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BRS YR2 > Back Anatomy and Management of a Slipped Disc > Flashcards

Back Anatomy and Management of a Slipped Disc Flashcards

1
Q

What is the function of the spine?

A
  • locomotor function
  • protects the spinal cord
  • spinal cord transmission of signals between brain and periphery
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2
Q

What is the spinal column made up of?

A
  • vertebrae
  • intervertebral discs
  • facet joints
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3
Q

How many spinal vertebrae are there?

A

24
- 7 cervical
- 12 thoracic
- 5 lumbar

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4
Q

What is the role of the intervertebral discs?

A

shock absorbers, allow segmentation & multi-directional movement

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5
Q

What is the role of the facet joints?

A

small synovial joints at posterior spinal column linking each vertebra

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6
Q

What are the key neurologial structures of the spine?

A
  • vertebrae
  • cauda equina
  • nerve roots
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7
Q

Where does the spinal cord end and corda equina start?

A

L2

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8
Q

Where do the nerve roots exit the spinal cord?

A

Bilaterally

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9
Q

What are the different movements of the spine?

A
  • flexion (bending forward)
  • extension (bend back)
  • rotation
  • lateral flexion (side bend)
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10
Q

What is chronic back pain?

A
  • back pain > 12 weeks
  • can be due to sedentary lifestyle
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11
Q

What is non-specific low back pain?

A

pain not due to any specific or underlying disease that can be found

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12
Q

What is mechanical low back pain?

A
  • Pain after abnormal stress and strain on the vertebral column
  • Reproduced or worse with movement
  • Better or not present at rest
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13
Q

What are the common causes of mechanical back pain?

A
  • Muscular tension (e.g. chronic poor posture, weak muscles)
  • Acute muscle sprain/spasm
  • Degenerative disc disease
  • Osteoarthritis of facet joints
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14
Q

What is nerve root pain (sciatica)?

A
  • pain radiating down one leg with or without neuralogical symptoms
  • may accompany mechanical back pain
  • often due to herniated disc compressing a lumbar nerve root
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15
Q

What determines the location of the pain caused by sciatica?

A

The level of the herniated disc

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16
Q

What is the natural history of a herniated disc?

A
  • most prevalent age 30-50
  • good outlook
  • normally spontaneous improvement but slower than lower back pain alone
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17
Q

What is the treatment for a herniated disc?

A
  • analgesia (NSAIDs)
  • physiotherapy to improve core strength and treat muscle spasms
  • inject nerve roots with local anaesthetic or glucocorticoid
  • surgery if neurological symptoms or symptoms persist
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18
Q

What are the serious causes of back pain?

A
  • tumour
  • infection
  • inflammatory spodnyloarthropathy
  • fracture
  • large disc prolapse
  • referred pain
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19
Q

What are the different infections which could cause back pain?

A
  • Discitis
  • Vertebral osteomyelitis
  • Paraspinal abcess
  • Microbiology: Staphylococcus, streptococcus, tuberculosis
20
Q

What are the different inflammatory spondyloarthropathies?

A
  • ankylosing spondylitis
  • psoriatic arthritis
  • inflammatory bowel disease (IBD)-associated
21
Q

What is the current NICE guidance for investigatinf back pain?

A
  • investigation usually not required if there are no red flags
  • do not routinely arrange imaging to diagnose non-specific back pain in primary care
  • arrange review of symptoms persist or worsen after 3-4 weeks and assess underlying causes

-

22
Q

What are the treatments for lower back pain with no red flags?

A
  • Time
  • Analgesia (NSAIDs e.g. ibuprofen, paracetamol, codeine)
  • AVOID bed rest: keep moving
  • Physiotherapy (Soft tissue work, Corrective exercises esp. core)
23
Q

Which blood tests are done for back pain?

A
  • ESR (myeloma, chronic inflammation, TB)
  • CRP (infection or inflammation)
  • FBC (anaemia in myeloma, chronic disease)
  • ALP (bony metastases)
  • PSA (bony metastases)
  • Calcium (myeloma, bony metastases)
24
Q

What imaging is done for back pain?

A
  • radiograph
  • CT
  • MRI
25
Q

What are the pros and cons of radiographs?

A
  • poor sensitivity, radiation
  • cheap, widely available
26
Q

What are the pros and cons of CT scans?

A

good for bony pathology, larger radiation dose

27
Q

What are the pros and cons of MRI scans?

A
  • Best visualization of soft tissue structures like tendons and ligaments
  • Best for spinal imaging: can see spinal cord and exiting nerve roots
  • Expensive and time-consuming
28
Q

What is the current NICE guidance for managing low back pain?

A
  • injections
  • exercise
  • manipulation
  • psychological therapy
  • NSAIDs
  • weak opioids
  • radiofrequency denervation
  • epidural
29
Q

What are the conservative treatment options of low back pain?

A
  • analgesia
  • anti-infloammatory drugs
  • manipulation
  • acupuncture
  • massage
  • time
30
Q

What are the red flag symptoms associated with low back pain?

A
  • weight loss
  • fever
  • night pain
  • < 20 or > 55
  • constant pain
  • thoracic pain
  • previous malignancy
  • immunosuppressed
  • bladder or bowel disturbance
  • leg weakness or sensory loss
31
Q

What is cauda equina syndrome?

A
  • neurosurgical emergency
  • spinal stenosis causing compression of the cauda equina
  • untreated leads to permanent lower limb paralysis and incontinence
32
Q

What are the signs and symptoms of cauda equina?

A
  • Saddle anaesthesia
  • Bladder/bowel incontinence
  • Loss of anal tone on PR
  • Radicular leg pain
  • Ankle jerks may be absent
33
Q

What are the causes of cauda equina syndrome?

A
  • disc herniation
  • bony mets
  • myeloma
  • TB
  • paraspinal abcess
34
Q

What investigations should be done for suspected cauda equina syndrome?

A

Urgent lumbar spine MRI

35
Q

What is inflammatory spondyloarthirits (SpA)?

A
  • Group of immune-mediated inflammatory diseases
  • Ankylosing spondylitis (AS), psoriatic arthritis and inflammatory bowel disease (IBD)
36
Q

Which joints are affected in SpA?

A
  • spine (spondylitis) and sacro-iliac joints (sacro-iliitis)
  • peripheral joints, esp. tendon insertions (entheses), can also be affected
37
Q

What are the extra-articular manifestations of SpA?

A
  • Anterior uveitis (iritis) – ocular inflammation
  • Apical lung fibrosis
  • Aortitis/aortic regurgitation
  • Amyloidosis – due to chronically serum amyloid A (SAA) depositing in organs
38
Q

What is ankylosing spondylitis?

A
  • loss of spinal movements
  • characterised by enthesitis (inflammation of the entheses- sites where tendon and ligaments join to bone)
39
Q

How do genetic impact ankylosing spondylitis?

A
  • HLA-B27 is the strongest genetic risk factor, used as a diagnostic marker
  • polygenic
40
Q

Which cytokines play a role in the pathogenesis of ankylosing spondylitis?

A
  • tumour necrosis factor alpha (TNF-alpha)
  • interleukin-17 (IL-17)
  • interleukin-23 (IL23)
41
Q

How do metastases look on an MRI?

A

darkening/blackening of the spinal cord

42
Q

How does inflammatory arthropathy look on an MRI?

A
  • lightening/whitening of the spinal cord (shiny corners)
  • seen before x-ray changes develop
43
Q

What should be done in someone Under 35 and 3 months of pain?

A

whole spine MRI

44
Q

How does myeloma look on an MRI?

A

like metastases

45
Q

What can osteoporosis lead to?

A
  • vertebral collapse
  • wedge fracture

BRS YR2 (67 decks)

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