4: Spinal deformity and red flags Flashcards
What are
a) red flag
b) yellow flag symptoms of back pain?
a) Aspects of history suggesting serious underlying pathology (e.g cancer, infection)
b) Social/behavioural factors indicating that patient outcome will be poor unless resolved
What ages of patient with back pain are red flags?
< 20 years old
> 60 years old
What type of back pain is a red flag?
Constant non-mechanical pain
(differential: inflammatory arthritis - spondyloarthropathy, infection)
If a patient has a past history of ___ their back pain should be taken very seriously.
cancer
Patients using which type of drug should be treated seriously if presenting with back pain?
Why?
Steroids
Osteoporosis
What are three signs of cauda equina syndrome?
Saddle anaesthesia
Loss of bowel and bladder control
Cauda equina syndrome is described as bilateral ___ with loss of ___ and ___ control.
sciatica
bowel, bladder
How long do you have to treat cauda equina syndrome?
How is it treated?
Around 48 hours
Decompression
What type of bladder problems are seen in cauda equina syndrome?
Painless urine retention
What causes cauda equina syndrome?
Disc prolapse
How are patients with suspected spinal fractures assessed?
Immobilise on spinal board
X-ray / CT scan
Do sensory and motor nerves have to be affected at the same spinal level?
No
Which aspect of the cervical spine is important to examine on an X-ray?
C7/T1
Where do thoracolumbar spinal injuries tend to occur?
T12 / L1
i.e the junction between thoracic and lumbar
What is more likely to kill a patient than moving their damaged spine?
Ischaemia / poor oxygenation from position they’re in
So move them if you need to
Spinal cord injuries can be either ___ or ___.
complete , incomplete
What type of abnormal movement tends to cause an incomplete central cord injury?
What are affected more severely - the arms or the legs?
Hyperextension of spine
Arms worse than legs
If a patient with ankylosing spondylitis has a suspected spine fracture, how should they be immobilised?
In their “natural” position i.e with face pointing towards the ground
People with ankylosing spondylosis tend to have very (stable / unstable) spine injuries.
unstable
What is scoliosis?
Lateral curvature of the spine
Scoliosis caused by an unbalanced number of growth plates on either side of the spine, seen from birth, is called ___ scoliosis.
congenital
What causes scoliosis?
Idiopathic
nobody knows
The centre of gravity working on the spine is anterior.
What stops your spine from becoming kyphotic?
Structural support of bones
Erector spinae muscles
What is spondylolysis?
Umbrella term for degenerative disease affecting the spine
What is spondylolitshesis?
What can this cause?
Anterior / posterior movement of vertebrae
Pressure on nerve roots - sciatica amongst other things
Spondylolisthesis is graded from 1 - 5 based on severity.
What name is given to Grade 5 spondylolisthesis?
Spondyloptosis
spine has literally detached from itself
