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Trauma + Orthopaedics > 2: Disorders Of The Spine > Flashcards

2: Disorders Of The Spine Flashcards

1
Q

What do red flags of back pain indicate

A

Severe underlying pathology

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2
Q

What is a mnemonic to remember the red flags of back pain

A

TUNA FISH

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3
Q

What are the red-flags of back pain

A 
Trauma 
Unexplained weight loss 
Night sweats 
Age <20 or >50 
Fever
IVDU
Steroid use 
History of malignancy (breast, renal, prostate, lung)
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4
Q

What do yellow flags of back pain indicate

A

Factors which are prognostic are long-term disability

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5
Q

What are 7 yellow-flags of back pain

A
  • Over-protective or under supportive family
  • Financial issues
  • History of depression
  • Idea the active movement is worse
  • Belief that passive treatment would be better
  • Idea that pain is severely disabling
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6
Q

How will mechanical back pain present

A

It is a diagnosis of exclusion, if there are no underlying sinister features

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7
Q

How will disc prolapse present

A

sudden-onset lower back pain which may radiate down the leg or buttock - it is worse on increase in pressure

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8
Q

What age-group will present with disc prolapse

A

younger patients

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9
Q

How will spondylolisthesis present

A

sudden onset back pain and sciatica

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10
Q

When is pain worse in spinal stenosis

A

on walking

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11
Q

What movements are worse in spinal stenosis

A

extension is worse.

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12
Q

What movements are better in spinal stenosis

A

spinal flexion (leaning forwards) relieves pain

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13
Q

In which age group does spinal stenosis present more

A

older patients

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14
Q

How may malignancy in the spinal cord present clinically

A

LMN symptoms at the level of the lesion and UMN symptoms above this

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15
Q

How may discitis present

A

Pain on movement

Systemic signs of infection

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16
Q

How may spinal TB present clinically

A

Pain and stiffness across all movements

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17
Q

What is degenerative disc disease

A

a group of disorders with displacement of the intervertebral disc into the spinal canal

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18
Q

What is disc protrusion

A

the nucleus pulpous presses on the annulus fibrosis creating a bulge which may compress a spinal nerve

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19
Q

What is disc herniation

A

tear in the annulus fibrosis which causes protrusion of the nucleus pulpous and may compress a spinal nerve

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20
Q

What is disc sequestration

A

extrusion of nucleus pulpous and separation of fragments that enter the spinal canal causing compression of the spinal nerve

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21
Q

Which age group is degenerative disc disease more common

A

30-50y

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22
Q

Which gender is degenerative disc disease more common

A

Males

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23
Q

What is the most common site of degenerative disc disease

A

L4-L5

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24
Q

Explain clinical presentation of degenerative disc disease

A
  • Acute onset severe lower back pain. May radiate down the legs
  • Pain is worse with pressure
  • Relieved by short walk or changing position
  • May present with parasthesia, weakness and loss of deep tendon reflexes
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25
If L3 radiculopathy where will the sensory deficit be
Lateral thigh
26
If L3 radioculopathy what motor action will be impaired
Hip Flexion
27
If L3 radioculopathy what reflexes will be lost
Patella reflex
28
If L4 radiculopathy were will the sensory deficit be
Disco-Lateral thigh to inside of lower leg
29
What motor actions are impaired in L4 radiculopathy
Knee extension | Foot dorsiflexion
30
What reflexes are lost in L4 radiculopathy
Patella reflex
31
If L5 radiculopathy where is sensation lost
Lateral knee to big toe
32
If L5 radiculopathy what motor action is lost
First toe dorsiflexion
33
L5 radiculopathy what reflexes are lost
Posterior tibial reflex
34
In S1 radiculopathy where is the sensory deficit
Lateral foot
35
In S1 radiculopathy, which reflex is lost
Achille's
36
What sign is positive in disc herniation
Straight Leg Raises
37
What is a positive straight leg raise test
Lifting the leg causes pain in sensory or motor distribution of affected nerve root
38
Describe the structure of an inter-vertebral disc
In the centre is a gelatinous core termed the nucleus pulpous. This is surrounded by a fibrous structure termed the annulus fibrosis
39
Explain pathophysiology of disc herniation
Compression/force through the spinal disc causes degenerative changes which leads to tears causing protrusion and herniation leading to impingement
40
What imaging modality is ordered in suspected disc herniation
MRI
41
How will disc degeneration present on MRI
Hypointense on T2 (sclerosed disc)
42
What is first-line management of disc herniation
Analgesia Physio Continue daily activities
43
What is second line for disc herniation
Laminotomy and discectomy
44
When is a laminotomy and discectomy indicated
- Severe disabling pain | - Cauda equina syndrome
45
What is spondylosis
decrease in space between two adjacent vertebrae which may result in compression of the spinal nerve root
46
What can cause spondylosis
osteoarthritis. Osteophytes causing narrowing between vertebrae
47
What is spondylolysis
fracture in pars interarticularis of the vertebral arch in a vertebrae
48
What is spondylolisthesis
stress fractures cause weakening meaning position of vertebrae cannot be maintained and one may slide over the other
49
In which gender is spondylosis, spondylolysis and spondylolisthesis more common
Females
50
What is the most common site for spondylolysis
L5
51
What is the most common site for spondylolisthesis
L5/S1
52
What are the 5 causes of spondylolisthesis
- Paget's disease - Degnerative - Congenital - Spondylolysis - Trauma
53
What is the commonest cause of spondylolisthesis
Spondylolysis (50%)
54
How may spondylolysis present
- Asymptomatic | - Can present with lower back pain and stiffness
55
How may spondylolisthesis present
- Asymptomatic - Lower back pain + muscle spasms - Waddling gait
56
In what % of people is spondylolisthesis asymptomatic
90%
57
What is first-line investigation in spondylosis/lysis/listhesis
Oblique and lateral x-rays of the spine
58
What is the x-ray sign of spondylolysis
'Scotty dog sign' = fracture in pars interarticularis presents as a collar around a scotty dogs neck
59
What is second-line investigation of spondylo-disease
MRI
60
What is first-line management of spondylolisthesis
Conservative: - NSAIDs - Physiotherapy - Epidural corticosteroid injection
61
What is second-line management of spondylolisthesis
Surgical decompression
62
Define scoliosis
abnormal curvature in the spine of more than 10' in the horizontal plane
63
In which gender is scoliosis more common
Females (10:1)
64
What are causes of scoliosis
Congenital Neuromuscular Neurofibromatosis Marfan's syndrome
65
How may scoliosis present clinically
- Asymptomatic | - As it progresses may develop lower back and neurological symptoms
66
What is first-line investigation for scoliosis
Lateral and AP X-ray
67
What is second-line investigation for scoliosis
MRI
68
What is first-line management of scoliosis
- Active monitoring and orthoses
69
When may surgical management of scoliosis be indicated
Neurological symptoms | Severe pain

Trauma + Orthopaedics (11 decks)

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