hazem eissa, md - education · hazem eissa, md . introduction ... bertolotti’s syndrome
TRANSCRIPT
HAZEM EISSA, MD
Introduction One of the most common reason for healthcare & lost
work $$$
The majority will suffer with LBP at some point in their life
Variable etiologies
Etiology Injury
Degenerative disease
Psychological
Tumor
Infection
Idiopathic
Anatomy
Sagittal graphic of lumbar spine through neural foramen shows position of exiting nerves within the superior aspect of the neural foramen. The segmental vessels are located inferior to the exiting nerve. Neural foramina are bounded anteriorly by dorsal vertebral body above and intervertebral disc below, pedicle above and facet joint and ligamentum flavum posteriorly. The lumbar vertebral bodies are large with a large intervening intervertebral disc. The pedicles are directed posteriorly, giving rise to large superior and inferior articular facets.
Anatomy
Pain Generators
Facet Joint Disease
Degenerative
Disc
Sacroiliac Joint Dysfunction
Soft Tissue
Compression fracture
(Radicular)
History Acute or chronic
Functional impact
Location of pain
Type of pain
Radiation or referral patterns
Time of pain
Associated symptoms
Previous treatments
Physical Exam Gait/cadence
Toe walking
Muscle strength
Reflexes
Provocative maneuvers.
Management Physical therapy
Lifestyle/ergonomic changes
Medication
Intervention depending on etiology/pain generator
Facet/Zygapophysial joint Pain Injections intraarticular or medial branch
Radiofrequency ablation/Rhizotomy
Facet Joint Injection
Medial Branch RFA
Facet Synovial Cyst May compress surrounding structures
Aspiration/lysis/injections
In recurrent cases surgical management
Interspinus Ligament Spinous processes (Baastrup’s Dz) Local steroid injection
Compression fracture Always check & manage osteoporosis
Conservative management (PT, Pain meds, Bracing)
Interventions Kyphoplasty/vertebroplasty (better results expected in acute & subacute fractures)
What happens if not treated?
Kyphoplasty
Sacral Fractures Conservative (same as Compression fractures)
Sacroplasty for alar fractures
Sacroiliac dysfunction Conservative (PT, belt, meds)
Injection
Radiofrequency ablation
Surgical fusion
Bertolotti’s Syndrome Pseudoarticulation between L5 & sacral/iliac bones
Injection
Spinal Stenosis Classic presentation
PT and medications
ESI
Surgical decompression
Lumbar Radiculopathy Does NOT usually cause LBP
Specific radicular dermatomal pattern
ESI
Surgical management
Epidural Steroid Injections
Caudal ESI with Catheter
Discogenic pain Sometimes hard to manage
Clinical picture
ESI, Intradiscal diathermy/regenerative medicine injections
Spinal Cord Stimulator Indications
New technology
Thank you