Overview of the case studies
Cervical and lumbar spine
chapter 22
Prof.dr. G. Stassijns
Physical Medicine and Rehabilitation
Medical history
• 42-year-old teacher
• Acute back pain after picking up a paper
• The pain is located at the right side, lumbar region
Case x not in book • Moving worsens the pain
Group I and II • Resting relieves the pain
, Questions II
Questions I • Q5: What is the evolution of low back pain without treatment?
• Q6: What is the most common cause of low back pain?
• Q7: How do you treat low back pain?
• Q1: How frequent is low back pain?
• Q8: What is the relevance of radiological examinations into low
• Q2: Which type of pain is described in the case, which type of pain is
back pain?
most common in low back pain and which questions are important to
exclude other types of pain? • Q9: Which repetitive movements induce disc or facet
degenerative changes and how can you differentiate both
• Q3: In which spinal regions would you expect most degenerative
structures clincally as possible causes of LBP?
changes and why?
• Q4: Which red flags would make you suspect that the low back pain
suggests a severe disease?
80% krijgt ooit pijn in LWK Q7: analgetica, oefeningen (core stability)
soorten pijn = neurogene, psychogene, oncogene, mechanische, inflammatoire --> operatie enkel nodig bij motorische uitval
meest in: Q8: Radiologisch onderzoek:
- LWK want grootste gewichtsdragend deel - altijd linken aan kliniek
- CWK door veel beweging - na 40j = bijna iedereen degeneratie --> geen relevantie
rode vlaggen= - discus w zwart op RX
- nachtelijke pijn - belangrijk ter exclusie v rode vlaggen
--> continu (onco) of bij beweging (mechanish) --> doen bij ptn <18 en >50jr
- gewichtsverlies: onco Q9: discusdegeneratie = door druk op ant zijde
- systemische cortico's
80% aspecifiek Medical history
meestal zelflimiterend: geruststellen, opvolgen, pt activeren, symptomatische behandeling
follow-up na 2w
• 48-year-old man
• For 1 year: neck pain radiating down the right arm, some tingling in the
thumb
Group III and IV • Disturbs his sleep at night
• Conservative treatment, physiotherapy, cervical traction, acupuncture
Case 31 did not decrease the pain levels
, Clinical examination Questions III
• Pain intensified by lateral cervical rotation to the right and vertical
compression of the head
• Subtle sensory change in the thumb and index finger • Q1: Which structures may compress the nerve roots?
• No detectable weakness
• Biceps reflex is sluggish in comparison with the left, other reflexes were • Q2: At which level in the case study does the pathology take place?
present and normal
• Clinical examination of the lower limbs is normal • Q3: Between which vertebrae are C6 and L1 located?
• Gait is normal
• Q4: Which examination would you consider and what is the clinical
relevance of any anomalies that emerge from this examination?
Q1: compressie door herniatie, osteofyten van OA
Q2: C5-6-7 T1: reflexen kennen+ dermatomen en myotomen KOE
Q4: spurling: rotatie en flexie geeft irritatie van wortel C5
Q5: geen manipulatie bij acute hernia!!!!
--> prognose: meestal spontane genezing
Q6: operatie aan radices bij paralyse
Questions IV
• Q5: Which treatment is advisable? What is the prognosis?
Group V
• Q6: Is operative treatment ever necessary?
Case y not in book
• Q7: How would an operation be performed?
• Q8: What is the most common differential
diagnosis for sensory changes in the thumb
and index finger?
,
Medical history Questions group V
• A 35-year-old woman had a car accident last week while she was waiting • Q1: What is the differential diagnosis?
at the traffic lights. Immediately after the accident she did not have any • Q2: Would you send this patient to the emergency department?
important symptoms.
• Q3: Which examinations would you order?
• She gradually developed pain in the neck going down the arms and
tingling of the fingers. She complains of headaches and concentration • Q4: Could you think of any causes, other than medical, that slow down
problems. the recovery?
Medical history
• 15-year-old girl
• Gymnast and ballet dancer
• Back pain for 1 year
Group VI
• For 3 months: Pain radiating from her back, via the buttock to the
Case 34 upper thigh, the lateral aspect of the right leg and the dorsum of the
right foot
• Vigorous activities worsen the pain, lying down relieves the pain
• No sphincter disturbances
Cervical and lumbar spine
chapter 22
Prof.dr. G. Stassijns
Physical Medicine and Rehabilitation
Medical history
• 42-year-old teacher
• Acute back pain after picking up a paper
• The pain is located at the right side, lumbar region
Case x not in book • Moving worsens the pain
Group I and II • Resting relieves the pain
, Questions II
Questions I • Q5: What is the evolution of low back pain without treatment?
• Q6: What is the most common cause of low back pain?
• Q7: How do you treat low back pain?
• Q1: How frequent is low back pain?
• Q8: What is the relevance of radiological examinations into low
• Q2: Which type of pain is described in the case, which type of pain is
back pain?
most common in low back pain and which questions are important to
exclude other types of pain? • Q9: Which repetitive movements induce disc or facet
degenerative changes and how can you differentiate both
• Q3: In which spinal regions would you expect most degenerative
structures clincally as possible causes of LBP?
changes and why?
• Q4: Which red flags would make you suspect that the low back pain
suggests a severe disease?
80% krijgt ooit pijn in LWK Q7: analgetica, oefeningen (core stability)
soorten pijn = neurogene, psychogene, oncogene, mechanische, inflammatoire --> operatie enkel nodig bij motorische uitval
meest in: Q8: Radiologisch onderzoek:
- LWK want grootste gewichtsdragend deel - altijd linken aan kliniek
- CWK door veel beweging - na 40j = bijna iedereen degeneratie --> geen relevantie
rode vlaggen= - discus w zwart op RX
- nachtelijke pijn - belangrijk ter exclusie v rode vlaggen
--> continu (onco) of bij beweging (mechanish) --> doen bij ptn <18 en >50jr
- gewichtsverlies: onco Q9: discusdegeneratie = door druk op ant zijde
- systemische cortico's
80% aspecifiek Medical history
meestal zelflimiterend: geruststellen, opvolgen, pt activeren, symptomatische behandeling
follow-up na 2w
• 48-year-old man
• For 1 year: neck pain radiating down the right arm, some tingling in the
thumb
Group III and IV • Disturbs his sleep at night
• Conservative treatment, physiotherapy, cervical traction, acupuncture
Case 31 did not decrease the pain levels
, Clinical examination Questions III
• Pain intensified by lateral cervical rotation to the right and vertical
compression of the head
• Subtle sensory change in the thumb and index finger • Q1: Which structures may compress the nerve roots?
• No detectable weakness
• Biceps reflex is sluggish in comparison with the left, other reflexes were • Q2: At which level in the case study does the pathology take place?
present and normal
• Clinical examination of the lower limbs is normal • Q3: Between which vertebrae are C6 and L1 located?
• Gait is normal
• Q4: Which examination would you consider and what is the clinical
relevance of any anomalies that emerge from this examination?
Q1: compressie door herniatie, osteofyten van OA
Q2: C5-6-7 T1: reflexen kennen+ dermatomen en myotomen KOE
Q4: spurling: rotatie en flexie geeft irritatie van wortel C5
Q5: geen manipulatie bij acute hernia!!!!
--> prognose: meestal spontane genezing
Q6: operatie aan radices bij paralyse
Questions IV
• Q5: Which treatment is advisable? What is the prognosis?
Group V
• Q6: Is operative treatment ever necessary?
Case y not in book
• Q7: How would an operation be performed?
• Q8: What is the most common differential
diagnosis for sensory changes in the thumb
and index finger?
,
Medical history Questions group V
• A 35-year-old woman had a car accident last week while she was waiting • Q1: What is the differential diagnosis?
at the traffic lights. Immediately after the accident she did not have any • Q2: Would you send this patient to the emergency department?
important symptoms.
• Q3: Which examinations would you order?
• She gradually developed pain in the neck going down the arms and
tingling of the fingers. She complains of headaches and concentration • Q4: Could you think of any causes, other than medical, that slow down
problems. the recovery?
Medical history
• 15-year-old girl
• Gymnast and ballet dancer
• Back pain for 1 year
Group VI
• For 3 months: Pain radiating from her back, via the buttock to the
Case 34 upper thigh, the lateral aspect of the right leg and the dorsum of the
right foot
• Vigorous activities worsen the pain, lying down relieves the pain
• No sphincter disturbances
