Back pain Flashcards
Cauda equina
Back pain due to tumour or large disc herniation compressing the nerves of the cauda equina
Clinical presentation of Cauda equina syndrome
- back pain
- urinary retention with overflow
- saddle anaesthesia
- bilateral sciatica
- leg weakness
- faecal incontinence,
- progressive motor or sensory deficit
- lower motor neurone signs and symptoms
Sciatica
sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae,compressed by a tumor or damaged by diabetes.
Lumbar spinal stenosis
central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.
Treat with Laminectomy- type of surgery in which a surgeon removes part or all of the vertebral bone
clinical presentation spinal stenosis
- Back pain
- absence of pain when the spine is in a flexed position
- Sitting is better than standing and patients may find it easier to walk uphill rather than downhill
- transient leg tingling
- pain in calf and lower extremity that is triggered by ambulation and improves with rest
Ankylosing spondylitis
Chronic inflammatory disorder affecting the axial skeleton
Affected articulations develop bony or fibrous changes
Typical spinal features include loss of the lumbar lordosis and progressive kyphosis of the cervico-thoracic spine
Spondylolysis
Congenital or acquired deficiency of the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/ L5
May be asymptomatic
Spondylolysis is the commonest cause of spondylolisthesis in children
Lumbar spondylolisthesis
occurs when one vertebra is displaced relative to its immediate inferior vertebral body
May occur as a result of stress fracture or spondylolysis
Traumatic cases may show the classic ‘Scotty Dog’ appearance on plain films
Young athletic females
Clinical presentation Lumbar spondylolisthesis
- low back pain
- often exacerbated by movement, particularly lumbar extension and twisting.
- radiation of pain into the buttocks
- more seen during the growth spurt in late childhood and early adolescence, probably due to increased physical activity
Prolapsed disc
usually produces clear dermatomal leg pain associated with neurological deficits
leg pain usually worse than back
pain
often worse when sitting
Spinal metastases
Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness
History of cancer.
Systemic cancer symptoms eg. fever / weight loss / night sweats.
Risk Factors for spinal infections
IVDU
immunosuppression (including steroid and immunosuppressant use)
Malignancy
diabetes mellitus
recent spinal surgery (via direct inoculation)
Mechanical back pain
Any age
Acute onset
< 4 weeks duration
< 30 min am stiffness
No nocturnal pain
Worse with activity
Abnormal flexion
Normal chest expansion
Possible neurologic deficits
may have paraspinal tenderness
Inflammatory back pain
Age of onset < 40
Insidious onset
> 3 months duration
> 60 min am stiffness
Nocturnal pain
Improves with activity
Loss of mobility in all planes (spondylitis)
Decreased chest expansion (involvement of costovertebral joints)
Neurologic deficit unlikely
Spinal metastases
Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness
Discitis
Isolated infection of the intervertebral disc (the nucleus pulposus), however can also spread to adjacent vertebral bodies (termed spondylodiscitis). The condition has a high prevalence in children.
Staphylococcus aureus is the most common cause
Features of discitis back pain
Systemic infection symptoms eg. fever / weight loss / night sweats.
Immunosuppression.
IV drug usage
for all types of spinal infection is back pain is often worse on movement and worse at night.
Red flags for back pain
New onset age ≤20 or ≥55.
Thoracic or cervical spine pain.
Pain is progressive or not relieved by rest.
Spinal (rather than paraspinal) tenderness.
spinal column consists of:
Seven cervical vertebrae
Twelve thoracic vertebrae
Five lumbar vertebrae
Sacrum
Coccyx
Atlas (C1) fractures
Burst fracture of atlas, both the anterior and posterior rings of C1 with lateral displacement of the lateral masses.Mechanism is by axial loading
Axis (C2) fractures
Odontoid peg fractures
Fractures of the odontoid peg are common spinal injuries in the elderly. They may follow a low-velocity injury, especially in patients with osteoporosis and those with age-related limitation of movement of the cervical spine
