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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
Q

If L3 radiculopathy where will the sensory deficit be

A

Lateral thigh

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26
Q

If L3 radioculopathy what motor action will be impaired

A

Hip Flexion

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27
Q

If L3 radioculopathy what reflexes will be lost

A

Patella reflex

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28
Q

If L4 radiculopathy were will the sensory deficit be

A

Disco-Lateral thigh to inside of lower leg

29
Q

What motor actions are impaired in L4 radiculopathy

A

Knee extension

Foot dorsiflexion

30
Q

What reflexes are lost in L4 radiculopathy

A

Patella reflex

31
Q

If L5 radiculopathy where is sensation lost

A

Lateral knee to big toe

32
Q

If L5 radiculopathy what motor action is lost

A

First toe dorsiflexion

33
Q

L5 radiculopathy what reflexes are lost

A

Posterior tibial reflex

34
Q

In S1 radiculopathy where is the sensory deficit

A

Lateral foot

35
Q

In S1 radiculopathy, which reflex is lost

A

Achille’s

36
Q

What sign is positive in disc herniation

A

Straight Leg Raises

37
Q

What is a positive straight leg raise test

A

Lifting the leg causes pain in sensory or motor distribution of affected nerve root

38
Q

Describe the structure of an inter-vertebral disc

A

In the centre is a gelatinous core termed the nucleus pulpous. This is surrounded by a fibrous structure termed the annulus fibrosis

39
Q

Explain pathophysiology of disc herniation

A

Compression/force through the spinal disc causes degenerative changes which leads to tears causing protrusion and herniation leading to impingement

40
Q

What imaging modality is ordered in suspected disc herniation

A

MRI

41
Q

How will disc degeneration present on MRI

A

Hypointense on T2 (sclerosed disc)

42
Q

What is first-line management of disc herniation

A

Analgesia
Physio
Continue daily activities

43
Q

What is second line for disc herniation

A

Laminotomy and discectomy

44
Q

When is a laminotomy and discectomy indicated

A
  • Severe disabling pain

- Cauda equina syndrome

45
Q

What is spondylosis

A

decrease in space between two adjacent vertebrae which may result in compression of the spinal nerve root

46
Q

What can cause spondylosis

A

osteoarthritis. Osteophytes causing narrowing between vertebrae

47
Q

What is spondylolysis

A

fracture in pars interarticularis of the vertebral arch in a vertebrae

48
Q

What is spondylolisthesis

A

stress fractures cause weakening meaning position of vertebrae cannot be maintained and one may slide over the other

49
Q

In which gender is spondylosis, spondylolysis and spondylolisthesis more common

A

Females

50
Q

What is the most common site for spondylolysis

A

L5

51
Q

What is the most common site for spondylolisthesis

A

L5/S1

52
Q

What are the 5 causes of spondylolisthesis

A
  • Paget’s disease
  • Degnerative
  • Congenital
  • Spondylolysis
  • Trauma
53
Q

What is the commonest cause of spondylolisthesis

A

Spondylolysis (50%)

54
Q

How may spondylolysis present

A
  • Asymptomatic

- Can present with lower back pain and stiffness

55
Q

How may spondylolisthesis present

A
  • Asymptomatic
  • Lower back pain + muscle spasms
  • Waddling gait
56
Q

In what % of people is spondylolisthesis asymptomatic

A

90%

57
Q

What is first-line investigation in spondylosis/lysis/listhesis

A

Oblique and lateral x-rays of the spine

58
Q

What is the x-ray sign of spondylolysis

A

‘Scotty dog sign’ = fracture in pars interarticularis presents as a collar around a scotty dogs neck

59
Q

What is second-line investigation of spondylo-disease

A

MRI

60
Q

What is first-line management of spondylolisthesis

A

Conservative:

  • NSAIDs
  • Physiotherapy
  • Epidural corticosteroid injection
61
Q

What is second-line management of spondylolisthesis

A

Surgical decompression

62
Q

Define scoliosis

A

abnormal curvature in the spine of more than 10’ in the horizontal plane

63
Q

In which gender is scoliosis more common

A

Females (10:1)

64
Q

What are causes of scoliosis

A

Congenital
Neuromuscular
Neurofibromatosis
Marfan’s syndrome

65
Q

How may scoliosis present clinically

A
  • Asymptomatic

- As it progresses may develop lower back and neurological symptoms

66
Q

What is first-line investigation for scoliosis

A

Lateral and AP X-ray

67
Q

What is second-line investigation for scoliosis

A

MRI

68
Q

What is first-line management of scoliosis

A
  • Active monitoring and orthoses
69
Q

When may surgical management of scoliosis be indicated

A

Neurological symptoms

Severe pain

Trauma + Orthopaedics (11 decks)

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