Back pain Flashcards
What is the function of the spine?
Locomotor: capable of being both rigid & mobile
Bony armour: protects the spinal cord
Neurological: spinal cord transmission of signals between brain & periphery
Describe the structure of the spine
1) Spinal column made up of:
- Vertebrae – 24 bones
7 cervical
12 thoracic
5 lumbar
- Intervertebral discs – shock absorbers, allow segmentation & multi-directional movement
- Facet joints – small synovial joints at posterior spinal column linking each vertebra
2) Muscles – move the spine
What are the key neurological structures of the spine?
Spinal cord – transmission of signals to/from brain. Ends at L2 vertebra*
Nerve roots – exit the spinal cord bilaterally
Cauda equina – nerve bundle
What type of movements of the spine are there?
Flexion (forward bend) vs extension (backward bend)
Lateral flexion (side bend)
Rotation (twist)
What is the difference between acute and chronic back pain?
Acute back pain usually self-limiting
Most better in a few days, 96% are better in six weeks
Chronic back pain (>12 weeks duration) also common – sedentary lifestyle
What is mechanical back pain?
- Mechanical means that the source of the pain may be in your spinal joints, discs, vertebrae, or soft tissues
- mechanical pain tends to be more acute and can often be linked to an injury
- Reproduced or worse with movement
- Better or not present at rest
What are the common causes of mechanical back pain?
-Muscular tension (e.g. chronic poor posture, weak muscles)
-Acute muscle sprain/spasm
-Degenerative disc disease
-Osteoarthritis of facet joints
What is sciatica?
(associated symptom not disease)
“ pain radiating down one leg + common symptoms of pins and neddles/ numbness”
- Sciatica typically due to a disc herniation (“slipped disc”) contacting the exiting lumbar nerve root
- disc herniation: the annulus fibrosus (outer layer of disc) tears, inner nucleus pulposus spills out and hits the nerve
- Location of the pain determined by the level of the herniated disc
What are some serious causes of back pain?
- Tumour - Metastatic cancer or Myeloma
- Infection:
- Discitis
- Vertebral osteomyelitis
- Paraspinal abcess
- Microbiology: Staphylococcus, streptococcus, tuberculosis (TB) - Inflammatory spondyloarthropathy
- ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease (IBD)-associated - Fracture (traumatic or atraumatic)
- Large disc prolapse causing neurological compromise
- Referred pain (pancreas, kidneys, aortic aneurysm)
How do you identify serious causes of back pain?
“Red flag” symptoms:
- Pain at night or increased pain when supine
- Constant or progressive pain
- Thoracic pain
- Weight loss
- Previous malignancy
- Fever/night sweats
- Immunosuppressed
- Bladder or bowel disturbance (Sphincter dysfunction)
- Leg weakness or sensory loss
- `Age <20 or >55 yrs
What is cauda equina syndrome?
Cauda equina syndrome occurs when the nerve roots in the lumbar spine are compressed, cutting off sensation and movement
What are the signs/ symptoms of cauda equina syndrome?
Symptoms/signs:
Saddle anaesthesia
Bladder/bowel incontinence
Loss of anal tone on PR
Radicular leg pain
Ankle jerks may be absent
What investigations are used to monitor cauda equina syndrome?
A lumbar magnetic resonance imaging (MRI) scan
What are the causes of cauda equina syndrome?
large disc herniation, bony mets, myeloma, TB, paraspinal abcess
How is cauda equina syndrome treated?
- according to cause: may require urgent surgery
- Neurosurgical emergency: Untreated = permanent lower limb paralysis and incontinence
