GC226 Lumbar Spine Pathology: Part B
Lumbar spine pathology Part B encompasses conditions such as lumbar disc herniation, spinal stenosis, spondylolisthesis, and cauda equina syndrome that cause low back pain, radiculopathy, or neurological deficits due to structural or degenerative changes in the lumbar region.
Physical Examination of the Lumbar Spine — GC 226 Lumbar Spine Pathology Part B
The Big Idea: This lecture teaches you the systematic physical examination of a patient presenting with back pain or suspected lumbar spine pathology. It follows the classic orthopaedic "Look, Feel, Move" framework, with the critical additions of neurological assessment (including SLR), reflexes (to rule out cord lesions), and vascular examination. The lecture is delivered by Professor Jason Pui Yin Cheung and forms Part B of a multi-part series (GC 226). [1]
Learning Objectives (from GC 226 Part A, applicable across the series) [2]:
- Understand lumbar spine terminology
- Know examination skills for the lumbar spine
- Make use of investigations to diagnose specific conditions
- Understand how nonoperative vs operative decisions are made
- Know common and rarer diseases clinicians encounter
How this fits into clinical practice and exams: The physical examination is the bridge between history (Part A) and investigations/management (Parts C–G). In exams, you will be asked to describe examination findings that localise the lesion, differentiate neurogenic from vascular claudication, and recognise red flag signs. OSCE stations on lumbar spine examination are common, and written papers test interpretation of examination findings (e.g. "what nerve root is affected given these findings?").
1. LOOK (Inspection)
"Look" encompasses deformity assessment, standing posture, listing, muscle atrophy, assessment of spine movement, flexibility, and gait. [1]
Before you touch the patient, you observe. The patient should be standing, adequately exposed (underwear only), viewed from the front, side, and behind [3].
What to look for:
- Kyphosis (increased thoracic curvature) or loss of lumbar lordosis — loss of the normal inward lumbar curve is a key sign of paravertebral muscle spasm or disc pathology. In sciatica, patients often have a flattened lumbar spine because the paraspinal muscles go into protective spasm to splint the painful segment. [3][4]
- Scoliosis — lateral curvature. Can be "C-shaped" (simple) or "S-shaped" (complex). Important to distinguish structural from functional (antalgic) scoliosis. [3]
- Gibbus deformity — angular kyphosis suggesting vertebral collapse (infection, tumour, osteoporotic fracture).
High Yield — Listing (Sciatic List)
Listing refers to the patient leaning laterally. The lecture specifically distinguishes:
- Lateral lean AWAY from the painful side
- Lateral lean TOWARDS the painful side [1]
This is a critical concept for understanding disc herniation mechanics:
- Lean AWAY from the painful side: This typically occurs when the disc herniation is lateral (axillary) to the nerve root. The patient leans away to open up the foramen and reduce pressure on the nerve.
- Lean TOWARDS the painful side: This occurs when the herniation is medial (shoulder) to the nerve root. The patient leans towards the painful side to move the nerve root away from the disc fragment.
Why this matters: The direction of listing tells you the anatomical relationship of the disc herniation to the nerve root, which is relevant for surgical planning and understanding the pathoanatomy.
- Look at the gluteal muscles, quadriceps, and calf muscles for asymmetry
- Chronic denervation from nerve root compression leads to muscle wasting in the myotomal distribution
- Calf wasting → think S1 root (gastrocnemius/soleus)
- Quadriceps wasting → think L3/L4 root
- Atrophy takes weeks to develop — its presence indicates chronicity
Assess flexibility and active range of motion (AROM) in all directions [1]
| Direction | How to Test | Normal Range | Significance of Limitation |
|---|---|---|---|
| Flexion | Ask patient to bend forward, try to touch toes | Finger-to-floor ≤ 5 cm; Schober's test: ≥ 5 cm increase | Limited in disc disease, ankylosing spondylitis, muscle spasm |
| Extension | Lean backward (with support!) | ~30° | Pain on extension suggests facet joint pathology or spinal stenosis |
| Lateral flexion | Slide hand down outside of leg | ~30° each side | Asymmetric limitation suggests unilateral pathology |
| Rotation | Seated (fixes pelvis), arms folded, rotate trunk | ~40° each side | Less relevant in lumbar spine (mainly thoracic function) |
Schober's Test [3]:
- Mark the midpoint of a line joining both PSIS (approximately L5 spinous process)
- Mark 10 cm above this point
- Ask patient to bend forward maximally
- Measure the increase in distance between the two marks
- Normal: ≥ 5 cm increase. < 5 cm = limitation (classic in ankylosing spondylitis)
- The lecture includes gait as part of the "Look" section [1]
- Observe the patient walking — look for:
- Antalgic gait: shortened stance phase on the painful side
- "Half-shut knife" posture: forward lean with partially flexed back, characteristic of sciatica [4]
- Foot drop gait (steppage gait): high stepping to clear a dropped foot → L5 root lesion
- Trendelenburg gait: pelvic drop on contralateral side → L5 root (gluteus medius weakness)
- Wide-based/spastic gait: think upper motor neuron lesion (cord compression — should not be missed!)
2. FEEL (Palpation)
"Feel" includes tenderness assessment over muscle, spinous process, SIJ, and hip, as well as tone assessment. [1]
Systematic palpation approach:
| Structure | How to Palpate | What It Means |
|---|---|---|
| Spinous processes | Trace from C7 downward, press each one; also percussion with fist [3] | Point tenderness over a spinous process → fracture, infection, tumour, spondylolysis |
| Paraspinal muscles | Palpate bilateral paravertebral muscles | Spasm/tenderness → muscle strain, disc pathology causing protective spasm |
| Sacroiliac joint (SIJ) | Palpate over SIJ area (patient sitting); pelvic springing (patient supine — hands pressing down on bilateral iliac spines) [3] | Tenderness → sacroiliitis (ankylosing spondylitis, mechanical SIJ dysfunction) |
| Hip | Palpate greater trochanter; log-roll hip | Hip pathology can mimic lumbar spine pathology (referred pain) |
Don't Forget the Hip!
A very common exam trap: hip pathology (e.g., osteoarthritis, avascular necrosis) can present as groin pain, buttock pain, or even referred pain down the thigh — easily confused with lumbar radiculopathy. Always examine the hip when assessing the lumbar spine.
- Assess muscle tone in the lower limbs
- Increased tone (spasticity) → upper motor neuron lesion (cord compression above the conus)
- Decreased tone (flaccidity) → lower motor neuron lesion (cauda equina, nerve root)
- This bridges into the neurological examination
3. MOVE (Neurological Examination)
"Move" includes neurology, SLR, and reflexes (to rule out cord lesions). [1]
This is the most clinically important part of the lumbar spine examination. It localises the lesion and determines urgency.
| Root | Key Muscle | Action Tested | How to Test |
|---|---|---|---|
| L2 | Iliopsoas | Hip flexion | Resist hip flexion in seated/supine position |
| L3 | Quadriceps | Knee extension | Resist knee extension |
| L4 | Tibialis anterior | Ankle dorsiflexion | Ask patient to walk on heels |
| L5 | Extensor hallucis longus (EHL) | Great toe dorsiflexion | Resist great toe extension; also hip abduction (gluteus medius) |
| S1 | Gastrocnemius/Soleus (+ peroneus longus/brevis) | Ankle plantarflexion + eversion | Ask patient to walk on toes; single-leg heel raise |
MRC Power Grading (0–5):
| Grade | Description |
|---|---|
| 0 | No contraction |
| 1 | Flicker/trace of contraction |
| 2 | Active movement with gravity eliminated |
| 3 | Active movement against gravity |
| 4 | Active movement against resistance (but reduced) |
| 5 | Normal power |
| Root | Key Sensory Area |
|---|---|
| L2 | Anterior thigh (upper) |
| L3 | Anterior thigh (lower) / knee |
| L4 | Medial leg / medial malleolus |
| L5 | Lateral leg, dorsum of foot, first web space |
| S1 | Lateral foot, sole, behind lateral malleolus |
| S2-S5 | Perianal / "saddle" area |
Test with light touch and pinprick. Always check perianal sensation (saddle area) — this is critical for cauda equina syndrome screening.
SLR is highlighted as a key component of the "Move" section. [1]
Technique [4]:
- Patient supine, relaxed
- One hand behind the heel, one hand above the knee to keep it in extension
- Gradually passively flex the hip, raising the straight leg
- Positive SLR = reproduction of radicular symptoms (pain or paraesthesia BELOW the knee) at 30–70°
- Report the angle at which symptoms are reproduced and the dermatome affected
Why 30–70°?
- Below 30°: The sciatic nerve is not yet under significant tension — pain here is likely from the hip or hamstrings
- 30–70°: This is the range where the sciatic nerve roots (L5, S1) are progressively stretched. A positive test in this range indicates nerve root irritation, usually from disc herniation
- Above 70°: Tension on the nerve is maximal but hamstring tightness, SIJ pathology, or other non-root causes can produce pain
SLR Variants:
| Test | Technique | Significance |
|---|---|---|
| Lasègue sign | Lower the leg 5° from the positive SLR angle, then dorsiflex the ankle → symptoms reproduced | Confirms neural tension (dorsiflexion stretches the sciatic nerve further via the tibial nerve) |
| Crossed SLR (Well Leg Raise) | Raise the CONTRALATERAL (unaffected) leg → reproduces pain on the AFFECTED side | Less sensitive but highly specific for disc herniation (suggests a large or central disc fragment) |
| Femoral stretch test (Reverse SLR) | Patient prone. Extend the hip (or flex the knee) → pain in anterior thigh | Tests L3/L4 root irritation. The femoral nerve is stretched by hip extension. |
High Yield — SLR Interpretation
SLR indicates L5/S1 root irritation. Positive SLR is reproduction of symptoms at 30-70°. Crossed SLR is less sensitive but more specific. [4]
The femoral stretch test is for upper lumbar roots (L2, L3, L4). Do NOT rely on SLR to detect upper lumbar radiculopathy — it will be negative because these roots are not components of the sciatic nerve.
Reflexes: rule out cord lesions [1]
This statement from the lecture is critically important. Reflexes help differentiate:
- Lower motor neuron (LMN) lesion (nerve root / cauda equina): diminished or absent reflexes at that level
- Upper motor neuron (UMN) lesion (spinal cord compression): hyperreflexia BELOW the level + pathological reflexes (Babinski positive, clonus)
| Reflex | Root | How to Test | LMN Lesion | UMN Lesion |
|---|---|---|---|---|
| Knee jerk (patellar) | L3/L4 | Tap patellar tendon | Diminished/absent if L3/L4 root affected | Brisk if cord compression above L3 |
| Ankle jerk (Achilles) | S1 | Tap Achilles tendon with foot dorsiflexed | Diminished/absent if S1 root affected | Brisk if cord compression above S1 |
| Babinski (plantar response) | — | Stroke lateral sole from heel to toe | Flexion (downgoing, normal) | Extension (upgoing = UMN lesion) |
| Clonus | — | Rapid dorsiflexion of ankle | Absent | Sustained clonus (≥3 beats) = UMN |
Why 'Rule Out Cord Lesions' Is Highlighted
The lumbar spine examination must not only detect radiculopathy but also exclude myelopathy. If you find UMN signs in the legs (hyperreflexia, upgoing plantars, spasticity, clonus), the problem is NOT in the lumbar spine — it is a cord lesion, likely cervical or thoracic. This changes the urgency and the investigation pathway dramatically (MRI of the whole spine, not just lumbar). Missing this is a critical clinical error.
Conus medullaris and cauda equina — clinical differentiation:
| Feature | Conus Medullaris | Cauda Equina |
|---|---|---|
| Level | L1-L2 (cord terminates here) | Below L2 (nerve roots only) |
| Pain | Less prominent, more back pain | Severe radicular pain, often bilateral leg pain |
| Motor | Symmetric, less severe weakness | Asymmetric, may be severe |
| Sensory | Saddle anaesthesia (S3-S5) | Saddle + dermatomal loss |
| Reflexes | Ankle jerks may be preserved (S1 above conus) | Ankle jerks lost if S1 roots affected |
| Bladder | Early (retention with overflow) | Late (but can be early if severe) |
| Type | UMN + LMN mixed | Pure LMN |
| Onset | Often sudden | Often gradual |
Cauda equina syndrome: urinary retention, saddle anaesthesia, bilateral lower limb weakness, loss of ankle reflexes — this is a surgical emergency [5][6]
- Per-rectal exam assesses anal tone and voluntary contraction
- Reduced anal tone = suggests cauda equina or conus lesion
- Always test in the context of red flags (urinary retention, saddle numbness, bilateral leg symptoms)
4. CIRCULATION (Vascular Assessment)
The lecture specifically includes a "Circulation" component — vascular assessment. [1]
This is included because vascular claudication must be differentiated from neurogenic claudication (spinal stenosis), and vascular disease can coexist with spinal pathology, especially in the elderly.
Palpate:
- Femoral artery (midinguinal point)
- Popliteal artery (popliteal fossa, knee slightly flexed)
- Posterior tibial artery (behind medial malleolus)
- Dorsalis pedis artery (dorsum of foot, lateral to EHL tendon)
| Feature | Neurogenic Claudication (Spinal Stenosis) | Vascular Claudication (PVD) |
|---|---|---|
| Pain character | Heaviness, aching, paraesthesia in both legs | Cramping, usually calf, sometimes thigh/buttock |
| Onset | Standing or walking | Walking (predictable distance) |
| Relief | Sitting or flexing the spine (e.g., leaning on shopping trolley) | Standing still (no need to sit) |
| Bicycle test | Can cycle (flexed spine opens canal) | Cannot cycle (still requires blood flow) |
| Pulses | Present | Absent or reduced |
| Skin changes | Normal | Hairless, shiny, ulcers, dystrophic nails |
| Walking distance | Variable | Fixed (reproducible) |
| "Park bench to park bench" | Yes — must sit to relieve symptoms [6] | No — can stand still to relieve |
High Yield — Why the Bicycle Test Works
In neurogenic claudication, lumbar flexion opens up the spinal canal (increases the anteroposterior diameter), reducing compression on the cauda equina. This is why patients with spinal stenosis can cycle (flexed posture) but cannot walk far (extended posture). In vascular claudication, the problem is arterial insufficiency — posture is irrelevant, but any exercise that demands blood flow will cause symptoms.
- ABPI < 0.9 = peripheral arterial disease
- If pulses are absent and symptoms suggest claudication, ABPI helps confirm vascular cause
- In exam settings, the vascular examination is often the differentiating step between neurogenic and vascular claudication
| Step | Component | Key Findings | What It Rules In/Out |
|---|---|---|---|
| LOOK | Deformity, posture, listing, atrophy, gait, ROM | Loss of lordosis, sciatic list, foot drop gait | Disc pathology, radiculopathy, stenosis |
| FEEL | Spinous process, paraspinal muscles, SIJ, hip | Point tenderness, spasm, SIJ tenderness | Fracture, infection, AS, hip pathology |
| MOVE | Motor, sensory, SLR, reflexes | Weakness in myotome, sensory loss in dermatome, positive SLR, altered reflexes | Specific root identification, UMN vs LMN |
| CIRCULATION | Pulses, skin, ABPI | Absent pulses, skin changes | Vascular vs neurogenic claudication |
The lecture PDF contains several pages (p3–p7) that are described as "Physical examination" with images. Based on the structure and the vascular slide label: [1]
- Pages 3-5 likely show clinical photographs of: listing (lean away vs towards), muscle atrophy, deformity, and gait patterns
- Page 6 likely demonstrates the SLR test and variants
- Page 7 is labeled "Vascular" — showing pulse palpation points and/or comparison of neurogenic vs vascular claudication
7. Integration with Related Material
- Red flag signs for back pain include: age > 50 or < 20 with new back pain, history of cancer, unexplained weight loss, fever, night pain, progressive neurological deficit, bladder/bowel dysfunction, saddle anaesthesia, immunosuppression, IV drug use, prolonged steroid use [2]
- UMN signs in the legs with back pain = suspect spinal cord compression (above conus)
- This is why the lecture emphasizes "reflexes — rule out cord lesions"
- The examination sequence is designed to be efficient: LOOK (standing) → FEEL (standing then lying) → MOVE (lying) → CIRCULATION (lying) [7]
Exam Intelligence
| Trap | Correct Understanding |
|---|---|
| Positive SLR = any leg pain when raising | NO — positive SLR is specifically pain or paraesthesia BELOW the knee reproduced at 30-70° |
| SLR tests all lumbar roots | NO — SLR tests L5/S1. For L2/L3/L4, use the femoral stretch test |
| Absent ankle jerk = always S1 root lesion | Not always — can also be lost bilaterally in elderly (age-related), diabetic neuropathy. Must correlate clinically |
| Hyperreflexia in legs = lumbar pathology | NO — hyperreflexia = UMN = cord lesion ABOVE the lumbar segment. Think cervical/thoracic myelopathy |
| Listing always means disc herniation | Usually, but consider muscle spasm from any cause, scoliosis, or antalgic posture from hip pathology |
| Vascular claudication relieved by sitting only | NO — vascular claudication is relieved by simply stopping walking (standing still). NEUROGENIC requires sitting/flexion |
- L4 vs L5 root: L4 = knee extension weakness + reduced knee jerk + medial leg sensory loss. L5 = great toe dorsiflexion weakness + NO reflex change (no reliable L5 reflex) + dorsal foot sensory loss
- L5 vs S1 root: L5 = EHL weakness, dorsal foot numbness. S1 = plantarflexion weakness, reduced ankle jerk, lateral foot numbness
- Cauda equina vs conus: Cauda equina = severe radicular pain, asymmetric, pure LMN. Conus = less pain, symmetric, mixed UMN/LMN, early bladder involvement
Past Paper Questions
Stem: "A middle-aged obese man developed acute back pain, urinary incontinence, buttock numbness and bilateral lower limb weakness after lifting heavy objects at work. What is the MOST LIKELY diagnosis?"
- A. Aortic dissection
- B. Cauda equina syndrome ✓
- C. Psoas abscess
- D. Transverse myelitis
Rationale: Acute back pain + urinary incontinence + buttock (saddle) numbness + bilateral LE weakness after lifting = classic cauda equina syndrome from acute large central disc herniation. Aortic dissection causes tearing pain radiating to back but not buttock numbness or bilateral LE weakness in this pattern. Psoas abscess causes hip flexion pain and fever. Transverse myelitis is inflammatory and typically presents subacutely with a sensory level and UMN signs below it.
Stem: "A 56-year-old gentleman, was receiving chemotherapy for his metastatic lung cancer. He was admitted through A&E for severe low back pain. His lower limb power was 3 out of 5. An MRI of the spine noted a pathological collapse of the L1 vertebra with cord compression. What is the MOST APPROPRIATE initial management?"
- A. Arrange urgent staging FDG PET-CT scan
- B. Obtain urgent bone scan
- C. Start high-dose steroids and arrange urgent orthopaedic consultation for decompressive surgery ✓
- D. Stereotactic radiotherapy to L1
Rationale: Cord compression is an emergency. The initial step is high-dose dexamethasone (reduces vasogenic edema around the cord) and urgent surgical consultation for decompression. PET-CT and bone scan are staging investigations — not urgent in the acute setting. Radiotherapy may be adjunctive but not the initial step when the patient has significant weakness (power 3/5).
Stem: "Mr. Chan, a 75-year-old man presented with lower back pain for a few weeks, low-grade fever since last week. BP 152/77, PR 95, SpO2 98%, temp 38°C. Urinalysis normal."
Q1: "Name four red flag signs for back pain." (8 marks)
Markscheme answer: (any four of) Fever, unexplained weight loss, history of malignancy, night pain not relieved by rest, progressive neurological deficit, bladder/bowel dysfunction, age > 50 or < 20 with new-onset back pain, immunosuppression, IV drug use, prolonged corticosteroid use, trauma in osteoporotic patient.
Q2: "Name three MOST LIKELY differential diagnoses." (6 marks)
Markscheme answer: Pyogenic spondylodiscitis (spinal infection), TB spondylitis (Pott's disease), spinal metastasis with pathological fracture. (Back pain + fever + elderly → infection is top of list)
Q3: "Name three investigations." (6 marks)
Markscheme answer: Blood tests (WCC, CRP, ESR, blood cultures), MRI spine (gold standard for infection/tumour), CT-guided biopsy for culture and histology.
Stem: "A 70-year-old man has chronic neck pain, falls on level ground causing hyperextension. XR shows multiple osteophytes, narrowed spinal canal. MRI shows hyperintense T2 signal in cervical cord. What is MOST LIKELY on clinical exam?"
- A. Clumsy hand movement ✓
- B. Foot drop
- C. Loss of proprioception in lower limbs
- D. Urinary retention
Rationale: Central cord syndrome (from hyperextension injury in a stenotic canal) preferentially affects the upper limbs (central fibres of the corticospinal tract supply arms medially). Clumsy hand movement (myelopathic hand) is the classic finding. Foot drop is a peripheral nerve/L5 root issue. Loss of proprioception and urinary retention can occur but are not the MOST LIKELY earliest finding. This question reinforces why the lecture says "reflexes — rule out cord lesions" — even in a lumbar spine lecture, always think about cervical pathology.
Stem: "A 26-year-old man with recurrent uveitis, alternating buttock pain, bilateral plantar fasciitis has lower back pain for 6 months. You suspect ankylosing spondylitis."
Q(a): "Name four characteristics of back pain in this condition." (4 marks)
Markscheme: Insidious onset, onset before age 40, morning stiffness > 30 min, improves with exercise/activity, not relieved by rest, alternating buttock pain, nocturnal pain (wakes patient from sleep), duration > 3 months.
[1] GC 226. Lumbar Spine Pathology_Part B.pdf (all pages) [2] GC 226. Lumbar Spine Pathology_Part A.pdf (p2 — Learning Objectives) [3] Ryan Ho Fundamentals.pdf (p145 — Examination of the Spine); Ryan Ho Rheumatology.pdf (p24) [4] Ryan Ho Fundamentals.pdf (p148 — Sciatica examination); Ryan Ho Rheumatology.pdf (p27) [5] MBBS Final MB (Medicine) (Felix PY Lai).pdf (p1114 — Cauda equina syndrome) [6] Ryan Ho Neurology.pdf (p174 — Lumbar disc herniation, lumbar canal stenosis) [7] Ortho and Trauma - Spine.pdf (p2) [8] 2021 Fourth Summative Assessment MCQ.pdf (Q70, p25) [9] 2025 Fourth Summative MCQ.pdf (Q61, p24) [10] 2023 Fourth Summative Minicase.pdf (Case 3, Section 1, p17) [11] 2025 Fourth Summative MCQ.pdf (Q88, p40) [12] 2020 Fourth Summative SAQ.pdf (Q5, p6)
High Yield Summary
Physical examination of the lumbar spine follows LOOK → FEEL → MOVE → CIRCULATION:
-
LOOK: Deformity, loss of lordosis, sciatic list (AWAY = lateral disc, TOWARDS = medial disc), muscle atrophy, gait (antalgic, foot drop, Trendelenburg), spine ROM (Schober's test for AS).
-
FEEL: Tenderness over spinous processes (fracture/infection/tumour), paraspinal muscles (spasm), SIJ (sacroiliitis), hip (don't miss hip pathology mimicking spine disease). Assess tone.
-
MOVE (Neurology): Test myotomes (L2-S1), dermatomes, SLR (positive = radicular pain below knee at 30-70°, tests L5/S1), femoral stretch test (tests L3/L4). Reflexes: knee jerk (L3/4), ankle jerk (S1), Babinski/clonus (UMN signs = cord lesion, NOT lumbar root). Always check perianal sensation and anal tone for cauda equina syndrome.
-
CIRCULATION: Palpate peripheral pulses. Differentiate neurogenic (relieved by flexion/sitting, can cycle, variable walking distance, pulses present) from vascular claudication (relieved by standing still, cannot cycle, fixed walking distance, pulses absent/reduced).
-
Key exam points: Positive SLR must be pain BELOW the knee at 30-70°. Crossed SLR is less sensitive but more specific. UMN signs in legs = NOT lumbar pathology (think cervical/thoracic cord compression). Cauda equina syndrome (urinary retention + saddle anaesthesia + bilateral weakness) is a SURGICAL EMERGENCY.
Active Recall - Lumbar Spine Physical Examination
[1] GC 226. Lumbar Spine Pathology_Part B.pdf (all pages) [2] GC 226. Lumbar Spine Pathology_Part A.pdf (p2 — Learning Objectives) [3] Ryan Ho Fundamentals.pdf (p145); Ryan Ho Rheumatology.pdf (p24) [4] Ryan Ho Fundamentals.pdf (p148); Ryan Ho Rheumatology.pdf (p27) [5] MBBS Final MB (Medicine) (Felix PY Lai).pdf (p1114) [6] Ryan Ho Neurology.pdf (p174) [7] Ortho and Trauma - Spine.pdf (p2) [8] 2021 Fourth Summative Assessment MCQ.pdf (Q70, p25) [9] 2025 Fourth Summative MCQ.pdf (Q61, p24) [10] 2023 Fourth Summative Minicase.pdf (Case 3, p17) [11] 2025 Fourth Summative MCQ.pdf (Q88, p40) [12] 2020 Fourth Summative SAQ.pdf (Q5, p6)
GC226 Lumbar Spine Pathology: Part A
Lumbar spine pathology encompasses degenerative, herniated disc, stenotic, and spondylolisthetic conditions of the lower spine that can cause low back pain, radiculopathy, and neurological compromise.
GC226 Lumbar Spine Pathology: Part C
Lumbar spine pathology Part C encompasses conditions such as lumbar spinal stenosis, spondylolisthesis, and cauda equina syndrome that cause narrowing or structural displacement of the lower spinal canal, leading to neurological compromise.