Classifying the Lumbar Spine with Elaine Lonnemann

In this interview we discuss red flags, yellow flags, and compares the treatment based classification system to the International Classification of Functioning (ICF). We interviewed Elaine Lonnemann, faculty at Bellarmine University for 16 years, for the recent Low Back Pain course in Physiopedia Plus. Elaine entered teaching due to passion, complexity, and need to know more with treating low back pain. 

Roughly ten percent of low back pain patients have condition specific pain. Subgroups and classifications here are useful for when to decide whether to treat or refer patients. Red flags specific to low back pain include night pain, prior history of cancer, bowel/bladder insufficiency, unexplained weight loss, etc. Elaine notes that recent research which would require a referral to a physician or further medical work up would be applicable when patients present with multiple red flags, typically not just one. 

Compression fracture, oncological conditions, cauda equina are a few main red flag conditions to consider. Other rare conditions to be aware of are anklyosing spondylitis, diffuse idiopathic scoliosis, or infections such as osteomyelitis. Infection is of particular concern for immunocompromised patients or those with recent surgery.

Spondylolisthesis, radiculopathy, scoliosis, disc herniations, stenosis are reviewed as your more common lumbar conditions.

Subgroupings and classifications are also discussed. Elaine notes the pathoanatomical approach gave us a better understanding of physiological changes and understanding of the underlying anatomy. However, there has been a shift to the treatment based classification system by Delitto, et. al. This study broke patients down into which patients do better with particular treatments: manipulation, exercise, traction, or stabilization. As recent as 2012 there has been a push to the Lumbar ICF by the APTA. The ICF provides an excellent review of the impairment based guidelines, examination, and intervention for the lumbar spine.