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Back pain Flashcards

1
Q

What is vertebral osteomyelitis

A

Infection of the vertebra

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2
Q

Risk factors of vertebral osteomyelitis

A

People who inject drugs
Diabetes
GI infections
Infective endocarditis
UTi
Post operative

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3
Q

Cause of vertebral osteomyelitis

A

Haematogenous spread of infection from distant infections

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4
Q

Most common causative pathogen of vertebral osteomyelitis

A

S aureus

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5
Q

Complications of vertebral osteomyelitis

A

Vertebrae collapse -> kyphosis or flat vertebra

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6
Q

Symptoms of vertebral osteomyelitis

A

Insidious onset of Constant lumbar pain

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7
Q

Signs of vertebral osteomyelitis

A

Spinal tenderness
Paraspinal muscle spasm
Neuropathy (in severe case)

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8
Q

Investigations for vertebral osteomyelitis

A

Bloods - CRP
MRI
Blood cultures

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9
Q

Management of vertebral osteomyelitis

A
  1. CT guided biopsy
  2. High dose IV antibiotics
  3. Surgery if indicated
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10
Q

The response of vertebral osteomyelitis to IV antibiotics is assessed by

A

Clinical
CRP level

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11
Q

When is surgery indicated

A

No response to antibiotic therapy
Vertebral collapse
Neurological deficit

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12
Q

Surgical management for vertebral osteomyelitis

A

Debridement
Stabilization
Fusion of adjacent vertebrae

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13
Q

What is Pott disease

A

Vertebral osteomyelitis + intervertebral disci tis from TB

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14
Q

Risk factors

A

Immunosuppression
Skin and soft tissue infection
pulmonary TB

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15
Q

Symptoms of Pott disease

A
  • Often no systemic symptoms
  • Back pain
  • Lower limb weakness/paraplegia
  • Kyphotic deformity
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16
Q

Onset of symptoms of Pott disease

A

Insidious, slow

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17
Q

Investigations for Pott disease

A

Xray / MRI
check for immunosuppression / HIV

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18
Q

Management for Pott disease

A

TB treatment
Analgesia
Surgery

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19
Q

Describe TB treatment

A

isoniazid + rifampicin + ethambutol + pyrazinamide for 2 months
Isoniazid + rifampicin for another 4 months

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20
Q

What is mechanical back pain

A

Recurrent relapsing and remitting back pain with no neurological symptoms

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21
Q

Risk factors for mechanical back pain

A

20-55
Obese
Poor posture
Poor lifting technique
Lack of physical activity
Depression
Spondylosis
Degenerative disc prolapse

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22
Q

What is spondylosis

A

intervertebral discs lose water with age causing less cushioning and increased pressure on the facet joints

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23
Q

Spondylosis can cause

A

secondary facet joint OA

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24
Q

Symptoms of mechanical back pain

A

Pain in lumbosacral region, buttocks and thighs
Mechanical pain - worse at activity, at night
No red flag symptoms
Flare ups

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25
Where is the pain in mechanical back pain felt at
Lumbosacral region buttocks thighs (rarely below knee)
26
Management of mechanical back pain
Lifestyle advice Analgesia - NSAID Physiotherapy
27
What lifestyle advice is given to someone with mechanical back pain
Walk 30 minutes a day Weight control
28
Where does acute disc tear occur at
Outer fibrous layer of intervertebral disc (annulus fibrosus)
29
What usually causes acute disc tear
After lifting a heavy object
30
Pain in acute disc tear is worse when
coughing, because it increases disc pressure
31
Investigators for acute disc tear
MRI
32
Management for acute disc tear
Analgesia Physiotherapy Self resolving - 2-3 months
33
What is sciatica
Pain due to compression of any of the 5 nerve roots of sciatic nerve
34
What are the nerve roots of sciatic nerve
L4-S3 (L4,5, S1,2,3)
35
Where is the pain of sciatica felt at
Lumbar spine Buttocks Posterior thigh Posterior leg
36
Which nerve roots are the most commonly compressed in sciatica
L5 S1
37
Motor innervation of sciatic nerve
Posterior thigh Hamstring portion of adductor Magnus All muscles of the leg and foot via its branches
38
Branches of the sciatic nerve
Tibial nerve Common fibular nerve
39
Branches of the tibial nerve
Medial plantar nerve Lateral plantar nerve
40
Branches of the common fibular nerve
Superficial fibular nerve Deep fibular nerve Sural nerve Lateral sural nerve
41
Causes of sciatica
Prolapsed disc Bone spurs Spondylolisthesis Tumour Fractures Piriformis syndrome
42
Which structure of the intervertebral disc is the most likely to herniate and cause sciatica
Nucleus pulposus
43
Pathophysiology of sciatica
1. Intervertebral discs loosing water and weakening due to aging 2. The discs become prone to prolapse 3. Defect in annulus fibrosus allows the nucleus of the disc to herniate during strenuous physical activity 4. Prolapsed disc impinges on nerve roots of sciatic nerve
44
Symptoms of sciatica
Unilateral leg pain greater than back pain Sharp pain Pain radiating to foot Numbness in those areas
45
Do all patients have back pain in sciatica
No
46
Clinical signs of sciatica
Foot drop Numbness
47
Investigations for sciatica
Clinical
48
Management of sciatica
Analgesia Surgery if recurrent
49
Facet joint OA can cause
Osteophytes impinging on nerve roots
50
Management of osteophytes impinging on nerve roots
Surgical decompression Trimming of osteophytes
51
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
52
What is cauda equina syndrome
Compression of the nerve roots at cauda equina ( base of spinal cord)
53
Cauda equina level of spine
L1-L5
54
Most common cause of cauda equina syndrome
Large disc herniation at L4/L5 and L5/S1 level
55
Symptoms of cauda equina syndrome
Bilateral leg pain Groin pain Loss of bowel or bladder control Sexual dysfunction Weakness in legs
56
Clinical signs of cauda equina syndrome
Loss of anal sphincter tone in PR exam
57
Investigations for cauda equina syndrome
Urgent MRI
58
Management for cauda equina syndrome
Urgent discectomy
59
What is cervical spondylosis
Degenerative disease of cervical spine
60
Cervical spondylosis most commonly affects which age group
Elderly, above 50
61
Symptoms of cervical spondylosis
Neck pain neck stiffness Pain radiating to shoulders and occiput
62
Clinical signs of cervical spondylosis
Upper limb weakness Sensory changes
63
Management of cervical spondylosis
Physiotherapy Analgesics Surgical decompression if severe and recurrent
64
Cervical disc prolapse usually affects
C7 nerve root - at C6/7 discs C8 nerve root - at C7/T1 discs

Y2 MSK (19 decks)

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