Jeffrey Turner SPT, CSCS

Junsik Yoon SPT

5th most common condition

~25% adults report LBP w/in past 3 months

Prevalence of 70% over the course of one’s life

>85% cannot be reliably attributed to a specific disease or abnormality

Classified into 3 broad categories:

1. Nonspecific LBP

2. Nerve Root Syndrome (CES, etc.)

3. Serious Spinal Pathology

Images Courtesy of www.ericcressey.com

Less common than nonspecific

Potentially disabling condition

Most often caused by acute lumbar disc herniation

Commonly between ages of 30 – 55

Related to:

Radiculopathy

Spinal Stenosis

Cauda Equina Syndrome

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Rare and devastating condition

Prevalence of ~0.04% of all patients presenting w/ LBP

“True neurologic emergency”

Rapid clinical progression

For optimal prognosis:

Early recognition/diagnosis

Immediate surgical referral

Recommended w/in 48 hours of Dx

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32 year old male presented to a PT at a medical aid station in Iraq.

Convoy machine gunner

Prolonged periods of standing >8 hrs

Wearing equipment up to ~80 lbs

4 week history of insidious onset and recent worsening of:

Low back pain

Left buttock pain

Posterior left thigh pain

Goal: Decrease pain during work

Images Courtesy of www.defense.gov

Pain: 4/10 resting and 7/10 at worst

Hx: 3-4 prior occurrences of LBP

Physical Exam:

Neurologically intact, and negative SLR

Limited lumbar flexion AROM

Reduction of Sx w/ lumbar extensions

Findings consistent w/ nonspecific LBP

No red flag signs or symptoms

Treatment:

Prescribed extension-oriented exercises

Prescribed NSAIDs for pain

Patient education

New Symptoms:

Saddle anesthesia, LE paresthesia constipation, and urinary hesitancy.

Physical Exam:

Right plantar flexor weakness, absent right ankle reflex, and decreased anal sphincter tone.

Findings consistent w/ CES

Referral:

Medically evacuated to neurosurgeon

L4-5 Laminectomy/decompression w/in 48 hours of CES diagnosis

Returned to full military duty 18 weeks after surgery without back or lower extremity symptoms or neurological deficits.

Demonstrates the importance of medical screening.

Demonstrates the importance of immediate referral to surgical specialties when CES is suspected.

Rapid intervention offers the best prognosis.

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Spinal cord ends between vertebrae L1 & L2

Originates after Conus Medullaris

L2 to S5 nerve roots looks like horse’s tail

Includes motor nerves, sensory nerves and parasympathetic innervation of the bladder

Images Courtesy of Clinically Oriented Anatomy

Compressive causes

Herniated lumbosacral disc

Spinal stenosis

Spinal neoplasm

Fracture of vertebrae

Non-compressive causes

Ischemia

Infection

inflammation

Image Courtesy of www.publichealthwatchdog.com

Images Courtesy of www.publichealthwatchdog.com

Making a thorough evaluation

Continually monitoring patient’s status throughout the patient management

Acting appropriately when conditions emerge that requires immediate referral

Image Courtesy of www.bu.edu

Crowell MS, Gill NW. Medical Screening and Evacuation: Cauda Equina Syndrome in a Combat Zone. J Orthop Sports Phys Ther. 2009; 39(7):541-549.

Moore KL, Dalley AF, Agur AMR, et al. Clinically Oriented Anatomy 7th Edition. Lippincott Williams & Wilkins; 2013.