Back pain Flashcards
In MRI, what colour are degenerate IV discs?
black
What are bone spurs (osteophytes)? How are they caused?
Small smooth bony growths that can develop near edges of vertebral body endplates or spines facet joints when cartilage has been worn
How does disc herniating happen? Where does it happen most commonly? What can be the consequence? what is damage associated with?
- Part/all of nucleus pulposus protrudes through annulus fibrosus.
- Can compress the nerve root (impinge on nerve).
- Damage associated with fully flexing spine for repeated time.
- Degenerative process as we age nucleus pulposus becomes less hydrated/weakens.
- Most common in lumbar spine followed by thoracic spine
What is non-specific back pain?
Pain not due to any specific or underlying disease that can be found
What is mechanical low back pain?
Pain after abnormal stress & strain on vertebral column
What is sciatica?
Pain radiating to lower limbs with or without neuralgic symptoms (due to disc prolapse impinging on nerve)
What are causes of low back pain?
- Tumour including myeloma (blood cancer - back pain early sign needs early diagnosis)
- spondyloarthropathy
- infection
- pars interarticularis injury (stress injury usually in teenagers)
- compression fracture
- visceral pain (pancreatitis, dissecting aortic aneurysm)
What are indicators for sciatica?
- Unilateral leg pain greater than low back pain
- pain radiating to foot or toes, numbness & paraesthesia in same distribution
- straight leg raising test induces more leg pain
- localised neurology (limited to one nerve root)
What is NICE guidance on imaging for low back pain?
- Do not routinely offer imaging for low back pain whether sciatica or not.
- Consider imaging in specialist settings for those with low back pain if result likely to change management
What is NICE guidance for treatment of low back pain?
Exercise, injections, manipulation, NSAIDs, radiofrequency denervation, epidural
What is conservative treatment for low back pain? What isnt indicated?
- Analgesia (paracetamol), anti-inflammatory drugs, manipulation, acupuncture, massage, allow time to pass.
- Bed rest wont aid faster recovery
What are low back pain red flags?
Weight loss, fever, night pain, under 19 years old (could be cancer or serious)
What are leg pain red flags?
Bowel or bladder dysfunction, saddle anaesthesia, profound neurological deficit
-could be cauda equina which can cause paralysis/incontinence for life if not operated quick
Impact of early diagnosis for metastases?
May not impact prognosis, risk of fracture or paralysis
Impact of early diagnosis for inflammatory arthropathy? When should you investigate it?
- Needed for effective biologics treatment.
- Investigate under 35 yrs after 3 month pain
