Spinal metastases
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Presented by: Dr Maree Colosimo – Oncologist Dr Paul Licina – Spine Surgeon Event: Challenges in the Ageing Spine - 2014
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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.
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Dr David Lisle — Radiologist
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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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1. Physiotherapy plays an important role in both antenatal and postnatal care by addressing musculoskeletal issues, promoting healthy lifestyles, providing education on posture, exercise and preparing for labor.
2. During antenatal care, physiotherapists help prevent and treat back pain and pelvic girdle pain, teach exercises to strengthen the pelvic floor, and provide relaxation techniques and advice for maintaining mobility.
3. Postnatal physiotherapy can help with common issues like pelvic floor dysfunction and back pain, as well as educate mothers on recovering from birth and resuming normal activities.
Physiotherapyinantenatalpostnatalcare 170916144302-converted
1. Physiotherapy plays an important role in both antenatal and postnatal care by addressing musculoskeletal issues, promoting healthy lifestyles, providing education on posture, exercise and preparing for labor.
2. During antenatal care, physiotherapists help prevent and treat back pain and pelvic girdle pain, teach exercises to strengthen the pelvic floor, and provide relaxation techniques and advice for maintaining mobility.
3. Postnatal care involves addressing common issues like diastasis recti, pelvic floor dysfunction, and back pain, as well as ensuring a smooth recovery through continued education and guidance on exercises.
Physiotherapyinantenatalpostnatalcare 170916144302-converted
1. Physiotherapy plays an important role in both antenatal and postnatal care by addressing musculoskeletal issues, promoting healthy lifestyles, providing education on posture, exercise and preparing for labor.
2. During antenatal care, physiotherapists help prevent and treat back pain and pelvic girdle pain, teach exercises to strengthen the pelvic floor, and provide relaxation techniques and advice for maintaining mobility.
3. Postnatal care involves addressing common issues like diastasis recti, urinary incontinence, muscle cramps and back pain through techniques like exercises, electrical stimulation and manual therapy.
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapy plays an important role in both antenatal and postnatal care. During pregnancy, physiotherapists provide education on posture, exercise, and injury prevention. They also teach relaxation techniques to prepare women for labor. Postnatally, physiotherapists help mothers recover physically through an exercise program and treat any musculoskeletal issues. The overall goal is to help women maintain a healthy pregnancy and support their physical recovery after giving birth.
Ogilvie syndrome and a Review of the Pharmacologic Treatment of Constipation
Copy of my slides as a Guest Lecturer at the Midwest Society of Gastroenterology Nurses and Associates, March 2019
Over Active Bladder ‘an enigma’ Dr Jyoti Agarwal Dr Sharda Jain
This document discusses overactive bladder (OAB), a condition that affects quality of life. It defines OAB based on symptoms as a syndrome characterized by urgency, usually with frequency and nocturia, in the absence of infection or other pathology. OAB is common but underreported and undertreated. Treatment involves behavioral modifications, pharmacotherapy such as antimuscarinics or the newer drug Mirabegron, which is better tolerated. While OAB was previously poorly understood, recent research has improved diagnosis and management, though it remains a challenging condition to treat.
Move Over Diamonds, the Pelvic Floor is a Girls' NEW Best Friend
This document discusses the importance of pelvic floor health, especially for women. It provides an overview of common pelvic floor dysfunctions like incontinence, and discusses how pregnancy, childbirth, and exercise can impact the pelvic floor. The document also summarizes how a physical therapist can help treat various pelvic floor issues through techniques like pelvic floor muscle training and dry needling. Maintaining a strong pelvic floor is presented as important for bladder, bowel, sexual health and reducing pain.
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Intestinal obstruction occurs when the contents of the intestine are blocked from passing through due to a partial or complete blockage. It can be classified as mechanical or functional, and partial or complete. The pathophysiology involves proximal dilation and paralysis of the bowel above the obstruction. Causes include adhesions, hernias, tumors, and impacted stool. Diagnosis involves evaluating symptoms of pain, vomiting, distention and constipation along with imaging tests. Management consists of resuscitation, monitoring, conservative treatment with NG tubes and IV fluids or surgical intervention if signs of strangulation or perforation are present.
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A 60-year old diabetic male presented with progressive walking difficulty over 1 year and slurred speech for 10 months. Examination found masked face, mild cognitive impairment, spastic dysarthria, vertical gaze palsy, and unstable broad-based gait. MRI showed atrophy of the dorsal midbrain. He was diagnosed with progressive supranuclear palsy and diabetes. Treatment included medications, physiotherapy, and speech therapy, with some improvement in instability and falls over 2 months.
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.
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This document summarizes long-term issues in spinal cord injuries. It discusses types of spinal cord injuries such as complete or incomplete, and paraplegia or quadriplegia. It then outlines complications including autonomic dysreflexia, deep vein thrombosis, orthostatic hypotension, urinary tract infections, spasticity, osteoporosis, heterotrophic ossification, respiratory issues, pressure ulcers, pain, and sexual dysfunction. It provides information on managing each complication and concludes with describing functional outcomes based on the level of spinal cord injury.
NERVOUS SYSTEM CASE PRESENTATION.pptx
This case presentation describes a 49-year-old male patient who presented with gradually progressive weakness and loss of sensation in his right upper and lower limbs over the past two years. On examination, he had decreased strength, increased tone, absent sensation, and impaired coordination on the right side with similar but milder findings beginning on the left side. Based on the history and examination, the patient may have a compressive myelopathy, myeloradiculopathy, or other neurological condition affecting the spinal cord and nerves.
Ex in post natal period
1. The document provides information on exercise prescription in the post-natal period, including detailing the post-partum phases, common musculoskeletal and neurological impairments, and appropriate physical therapy interventions.
2. Recommendations include encouraging early mobility to reduce risks, pelvic floor muscle exercises for pain relief and strengthening, and stabilization exercises progressed cautiously based on impairments. Modalities like ice, ultrasound, and electrical stimulation may assist with pain and dysfunction.
3. Physical therapy can effectively treat common post-natal issues like low back pain, pelvic girdle pain, and urinary incontinence when appropriate exercises and modalities are implemented safely based on each woman's individual presentation.
Similar to Spinal metastases (20)
Case in pediatric gastroenterology - constipation.pptx
Case in pediatric gastroenterology - constipation.pptx
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Physiotherapyinantenatalpostnatalcare 170916144302-converted
Ogilvie syndrome and a Review of the Pharmacologic Treatment of Constipation
Ogilvie syndrome and a Review of the Pharmacologic Treatment of Constipation
Over Active Bladder ‘an enigma’ Dr Jyoti Agarwal Dr Sharda Jain
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Move Over Diamonds, the Pelvic Floor is a Girls' NEW Best Friend
Move Over Diamonds, the Pelvic Floor is a Girls' NEW Best Friend
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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
- The presence of leg pain may predict better outcomes for WorkCover fusion patients than significant back pain
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.
Imaging for back pain
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.
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.
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.
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.
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.
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.
Discectomy Activity Guide
Presented by:
Stephen Boyd — Physiotherapist
Event:
GP Education Day - 2013
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.
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.
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.
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
Presented by:
Dr Brendan Moore — Pain Medicine Specialist Physician
Event:
GP Education Day - 2013
This Unbearable Pain
Presented by:
Dr Brendan Moore — Pain Medicine Specialist Physician
Event:
GP Education Day - 2013
Appropriate imaging for 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.
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- 1. Spinal metastases Dr Paul Licina – Spine surgeon Dr Maree Colosimo – Oncologist
- 2. Case presentation History • 61 yo teacher • Previously fit and active • Excellent medical health • Developed severe left mid-back pain radiating to abdomen • Saw GP after 4 weeks
- 6. • Commenced Endone • Went on cruise • Developed worsening back pain and bilateral leg pain • Returned home early • Developed difficulty with bowel and bladder control • Seen at Caboolture Hospital – analgesia and physiotherapy
- 8. Presentation • Malaise, anorexia, weight loss • Severe back and leg pain esp at night despite narcotic analgesia • Difficulty mobilising • Perineal numbness • Difficulty passing urine
- 9. Examination • Pale and unwell • Incapacitating pain at rest • Only walking a few steps unaided • No significant lower limb neurological deficit
- 12. Discussion
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