4: Spinal deformity and red flags

Question 1

What are

a) red flag
b) yellow flag symptoms of back pain?

Answer 1

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

Question 2

What ages of patient with back pain are red flags?

Answer 2

< 20 years old

> 60 years old

Question 3

What type of back pain is a red flag?

Answer 3

Constant non-mechanical pain

(differential: inflammatory arthritis - spondyloarthropathy, infection)

Question 4

If a patient has a past history of ___ their back pain should be taken very seriously.

Answer 4

cancer

Question 5

Patients using which type of drug should be treated seriously if presenting with back pain?

Why?

Answer 5

Steroids

Osteoporosis

Question 6

What are three signs of cauda equina syndrome?

Answer 6

Saddle anaesthesia

Loss of bowel and bladder control

Question 7

Cauda equina syndrome is described as bilateral ___ with loss of ___ and ___ control.

Answer 7

sciatica

bowel, bladder

Question 8

How long do you have to treat cauda equina syndrome?

How is it treated?

Answer 8

Around 48 hours

Decompression

Question 9

What type of bladder problems are seen in cauda equina syndrome?

Answer 9

Painless urine retention

Question 10

What causes cauda equina syndrome?

Answer 10

Disc prolapse

Question 11

How are patients with suspected spinal fractures assessed?

Answer 11

Immobilise on spinal board

X-ray / CT scan

Question 12

Do sensory and motor nerves have to be affected at the same spinal level?

Answer 12

No

Question 13

Which aspect of the cervical spine is important to examine on an X-ray?

Answer 13

C7/T1

Question 14

Where do thoracolumbar spinal injuries tend to occur?

Answer 14

T12 / L1

i.e the junction between thoracic and lumbar

Question 15

What is more likely to kill a patient than moving their damaged spine?

Answer 15

Ischaemia / poor oxygenation from position they’re in

So move them if you need to

Question 16

Spinal cord injuries can be either ___ or ___.

Answer 16

complete , incomplete

Question 17

What type of abnormal movement tends to cause an incomplete central cord injury?

What are affected more severely - the arms or the legs?

Answer 17

Hyperextension of spine

Arms worse than legs

Question 18

If a patient with ankylosing spondylitis has a suspected spine fracture, how should they be immobilised?

Answer 18

In their “natural” position i.e with face pointing towards the ground

Question 19

People with ankylosing spondylosis tend to have very (stable / unstable) spine injuries.

Answer 19

unstable

Question 20

What is scoliosis?

Answer 20

Lateral curvature of the spine

Question 21

Scoliosis caused by an unbalanced number of growth plates on either side of the spine, seen from birth, is called ___ scoliosis.

Answer 21

congenital

Question 22

What causes scoliosis?

Answer 22

Idiopathic

nobody knows

Question 23

The centre of gravity working on the spine is anterior.

What stops your spine from becoming kyphotic?

Answer 23

Structural support of bones

Erector spinae muscles

Question 24

What is spondylolysis?

Answer 24

Umbrella term for degenerative disease affecting the spine

Question 25

What is spondylolitshesis?

What can this cause?

Answer 25

Anterior / posterior movement of vertebrae

Pressure on nerve roots - sciatica amongst other things

Question 26

Spondylolisthesis is graded from 1 - 5 based on severity.

What name is given to Grade 5 spondylolisthesis?

Answer 26

Spondyloptosis

spine has literally detached from itself