1. Lumber Spine Assessment Ahmed alhowimel,MSc.PT

2. Screening…  Red Flags. Means serious underlying condition that require more medical investigation like Cancer, Fracture etc. Each case should be asked special questions to clear the presence of Red flags. Asking about Weight loss in the last 3 months could guide diagnosing cancer.

3.  Asking about Trauma, could raise the attention toward Fractures.  Clinically any case with: 1. Saddle loss of sensation 2. Loss of motor control 3. Bowl/ bladder dysfunction Should be referred to Emergency.

4.  Yellow Flags: are a psychosocial factor that shown to be a high indicator of chronicity. Yellow flags can relate to the patient’s attitudes and beliefs, emotions, behaviors, family, and workplace.

5.  Example of Yellow flags: 1. Beliefs that pain and activity are harm. 2. Fear avoidance behavior. Most Common Outcome Measures: Fear Avoidance Beliefs Questionnaire. Tampa Questionnaire.

6. Case number one  A 32-year-old male presented to a medical aid station in Iraq with a history of 4 weeks of insidious onset and recent worsening of low back, left buttock, and posterior left thigh pain. He denied symptoms distal to the knee, paresthesias, saddle anesthesia, or bowel and bladder function changes. At the initial examination, the patient was neurologically intact throughout all lumbosacral levels with negative straight-leg raises. He also presented with severely limited lumbar flexion active range of motion, and reduction of symptoms occurred with repeated lumbar extension.

8.  At the follow-up visit, 10 days later, he reported a new, sudden onset of saddle anesthesia, constipation, and urinary hesitancy, with physical exam findings of right plantar flexion weakness, absent right ankle reflex, and decreased anal sphincter tone. No advanced medical imaging capabilities were available locally. Due to suspected CES, the patient was medically evacuated to a neurosurgeon and within 48 hours underwent an emergent L4-5 laminectomy/decompression. He returned to full military duty 18 weeks after surgery without back or lower extremity symptoms or neurological deficit

10. Case Number Two 26 y/o male referred from neuro-surgery was c/o pain in L anterior and inner thigh area since 3 years. No specific reason at onset of problem Agg. Factor: Leg crossing On floor sitting not including prayer position Difficulty with walking>15 min & inability to run Easing Factor: Rest and avoiding these positions MRI done outside: L3-L4, L4-L5 disc protrusion without nerve root compression

11. Obs: L hip AROM: Flex = 100IR/ER < 10 R hip AROM: Flex = 130IR/ER > 30 FABER test (+ve) Impingement (quadrant) test (+ve) unremarkable gait pattern slouched sitting posture Lx AROM: Flex. √√Ext. Mod LOMR&L SF Slump/SLR No neuro. deficit Accessory  L1-S1:, stiff