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Examination and Treatment of the Lumbar Spine

Physical Examination. HistoryMechanism onset of symptomsPQRSTFamily History (Genetic Twin Studies)Smoking. Physical Examination. Range of motionMuscle strengthAtrophySensory examSpecialized tests. Imaging Studies. Upright radiographsFlexion/Extension viewsAdvanced imagingMRICTBone scan

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Examination and Treatment of the Lumbar Spine

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    1. Examination and Treatment of the Lumbar Spine William L. Tontz, Jr., MD

    2. Physical Examination History Mechanism onset of symptoms PQRST Family History (Genetic Twin Studies) Smoking

    3. Physical Examination Range of motion Muscle strength Atrophy Sensory exam Specialized tests

    4. Imaging Studies Upright radiographs Flexion/Extension views Advanced imaging MRI CT Bone scan

    5. Aging Disc Boden study Disc Herniation Spinal Stenosis Segmental Instability Discogenic

    6. Herniated Disc Annular tear Posteriolateral herniation nucleus pulposus Pain Neurologic deficit Improvement

    7. Spinal Stenosis Pathophysiology Symptoms Low back pain Claudication Leg pain Weakness Co-existent cervical stenosis

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

    9. Discogenic “Internal disc disruption” Diagnostic dilemma Radial tearing in annulus fibrosis Advanced imaging MRI Discogram

    10. Spinal Fractures Denis column classification Vacarro/Anderson classification Compression fractures Traumatic Pre-existing Pathologic Burst Fractures

    11. Treatment Non-operative Calendar Medications Physical therapy Injections Epidurals

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

    13. Case Studies

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