3 - Spine

Question 1

What is mechanical back pain

Answer 1

Recurrent, relapsing and remitting back pain
No neurological symptoms
Pain is worse on movement and relieved by rest

Question 2

What can cause mechanical back pain

Answer 2

Obesity 
Poor posture 
Poor lifting technique 
Lack of exercise 
Depression 
Disc prolapse 
Facet joint OA 
Spondylosis

Question 3

What is spondylosis

Answer 3

Intervertebral discs lose water content with age
Results in less cushioning and increased pressure on facet joints
Leads to secondary OA

Question 4

How do you treat mechanical back pain

Answer 4

Analgesia

Physio - need to keep back moving

Question 5

When might a patient with mechanical back pain benefit from spinal stabilisation surgery

Answer 5

If a single level is affected by OA or instability
If they haven’t improved with physio and conservative treatment
No other issues that affect surgery outcome

Question 6

Surgery is effective in multi-level mechanical back pain - true or false

Answer 6

FALSE

there is no role for surgery

Question 7

Describe the pain of an acute disc tear

Answer 7

Can be severe due to rich innervation

Pain is often worse on coughing

Question 8

What is the classic cause of an acute disc tear

Answer 8

Lifting a heavy object

Question 9

How do you treat an acute disc tear

Answer 9

analgesia
physio
symptoms usually resolve but can take 2-3 months

Question 10

What can happen if a disc prolapses

Answer 10

disc material can press on an exiting nerve root

This can cause pain and altered sensation in a dermatomal distribution

Question 11

Describe the pain of sciatica

Answer 11

Neuralgic burning or severe tingling pain down the back of the thigh towards the knee

Question 12

How do you treat disc prolapse/ nerve pain

Answer 12

First line: analgesia, maintain mobility and physio

Then neuropathic pain drugs such as Gabapentin if severe pain

Question 13

How can OA lead to nerve pain

Answer 13

OA of the facet joints can result in osteophytes forming and impinging on exiting nerve roots

Question 14

How can nerve symptoms caused by OA be treated

Answer 14

Surgical decompression with trimming of osteophytes

Only done in suitable patients

Question 15

What is spinal stenosis

Answer 15

When various back pathologies such as bulging discs, spondylosis and osteophytes mean there is less space for the spinal cord and so multiple

Question 16

Spinal stenosis causes claudication in the legs - true or false

Answer 16

TRUE

Question 17

Describe the presentation of claudication caused by spinal stenosis

Answer 17

The claudication distance is inconsistent
The pain is burning
Pain is less walking uphill
Pedal pulses are preserved

Question 18

How do you treat spinal stenosis

Answer 18

Conservatively - physio and weight loss

Surgery - decompression

Question 19

What causes cauda equina syndrome

Answer 19

Very large central disc prolapse that compresses all the nerve roots in the cauda equina
It is an emergency

Question 20

What are the symptoms of cauda equina

Answer 20

Bilateral leg pain
Saddle anaesthesia
Altered urinary and bowel function

Question 21

How do you manage cauda equina syndrome

Answer 21

Mandatory PR exam
Urgent MRI to determine level of prolapse
Surgery

Question 22

List some red flags of back pain

Answer 22

Back pain in young patient
New back pain in older patient
Pain that is constant, severe or worse at night
Systemic upset

Usually suggests wither tumour or infection

Question 23

What is an osteoporotic crush fracture

Answer 23

Occurs in severe osteoporosis

Vertebral body will have a spontaneous crush fracture

Question 24

What are the symptoms of a osteoporotic crush fracture

Answer 24

Acute pain

Kyphosis

Question 25

How do you treat a osteoporotic crush fracture

Answer 25

Conservatively

Some perform surgery in those with chronic pain

Question 26

What are the symptoms of cervical spondylosis

Answer 26

slow onset of stiffness in the neck

Pain that can radiate to shoulders

Question 27

How do you treat cervical spondylosis

Answer 27

Physio

Analgesia

Question 28

What are the symptoms of a cervical disc prolapse

Answer 28

Neck pain
Shooting neuralgic pain in dermatomal pattern
Weakness and loss of reflexes (dependant on nerve affected)
Large prolapses may lead to myelopathy and upper motor neurone signs

Question 29

What conditions are related to cervical spine instability

Answer 29

Down’s syndrome e

Rheumatoid arthritis

Question 30

How can you manage cervical instability

Answer 30

Minor cases - avoid high impact/contact sport

More severe cases will need surgical stabilisation

Question 31

What is carpal tunnel syndrome

Answer 31

Compression of median nerve caused by swelling or inflammation of the carpal tunnel

Question 32

What can cause carpal tunnel syndrome

Answer 32

Idiopathic
RA
Conditions causing fluid retention - pregnancy, diabetes etc
Consequence of fractures

Question 33

How does carpal tunnel present

Answer 33

Parathesia in the digits innervated by the median nerve
Usually worse at night
Loss of sensation/weakness in the thumb

Question 34

How do you treat carpal tunnel syndrome

Answer 34

Wrist splints at night
Steroid injection
Surgery

Question 35

What is cubital tunnel syndrome

Answer 35

Compression of ulnar nerve at elbow (behind medial epicondyle)
Can be due to a tight band of fascia forming over the roof of the tunnel

Question 36

How does cubital tunnel syndrome present

Answer 36

Parathesia over the 1.5 fingers supplied by the ulnar nerve

Weakness of innervated muscles

Question 37

How do you confirm diagnosis of cubital and carpal tunnel syndromes

Answer 37

Nerve conduction studies