Back pain Flashcards
What is vertebral osteomyelitis
Infection of the vertebra
Risk factors of vertebral osteomyelitis
People who inject drugs
Diabetes
GI infections
Infective endocarditis
UTi
Post operative
Cause of vertebral osteomyelitis
Haematogenous spread of infection from distant infections
Most common causative pathogen of vertebral osteomyelitis
S aureus
Complications of vertebral osteomyelitis
Vertebrae collapse -> kyphosis or flat vertebra
Symptoms of vertebral osteomyelitis
Insidious onset of Constant lumbar pain
Signs of vertebral osteomyelitis
Spinal tenderness
Paraspinal muscle spasm
Neuropathy (in severe case)
Investigations for vertebral osteomyelitis
Bloods - CRP
MRI
Blood cultures
Management of vertebral osteomyelitis
- CT guided biopsy
- High dose IV antibiotics
- Surgery if indicated
The response of vertebral osteomyelitis to IV antibiotics is assessed by
Clinical
CRP level
When is surgery indicated
No response to antibiotic therapy
Vertebral collapse
Neurological deficit
Surgical management for vertebral osteomyelitis
Debridement
Stabilization
Fusion of adjacent vertebrae
What is Pott disease
Vertebral osteomyelitis + intervertebral disci tis from TB
Risk factors
Immunosuppression
Skin and soft tissue infection
pulmonary TB
Symptoms of Pott disease
- Often no systemic symptoms
- Back pain
- Lower limb weakness/paraplegia
- Kyphotic deformity
Onset of symptoms of Pott disease
Insidious, slow
Investigations for Pott disease
Xray / MRI
check for immunosuppression / HIV
Management for Pott disease
TB treatment
Analgesia
Surgery
Describe TB treatment
isoniazid + rifampicin + ethambutol + pyrazinamide for 2 months
Isoniazid + rifampicin for another 4 months
What is mechanical back pain
Recurrent relapsing and remitting back pain with no neurological symptoms
Risk factors for mechanical back pain
20-55
Obese
Poor posture
Poor lifting technique
Lack of physical activity
Depression
Spondylosis
Degenerative disc prolapse
What is spondylosis
intervertebral discs lose water with age causing less cushioning and increased pressure on the facet joints
Spondylosis can cause
secondary facet joint OA
Symptoms of mechanical back pain
Pain in lumbosacral region, buttocks and thighs
Mechanical pain - worse at activity, at night
No red flag symptoms
Flare ups
Where is the pain in mechanical back pain felt at
Lumbosacral region
buttocks
thighs
(rarely below knee)
Management of mechanical back pain
Lifestyle advice
Analgesia - NSAID
Physiotherapy
What lifestyle advice is given to someone with mechanical back pain
Walk 30 minutes a day
Weight control
Where does acute disc tear occur at
Outer fibrous layer of intervertebral disc (annulus fibrosus)
What usually causes acute disc tear
After lifting a heavy object
Pain in acute disc tear is worse when
coughing, because it increases disc pressure
Investigators for acute disc tear
MRI
Management for acute disc tear
Analgesia
Physiotherapy
Self resolving - 2-3 months
What is sciatica
Pain due to compression of any of the 5 nerve roots of sciatic nerve
What are the nerve roots of sciatic nerve
L4-S3 (L4,5, S1,2,3)
Where is the pain of sciatica felt at
Lumbar spine
Buttocks
Posterior thigh
Posterior leg
Which nerve roots are the most commonly compressed in sciatica
L5
S1
Motor innervation of sciatic nerve
Posterior thigh
Hamstring portion of adductor Magnus
All muscles of the leg and foot via its branches
Branches of the sciatic nerve
Tibial nerve
Common fibular nerve
Branches of the tibial nerve
Medial plantar nerve
Lateral plantar nerve
Branches of the common fibular nerve
Superficial fibular nerve
Deep fibular nerve
Sural nerve
Lateral sural nerve
Causes of sciatica
Prolapsed disc
Bone spurs
Spondylolisthesis
Tumour
Fractures
Piriformis syndrome
Which structure of the intervertebral disc is the most likely to herniate and cause sciatica
Nucleus pulposus
Pathophysiology of sciatica
- Intervertebral discs loosing water and weakening due to aging
- The discs become prone to prolapse
- Defect in annulus fibrosus allows the nucleus of the disc to herniate during strenuous physical activity
- Prolapsed disc impinges on nerve roots of sciatic nerve
Symptoms of sciatica
Unilateral leg pain greater than back pain
Sharp pain
Pain radiating to foot
Numbness in those areas
Do all patients have back pain in sciatica
No
Clinical signs of sciatica
Foot drop
Numbness
Investigations for sciatica
Clinical
Management of sciatica
Analgesia
Surgery if recurrent
Facet joint OA can cause
Osteophytes impinging on nerve roots
Management of osteophytes impinging on nerve roots
Surgical decompression
Trimming of osteophytes
Peripheral vascular disease and spinal stenosis can both cause claudication in lower legs. How do you differentiate
Pain is burning in SS whereas pain is cramping in PVD
Pulses are preserved in SS whereas pulse in PVD is absent
What is cauda equina syndrome
Compression of the nerve roots at cauda equina ( base of spinal cord)
Cauda equina level of spine
L1-L5
Most common cause of cauda equina syndrome
Large disc herniation at L4/L5 and L5/S1 level
Symptoms of cauda equina syndrome
Bilateral leg pain
Groin pain
Loss of bowel or bladder control
Sexual dysfunction
Weakness in legs
Clinical signs of cauda equina syndrome
Loss of anal sphincter tone in PR exam
Investigations for cauda equina syndrome
Urgent MRI
Management for cauda equina syndrome
Urgent discectomy
What is cervical spondylosis
Degenerative disease of cervical spine
Cervical spondylosis most commonly affects which age group
Elderly, above 50
Symptoms of cervical spondylosis
Neck pain
neck stiffness
Pain radiating to shoulders and occiput
Clinical signs of cervical spondylosis
Upper limb weakness
Sensory changes
Management of cervical spondylosis
Physiotherapy
Analgesics
Surgical decompression if severe and recurrent
Cervical disc prolapse usually affects
C7 nerve root - at C6/7 discs
C8 nerve root - at C7/T1 discs
