Lumbar Pathology

How are lumbar injuries defined?

Generally defined as injuries occurring below the level of the 12th rib and above the inferior gluteal folds, with or without leg pain

Red Flags in Lumbar Pain (7)

• Oncologic

• Infectious

• Gastrointestinal – perforated bowel, pancreatitis

• Genitourinary – endometriosis, prostatitis, pelvic inflammatory disease

• Rheumatologic

• Vascular – aortic aneurysm

• Renal – abscess, infection, kidney stone

Muscle Strain

• Dx: Commonly involves QL, erector spinae, semispinalis, multifidus

• MOI: acute forceful concentric contraction or excessive eccentric load

• Symptoms: sharp pain and tenderness

Zygapophyseal (Facet) Joint Sprain

• Dx: facet joint capsule injury

• MOI: acute or overuse

• Symptoms: pain just off midline, can refer down to posterior thigh

Facet Joint Syndrome

• Dx: Facet joint surface/capsule breakdown

• MOI: Overuse

• Symptoms: Refer to posterior thigh, Pain worse in the morning, better with movement, Pain with extension

Lumbar Spinal Stenosis

• Dx: Narrowing of spinal canal or space where nerve roots travel

• MOI: Overuse, degenerative

• Symptoms: Pain with walking and standing, Radiculopathy

Disc Herniation

• Dx: Protrusion/extrusion/sequestration of disc into nerve

• MOI: Acute or overuse

• Symptoms: Radiating pain, Pain with flexion

Schmorl’s Node

• Dx: Disc protrudes into endplate of vertebrae

• MOI: Axial loading or chronic degeneration

• Symptoms: Asymptomatic or low back pain

Lumbar Spondylosis

• Dx: Degeneration of discs/bony structures

• MOI: Overuse

• Symptoms: Low back and leg pain, Relief by sitting or laying supine, aggregated by walking and standing

Degenerative Disc Disease

• Dx: Decreased disc space, loss of fluid, annular tears

• MOI: Overuse

• Symptoms: Can cause radiculopathy, low back pain

Piriformis Syndrome

• Dx: Piriformis muscle injury that leads to sciatic nerve irritation

• MOI: Overuse, acute

• Symptoms: Pain, tenderness in gluteal region, can radiate down, Likely no neurological deficits

Spondylolysis

• Dx: Pars interarticularis fracture

• MOI: Repetitive extension and rotation

• Symptoms: Hyperlordosis, Insidious onset, pain with extension

Spondylolisthesis

• Dx: Slippage of vertebrae

• MOI: Often accompanies spondylolysis

• Symptoms: Pain with extension

Burst fracture

• Dx: Anterior and middle column fx

• MOI: trauma, axial overload, rapid flexion (seatbelt injury), extreme rotation or sheer

• Symptoms: pain, neurological deficits, weakness, loss of function

Wedge fracture

• Dx: Anterior column fx

• MOI: trauma, axial overload, rapid flexion (seatbelt injury), extreme rotation or sheer

• Symptoms: pain, neurological deficits, weakness, loss of function

Chance fracture

• Dx: middle and posterior entirely through the bone

• MOI: trauma, axial overload, rapid flexion (seatbelt injury), extreme rotation or sheer

• Symptoms: pain, neurological deficits, weakness, loss of function

Coccyx fracture/dislocation

• Dx: fx

• MOI: backward fall, childbirth

• Symptoms: tenderness and pain, sitting affected, no neurological deficits

Ankylosing spondylitis

• Dx: inflammatory condition with genetic predisposition to SI Joint, facet joints, vertebrae

• MOI: Ossifications lead to fusion

• Symptoms: Chronic low back pain and stiffness, Pain with static movements

Cauda equina syndrome

• Dx: disruption of lumbosacral nerves

• MOI: can be acute or gradual, can be caused by virtually any lumbar injury if severe enough

• Symptoms: Saddle anesthesia