for low back pain. It finds that staying active and exercise programs are effective in reducing pain and sick leave. Bed rest for more than 2 days and lumbar supports have insufficient evidence of effectiveness. Physical therapies including spinal mobilization and structured exercise programs are effective when combined with early active movement. Chiropractic and acupuncture may provide short-term pain relief but no significant difference compared to other interventions.
Pain management
Presented by:
Dr Brendan Moore – Pain Medicine Specialist Physician
Elena Yusim – Psychologist
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Mackay GP & Allied Health Education Day - 2014
Treating postoperative pain
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Initial Discectomy
This document outlines an exercise program for patients who have undergone a lumbar discectomy. The goals within 3 weeks are to do 2-3 exercise sessions per day, walk for a total of 5km split into two sessions, and lift weights up to 5kg. The program focuses on core stabilization exercises using a ball and includes exercises to do lying down, kneeling, sitting, and standing to strengthen the back and abdomen. Proper form is emphasized by engaging the transversus abdominis muscle and maintaining a neutral spine alignment throughout. Exercises are to be done in sets of 10-15 repetitions and held for 3-10 seconds, progressing to weight added as tolerated.
Radiological assessment – Part 1
Presented by:
Dr David Lisle — Radiologist
Event:
Mackay GP & Allied Health Education Day - 2014
Discectomy Patient Pathway
Dr. Paul Licina will perform a lumbar discectomy surgery on the patient. The patient will be admitted the morning of surgery and should expect to stay in the hospital for one day. Before surgery, the patient must stop taking certain medications and supplements. During the procedure, the surgeon will make an incision in the patient's back to remove a herniated disc putting pressure on a nerve root. After surgery, the patient will recover in the hospital before being discharged home, where they will do exercises and slowly resume normal activities over several weeks as pain improves.
3 week discectomy
This exercise program outlines rehabilitation exercises over 3 weeks following a lumbar discectomy surgery. The goals by 6 weeks include exercising 2-3 times per day, increasing walking, and lifting up to 10kg. The document provides detailed instructions for 20 different core-focused exercises involving positions like lying on the back or side, kneeling, and standing. Each exercise describes muscle activation and movements to help recovery while avoiding movements that could cause pain.
Where do I fit in?
The document discusses the role of a physiotherapist working in a multidisciplinary spine clinic. The physiotherapist has over 30 years of experience working with spinal and orthopaedic patients. In the clinic, they assess, educate, treat, and manage patients. Sessions involve assessment, education, manual therapy and exercise. The physiotherapist works as part of a team, following patients before and after surgery, conducting joint sessions with surgeons and an exercise physiologist, and liaising with other specialists. The goal is to provide continuum of care for patients.
Treating the elderly patient
The document discusses the challenges of managing back pain in an aging population. It notes that medical factors like tolerances for pharmacotherapy and operative fitness limit management options for back dysfunction in older patients. It also discusses challenges from attitudes and perceptions about back pain in older adults, including myths and legends about opioid use and dependence. Finally, it covers how lifestyle factors and priorities around independence, future activity, finances, and environment affect back pain management priorities for retirees.
WorkCover Certificates
This document provides guidance for medical practitioners on completing workcover medical certificates. It addresses key areas such as documenting diagnoses, assessing work capacity and rehabilitation plans. Practitioners are advised to consider the health benefits of work when certifying capacity, provide clear work restrictions, and identify barriers to timely return to work in order to facilitate claim processing. Confidentiality and obtaining appropriate consent for information sharing with insurers is also discussed.
This unbearable pain
Presented by:
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Discectomy Activity Guide
Presented by:
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How we think about back pain?
Presented by:
Dr Adrian Nowitzke — Neurosurgeon
Event:
Mackay GP & Allied Health Education Day - 2014
Where do I fit in?
Elena Yusim is a psychologist located at Level 7 of the Brisbane Private Hospital. She conducts consultations every second Monday and offers remote sessions by telephone. As a psychologist, she reviews medical histories, performs in-depth psychosocial assessments and assessments of psychological state. She assesses client willingness and expectations and develops approximate 6 session treatment plans while liaising with other practitioners and reviewing progress. Seeing a psychologist can help investigate the impact of thoughts, empower self-management techniques, assist with realistic goal setting, return to work strategies, and relapse prevention strategies.
Pain management
This document summarizes interventional pain procedures for chronic pain. It describes common origins of lumbar back pain such as degenerative discs and discusses invasive treatment options like surgery, injections, and radiofrequency ablation. Facet joint injections are described as effective for pain originating from facet joints. Epidural injections can provide temporary relief for nerve root compression or spinal stenosis. Medial branch blocks are used diagnostically prior to potential radiofrequency ablation to denervate medial branch nerves controlling facet joint sensation. Psychological assessment and management strategies are also outlined to optimize pain treatment.
6 week discectomy
The document provides instructions for a 6-week lumbar rehabilitation exercise program following back surgery. It includes over 20 different exercises targeting the lower back, core, and legs. Exercises should be done 2-3 times per day and include stretches, strengthening moves using balls, bands, and body weight as well as exercises done in standing, kneeling, and various positions on the floor or ball. The full range of motion and correct form are emphasized to protect the back during rehabilitation.
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Musculoskeletal Health Concerns of the Aging Population
This document discusses age-related health problems like low back pain and osteoarthritis that are on the rise due to an aging global population living longer lives. It focuses on low back pain, providing details on epidemiology, risk factors, anatomy, clinical evaluation through history, physical exam, imaging tests and diagnostic considerations. Case examples are presented to illustrate lumbar spondylosis, sciatica due to disc herniation, and degenerative spondylolisthesis diagnoses. The summary highlights the rising prevalence of age-related health issues, evaluation of low back pain, and examples of lumbar spine diagnoses.
Low back pain Ys.pptx
Failed conservative management
– Spinal stenosis with neurogenic claudication
– Herniated disc with radiculopathy
– Spinal instability or deformity
– Vertebral compression fracture with neurologic deficit
– Spinal infection or tumor
Ankylosing spondylitis
1) The patient is a 27-year-old male who presents with 6 months of lower back pain that is worse in the morning and improves with exercise. Examination finds reduced spinal mobility and tenderness over the lower spine.
2) Tests show a positive HLA-B27 and elevated inflammatory markers. X-rays are inconclusive for ankylosing spondylitis.
3) Ankylosing spondylitis is an inflammatory arthritis affecting the spine. Treatment includes exercises, NSAIDs, DMARDs like sulfasalazine, and biologic therapies like infliximab which have revolutionized treatment.
LOW BACK PAIN. Dr Haki Selaj Residency in Kosovo QKUK
back pain is a very widespread pathology in the world. There are health and socioeconomic consequences. widespread both in the young and in the old. The causes are different. The overwhelming majority is mechanical pain without a specific cause, while the others are pain from disc, infections, tumors, fractures, metabolic.
Degenerative disorder ms iii
This document summarizes several degenerative disorders of the musculoskeletal system. It discusses osteoarthritis, describing it as the breakdown of cartilage in the joints. It also covers degenerative diseases of the spine like degenerative disc disease, spinal stenosis, and spondylolisthesis. Additional topics include osteoporosis, scoliosis, fibromyalgia, and cervical spondylosis. For each condition, it provides information on causes, symptoms, diagnosis, and treatment options. The overall document provides an overview of common degenerative disorders that affect the bones, joints, and spine.
Low back pain
Low back pain is a common musculoskeletal disorder affecting 40% of people at some point in their lives. It can be acute (lasting less than 7 weeks) or chronic (more than 7 weeks). Common causes include muscle strains, poor posture, obesity, and injuries. Diagnosis involves physical examination and imaging tests like x-rays, CT scans, or MRIs. Treatment depends on whether the back pain is acute or chronic. For acute pain, conservative treatments like NSAIDs, muscle relaxants, and physical therapy are usually effective. Chronic back pain may require more intensive exercises, antidepressants if depression is present, or surgeries like laminectomy or spinal fusion if conservative treatments fail.
Lbp with radiculopathy
This document provides guidelines for treating radiculopathy and back pain. It discusses:
- Common causes of back pain including ligament/muscle strains and spinal issues
- Nonsurgical and pharmacological treatment options for acute, subacute, and chronic back pain including exercise, NSAIDs, muscle relaxants, and opioids
- Surgical indications and procedures for severe or persistent back pain such as spinal fusion, disc replacement, and microdiscectomy
- Approaches to acute radiculopathy including imaging, glucocorticoids, opioids, and exercise-based rehabilitation
Low Back Pain lecture with associated causes
1) Low back pain is a common condition that has many potential causes, including muscle strains, arthritis, herniated discs, and fractures.
2) Risk factors include obesity, smoking, heavy lifting, prolonged sitting or standing, and age.
3) Common causes are muscle strains (70%), degenerative changes like arthritis (10%), herniated discs (4%), and compression fractures (4%).
4) Treatment depends on the underlying cause but may include medications, physical therapy, exercises, injections, and sometimes surgery.
278 Treatment of disk and ligamentous diseases of the cervical spine
This document provides an overview of the pathophysiology, clinical presentation, diagnosis, and treatment of cervical disk and ligamentous diseases. It discusses the degenerative changes that occur with spondylosis including loss of disk height and osteophyte formation. Clinical findings are outlined for cervical radiculopathy including positive Spurling's and abduction relief signs, and for cervical myelopathy including upper and lower motor neuron signs. Diagnostic studies including plain radiographs, CT, MRI, and electrodiagnostic testing are covered. Nonoperative treatments include rest, medication, and physical therapy. Surgical indications and techniques for anterior cervical diskectomy with or without fusion and posterior cervical foraminotomy are summarized.
Patient education02102011
This document discusses lower back pain that originates from the sacroiliac joint. It provides information on the anatomy of the spine and sacroiliac joint, symptoms of sacroiliac joint pain, methods for diagnosing sacroiliac joint issues, and treatment options. Diagnostic methods include imaging, physical exams, and sacroiliac joint injections. Conservative treatment involves medications, physical therapy, belts, injections, or radiofrequency ablation to reduce pain. Surgical options aim to decrease joint mobility through minimally invasive implants. The goal of treatment is to both reduce pain symptoms and lower mobility at the problematic sacroiliac joint.
Spondylolisthesis
Dr. Mahak Jain presented on spondylolisthesis. Key points include:
1) Spondylolisthesis is the forward translation of one vertebra on another, commonly caused by defects in the pars interarticularis known as spondylolysis.
2) It is classified based on etiology, with dysplastic, isthmic, degenerative, traumatic, and pathological types.
3) Treatment depends on factors like grade, symptoms, and etiology, ranging from conservative care to surgical options like decompression, fusion, and instrumentation.
4) Studies show surgery with fusion has better outcomes for pain and function than nonsurgical treatment or decompression alone for degenerative
back_pain.pptx
1) The document discusses two cases of acute lower back pain - a 35-year-old male with pain after heavy lifting and no radiation, and a 37-year-old male with radiating pain down his left leg.
2) Common causes of lower back pain are discussed, including mechanical causes (80-90%), neurogenic causes (5-15%), and others. Red flags indicating potential serious causes are also outlined.
3) For acute lower back pain management in the emergency department, the focus is on ruling out serious causes through history and exams, providing pain management, and discharge instructions emphasizing patient education and regular activities. Pharmacological treatments like NSAIDs and opioids provide limited benefit.
Backaches.pptx
1) The document discusses two cases of acute lower back pain - a 35-year-old male with pain after heavy lifting and no radiation, and a 37-year-old male with radiating pain down his left leg.
2) Common causes of lower back pain are discussed, including mechanical causes (80-90%), neurogenic causes (5-15%), and others. Red flags indicating potential serious causes are also outlined.
3) For acute lower back pain management in the emergency department, the focus is on ruling out serious causes through history and exams, providing pain management, and discharge instructions emphasizing patient education and regular activities. Pharmacological treatments like NSAIDs and opioids provide limited benefit.
Lumbar spinal stenosis, laminectomy, prolapsed intervertebral disc
Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back that puts pressure on the spinal cord and nerves. It commonly occurs in people over 50 due to age-related wear and tear causing bone spurs or thickened ligaments. The best test for diagnosis is an MRI of the lumbar spine, which will show if there is compression of the spinal cord or nerves. Conservative treatment includes medications like NSAIDs, muscle relaxants, and epidural steroid injections, as well as physical therapy. Surgery such as laminectomy or discectomy may be considered if conservative measures fail to provide relief from pain and symptoms.
Lumbar disc presentation dr ajay bajaj neurosurgeon
Dr. Bajaj's presentation discusses lumbar disc disease, which is a major public health problem and common cause of back pain. The presentation covers the anatomy and physiology of intervertebral discs, age-related degeneration, types and causes of disc herniation, and diagnostic tools like MRI. Treatment options discussed include conservative care like physical therapy for 2 months initially before considering surgery, which provides faster relief but same long-term outcomes as non-surgical options. Discography is presented as a technique to confirm the painful disc for patients without clear compression.
Assessment and rehabilitation in Spondyloarthropathy
This document discusses assessment and rehabilitation for spondyloarthropathy. It begins by defining spondyloarthropathy as a group of inflammatory disorders affecting the spine and joints. It then focuses on ankylosing spondylitis (AS) and describes its characteristics, epidemiology, signs and symptoms, diagnostic criteria, treatments including NSAIDs, DMARDs, anti-TNF therapy, exercises and rehabilitation. The goal of treatment is to reduce symptoms and maintain spinal flexibility through non-pharmacological and pharmacological approaches.
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Musculoskeletal Health Concerns of the Aging Population
Musculoskeletal Health Concerns of the Aging Population
LOW BACK PAIN. Dr Haki Selaj Residency in Kosovo QKUK
LOW BACK PAIN. Dr Haki Selaj Residency in Kosovo QKUK
278 Treatment of disk and ligamentous diseases of the cervical spine
278 Treatment of disk and ligamentous diseases of the cervical spine
Lumbar spinal stenosis, laminectomy, prolapsed intervertebral disc
Lumbar spinal stenosis, laminectomy, prolapsed intervertebral disc
Lumbar disc presentation dr ajay bajaj neurosurgeon
Lumbar disc presentation dr ajay bajaj neurosurgeon
Assessment and rehabilitation in Spondyloarthropathy
Assessment and rehabilitation in Spondyloarthropathy
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Some WorkCover fusions work
- The study examined outcomes of 42 WorkCover fusion patients compared to 465 privately insured patients over 10 years
- WorkCover patients showed less improvement in ODI and VAS scores postoperatively, especially those with significant back pain preoperatively
- However, WorkCover patients with dominant leg pain preoperatively had similar outcomes to privately insured patients with leg pain
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Pain management
This document discusses interventional procedures for chronic pain, specifically in the lumbar back region. It describes common origins of lumbar pain such as degenerative discs and stenosis. Invasive treatment options are then outlined, including various injection procedures like epidural, facet joint, and medial branch nerve ablation using radiofrequency. The document provides details on how these procedures are performed and their goals in potentially providing temporary pain relief and allowing rehabilitation. Maximum recommended opioid doses and conversions between opioids are also presented.
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This document discusses several issues related to spine imaging. It covers the importance of radiation exposure from various imaging modalities like CT and highlights strategies to reduce radiation dose. Guidelines for imaging low back pain recommend no imaging for non-specific back pain but imaging if neurological deficits are present or specific causes are suspected. The document reviews imaging modalities like X-ray, bone scan, CT and MRI and what each shows. It provides details on MRI sequences and appearances of common spine findings.
Non-operative management for common back conditions
Lumbar disc herniation and stenosis are common causes of low back pain that often improve without surgery. Post-surgery rehabilitation focuses on education, low-impact exercises, and a gradual return to normal activities. Key goals include reducing pain and improving function to allow patients to return to work and daily life. Appropriate exercises target the lumbar spine, hips, and core muscles while avoiding positions that increase pain. Outcomes are best with a multidisciplinary approach including exercise prescription managed by a physiotherapist or exercise physiologist.
Patient cases
Dave is a 38-year old factory worker who presents with worsening back pain that has failed to improve with rest, over-the-counter medications, and a prescription for Endone. He wants advice on his diagnosis, pain management options, submitting a workers' compensation claim, and the possibility of surgery. A comprehensive assessment and multidisciplinary approach is needed to properly manage Dave's chronic back pain.
Pain management
This document discusses interventional pain procedures for chronic pain, including epidural injections, facet joint injections, medial branch blocks, and radiofrequency nerve ablation. It provides details on how each procedure is performed, when they are appropriate, and their potential benefits which include temporary pain relief and allowing patients to progress in rehabilitation. It also covers guidelines for opioid prescribing for chronic pain, including maximum recommended doses, conversion between opioid medications, requirements for authorities to prescribe, and factors to consider in opioid trials and maintenance therapy.
Non-operative treatment for common back conditions
Lumbar disc herniation and stenosis are common causes of low back pain that often improve without surgery. Post-surgery rehabilitation focuses on education, low-impact exercises, and a gradual return to normal activities. Key goals include reducing pain and improving function to allow patients to return to work and daily life. Appropriate exercises target areas like the lumbar spine, hips, and core to improve mobility and reduce recurrence, while avoiding movements that increase pain. Outcomes are best with a multidisciplinary approach including exercise prescription tailored to individual needs and abilities.
Lumbar Stretching
The document describes an exercise program for lumbar stretching rehabilitation. It includes 18 different stretching exercises targeting the lower back and hips. The exercises involve movements such as rolling the knees from side to side, bringing the bent knee towards the chest, tightening stomach muscles to lift the bottom, rocking backwards on hands and knees, and rotating the leg outwards while pulling it towards the chest. Each exercise provides instructions on body position, movement, and number of repetitions.
Lumbar Stabilisation
The document outlines an exercise program for lumbar stabilization rehabilitation. It provides 15 different exercises that involve contracting the transversus abdominis muscle to stabilize the spine. Each exercise lists instructions on positioning, muscle activation, and repetitions. The goal is to perform the full series of exercises while maintaining control of the lower back and pelvis.
Pain diagram and questionnaire
The document contains a pain diagram and questionnaire for a patient to report their back pain. The pain diagram has the patient mark areas of pain and tingling. Two pain scales have the patient rate their average back and leg pain in the past week from 0 to 10. The back pain questionnaire has 10 sections for the patient to select the statement that best describes how their back pain affects daily activities like personal care, lifting, walking, sitting, standing, sleeping, social and work life, and traveling.
Rehabilitation for back pain
This document provides guidance on rehabilitation for non-operative and operative back pain. It discusses assessing abnormalities and treating to correct them. For severe back pain, it recommends reducing pain and inflammation through comfort positions, movement, medications, modalities, and exercise away from aggravation. For sub-acute back pain, it recommends manual therapy, restoring range of motion and flexibility/strength training. Post-episode, it recommends modifying activities, correcting biomechanical abnormalities, and implementing a home exercise regime. Core stability and stabilization exercises are emphasized for retraining deep muscles to maintain functional stability. Post-operative rehabilitation focuses on early mobility, exercises in neutral spine, and functional control prior to discharge with a home program.
Interventional Procedures and Opioids
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Dr Brendan Moore — Pain Medicine Specialist Physician
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This Unbearable Pain
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Event:
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1) The document discusses appropriate imaging for back pain, describing different imaging modalities like X-rays, CT scans, bone scans, and MRI.
2) It categorizes back pain into 3 groups: nonspecific low back pain, back pain associated with radiculopathy, and back pain associated with a specific cause needing prompt evaluation.
3) Guidelines recommend triaging patients into these 3 categories and only imaging those with red flags, severe/progressive neurological symptoms, or if considering surgery/injections. Imaging is not recommended for nonspecific back pain.
Surgery for Lower Back Pain
This document discusses different types of back surgery for low back pain, including discectomy and spinal fusion. It provides details on discectomy for disc herniation, including causes, symptoms, prerequisites for surgery, expected outcomes, and the surgical procedure. For spinal fusion, it notes the procedure is generally only good for low back pain if there is a specific diagnosis, clearly defined pain source, suitable patient candidate without psychosocial factors, and an appropriate surgical technique is used to address the underlying pathology. Results are not as good for fusion compared to discectomy or for non-specific low back pain. The document also discusses factors that make a patient suitable or unsuitable for fusion surgery.
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Operative treatment for common back conditions
- 1. Surgery for degenerative conditions of the lumbar spine Dr Paul Licina – Spine Surgeon
- 6. MISCONCEPTIONS surgery is a last resort weakness doesn’t improve more trouble in the future these get beDer by themselves
- 7. THE PERFECT INDICATION HISTORY • pain for six weeks • leg pain > back pain • radicular pain EXAMINATION • nerve compression signs • nerve tension signs INVESTIGATIONS • MRI shows concordant herniation
- 8. • 35 y.o. male • 6 week history of severe sciaJca • numbness in S1 distribuJon • unable to single heel raise on right • right calf wasJng • right SLR limited to 15°
- 11. INDICATIONS FOR EARLIER SURGERY HISTORY • intolerable pain EXAMINATION • functional weakness INVESTIGATIONS • MRI shows huge herniation
- 12. • 33 y.o. female • 6 week history of severe sciaJca • bladder dysfuncJon and perineal numbness for 2 days • too painful for complete assessment • reduced bilateral SLR
- 13. INDICATIONS FOR STEROID INJECTION HISTORY • moderate pain for less than six weeks • nonradicular pain EXAMINATION • no positive supporting findings INVESTIGATIONS • MRI shows small herniation
- 14. • 42 y.o. female • 4 week history of sciaJca • iniJally incapacitaJng, now improving • no numbness, weakness or reflex loss • right SLR limited to 45°
- 18. SPINAL STENOSIS narrowing of the spinal canal with nerve compressionWhat is it ? leg pain and neurogenic claudication What does it cause ?
- 19. SPINAL STENOSIS when symptoms severeWhen do we operate ? SURGERY IN THE FORM OF DECOMPRESSION nonoperative treatment unsuccessful Why do we operate ?
- 22. SPINAL STENOSIS stenosis with instability • degenerative spondylolisthesis • degenerative scoliosis When do we add fusion ? SPONDYLOLISTHESIS SCOLIOSIS
- 23. Aetiology • due to degeneration of facet joint • facet joint stability fails and L4 slips forward on L5 • leads to spinal stenosis DEGENERATIVE SPONDYLOLISTHESIS
- 27. DEGENERATIVE SCOLIOSIS Aetiology • due to asymmetric degeneration of disc and facet joint • vertebral tilt leads to spinal deformity and accelerated degeneration • associated spinal stenosis
- 32. Thank you