Back conditions Flashcards
which imaging technique is used to show spinal cord damage, intervertebral discs, nerves etc
GOLD standard for back pain
MRI
what do xrays show
bone only
scoliosis definition
lateral curvature of the spine
aetiology of scoliosis (6)
congenital
idiopathic
secondary to; neuromuscular disease, tumours, infection, spina bifida
is scoliosis painful
sometimes
investigations for scoliosis
why
MRI - for tumour
blood tests - for infection
scoliosis treatment if causing no pain and not deteriorating (3)
physio
casts/brace
wheelchair
scoliosis treatment if painful and deteriorating
anterior surgery
risk of surgery of any back surgery (eg for scoliosis)
spinal cord injury
presentation of scoliosis
resp distress
posture to one side (L or R)
where is your centre of gravity in kyphosis
anterior to spine
what does chance fractures increased your risk of
kyphosis
treatment of kyphosis (4)
same as scoliosis;
physio
brace
surgery
pain management
forward slippage of one vertebrae onto another
spondylolisthesis
aetiology of spondylolisthesis (3)
arthritis
trauma
stress fracture
where does spondylolisthesis occur (vertebral levels (2))
L4/5
L5/S1
where is the pain in spondylolisthesis
lower back
risk factors for spondylolisthesis (3)
often young
sport (bending over)
jobs with heavy weights
treatment for spondylolisthesis
rest
pain relief
physio
surgery (rarely - if >50% slip)
mechanical back pain treatment (4)
generally nothing
increase exercise (NOT bed rest)
pain relief
acupuncture, physio
back pain with no neuro symptoms, no red flags
mechanical back pain
what is the problem in mechanical back pain
muscles
aetiology of mechanical back pain
poor posture
obesity
facet joint OA
when is the pain worst in mechanical back pain
movement
when is pain relieved in mechanical back pain
rest
are slipped discs and spondylolisthesis different things
yes, different aetiology, there is no slipped disc in spondylolisthesis (just the vertebrae)
what is the most common cause of back pain in primary care
mechanical back pain
common name of prolapsed intervertebral disc
slipped disc
risk factors for slipped disc (2)
heavy lifting
old age
pathophysiology of slipped disc
outer fibrous ring allows central part of disc (annulus) to bulge out
what are the common conditions at L4/5 and L5/S1 (2)
slipped disc
spondylolisthesis
where does slipped discs usually occur
L4/5 and L5/S1
why is a slipped disc painful
annulus is highly innervated
what feature of intervertebral discs makes them more likely to prolapse (slipped disc)
if they are dehydrated
presentation of PAIN in slipped disc
when is the pain worse
episodic back pain then onset of leg pain
worse walking uphill
what imagining technique shows disc dehydration for increased risk of slipped discs
MRI
treatment of slipped disc (4)
self limiting
pain relief - NSAID, gabapentin if leg pain
increased activity (not bed rest)
physio
slipped discs are self limiting, what % are fine after;
3 months
2 years
70%
90%
what is usually the cause of sciatica
slipped disc at L4-S3 = compression of sciatic nerve
buttock/leg pain not caused by hip, knee or ankle
sciatica
is sciatica usually unilateral or bilateral
unilateral
what pattern is the leg pain in sciatica in
dermatomal
pain worse walking downhill
spinal stenosis
what is spinal stenosis
narrowing of spaces in your spine = pressure on spinal cord = pain
aetiology of spinal stenosis (2)
bulging discs
osteophytosis (bony spurs)
spinal stenosis risk factors (4)
male
>50 years old
manual worker
obesity
when is pain worst in spinal stenosis
walking downhill
why does walking downhill cause pain in spinal stenosis
need to extend back to stay upright = compresses spinal cord
when is pain relived in spinal stenosis
example
bending forward eg cycling
apart from the back, where else might you get pain in spinal stenosis when walking downhill
legs
investigation for spinal stenosis
MRI
what causes discogenic pain (2)
acute disc tear
degenerative disc
how is discogenic back pain different from other types of back pain (how does the pain present)
severe sudden exacerbations of pain
worse as day goes on, worse with activity
deep seated central back pain
discogenic back pain treatment (2)
physio
analgesia
spinal stenosis treatment (3 think of risk factor)
physio
weight loss
surgery (spinal decompression)
degenerative disease of facet joints (cartilage between them)
facet joint arthritis (facet arthropathy)
why is there pain in facet joint arthritis (facet arthropathy)
nerves travel close to facet joints
when is pain worst in facet arthropathy
morning
rest (no movement)
when is pain relieved in facet arthropathy
exercise
which back problem presents with morning stiffness
facet arthropathy
treatment of facet arthropathy (3)
exercise
pain relief
facet joint injections
aetiology of cauda equina syndrome
disc prolapse at S3/4 level
where is the cauda equina in relation to the spinal cord
below it, but still in the vertebrae
presentation of cauda equina (3)
lower back pain
loss of bladder/bowel control
saddle anaesthesia - bilateral loss of sensation to buttocks/perineum/inner thigh
investigations for cauda equina syndrome (2)
MRI
PR exam
findings on PR exam in cauda equina syndrome
loss of anal tone
treatment of cauda equina syndrome
emergency surgery within 24 hours
complication of untreated cauda equina syndrome
paralysis
complication of treated cauda equina syndrome
permanent bladder/bowel dysfunction
spinal fracture with complete cord lesion results in…
complete paralysis
spinal fracture with incomplete cord lesion results in…
some sensory/motor loss function below the point of injury
what is the complete loss of sensation and motor function below the level of spinal cord injury that resolves in 24 hours called
spinal shock
what conditions that affect the rest of the spine can also affect the cervical spine (4)
ankylosing spondylosis (degeneration)
disc prolapse
instability
fractures
which 2 conditions are associated with cervical spine instability
downs syndrome
rheumatoid arthritis
where does cervical instability typically happen (spinal level)
between C1 and C2 (atlanto-axial subluxation)
acute pain and stiffness in cervical spine
bilateral foot pain
difficulty breathing
50 year old
ankylosing spondylitis
