Back pain

Question 1

Cauda equina

Answer 1

Back pain due to tumour or large disc herniation compressing the nerves of the cauda equina

Question 2

Clinical presentation of Cauda equina syndrome

Answer 2

• 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

Question 3

Sciatica

Answer 3

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.

Question 4

Lumbar spinal stenosis

Answer 4

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

Question 5

clinical presentation spinal stenosis

Answer 5

• 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

Question 6

Ankylosing spondylitis

Answer 6

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

Question 7

Spondylolysis

Answer 7

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

Question 8

Lumbar spondylolisthesis

Answer 8

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

Question 9

Clinical presentation Lumbar spondylolisthesis

Answer 9

• 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

Question 10

Prolapsed disc

Answer 10

usually produces clear dermatomal leg pain associated with neurological deficits
leg pain usually worse than back
pain
often worse when sitting

Question 11

Spinal metastases

Answer 11

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.

Question 12

Risk Factors for spinal infections

Answer 12

IVDU
immunosuppression (including steroid and immunosuppressant use)
Malignancy
diabetes mellitus
recent spinal surgery (via direct inoculation)

Question 13

Mechanical back pain

Answer 13

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

Question 14

Inflammatory back pain

Answer 14

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

Question 15

Spinal metastases

Answer 15

Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness

Question 16

Discitis

Answer 16

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

Question 17

Features of discitis back pain

Answer 17

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.

Question 18

Red flags for back pain

Answer 18

New onset age ≤20 or ≥55.
Thoracic or cervical spine pain.
Pain is progressive or not relieved by rest.
Spinal (rather than paraspinal) tenderness.

Question 19

spinal column consists of:

Answer 19

Seven cervical vertebrae
Twelve thoracic vertebrae
Five lumbar vertebrae
Sacrum
Coccyx

Question 20

Atlas (C1) fractures

Answer 20

Burst fracture of atlas, both the anterior and posterior rings of C1 with lateral displacement of the lateral masses.Mechanism is by axial loading

Question 21

Axis (C2) fractures

Answer 21

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