Back Pain

Question 1

most common cause of vertebral osteomyelitis

Answer 1

staph. aureus

Question 2

what is vertebral osteomyelitis

Answer 2

infection of the vertebrae

Question 3

what may vertebral osteomyelitis be associated with

Answer 3

abscesses (epidural, psoas)

Question 4

risk factors for vertebral osteomyelitis

Answer 4

PWID, poorly controlled diabetes, IV site infections, post operative

Question 5

symptom of vertebral osteomyelitis

Answer 5

insidious onset of back pain (usually lumbar) which is constant and unremitting

Question 6

clinical signs of vertebral osteomyelitis

Answer 6

paraspinal muscle spasm
spinal tenderness
may have fever
associated neurological deficit in severe cases

Question 7

bloods in vertebral osteomyelitis

Answer 7

raised CRP

Question 8

what is used to image vertebral osteomyelitis

Answer 8

MRI

Question 9

what needs to be considered when investigating vertebral osteomyelitis

Answer 9

endocarditis

Question 10

management of vertebral osteomyelitis

Answer 10

spinal stabilisation
high dose Abx after CT guided biopsy for cultures

Question 11

when is surgery indicated for vertebral osteomyelitis

Answer 11

inability to obtain cultures by needle biopsy
no response to antibiotic therapy
progressive vertebral collapse
progressive neurological deficit

Question 12

what is pott disease

Answer 12

vertebral body osteomyelitis and intervertebral discitis from tuberculosis

Question 13

clinical presentation of symptomatic vertebral TB

Answer 13

slow and insidious
back pain
lower limb weakness
kyphotic deformity

Question 14

imaging for vertebral TB

Answer 14

XR and MRI

Question 15

when does mechanical back pain often present

Answer 15

20-55

Question 16

name some risk factors for mechanical bone pain

Answer 16

obesity, poor posture, poor lifting technique, lack of physical activity

Question 17

what is spondylosis

Answer 17

IV discs lose water content with age, resulting in less cushioning and increased pressure on the facet joint

Question 18

what can spondylosis lead to

Answer 18

secondary OA

Question 19

clinical presentation of mechanical back pain

Answer 19

pain in lumbosacral region, bum and thighs

Question 20

management of mechanical back pain

Answer 20

restrict rather than avoid activity
lose weight
NSAIDs
physio

Question 21

what usually causes an acute disc tear

Answer 21

lifting a heavy object

Question 22

where does an acute disc tear occur

Answer 22

in the outer fibrosis of an intervertebral disc

Question 23

symptom of acute disc tear

Answer 23

pain worse on coughing

Question 24

imaging for acute disc tear

Answer 24

MRI

Question 25

management of acute disc tear

Answer 25

analgesia and physiotherapy

Question 26

what causes sciatica

Answer 26

compression of a nerve root

Question 27

most common nerve root compressed in sciatica

Answer 27

L5/S1

Question 28

what is the most common cause of sciatica

Answer 28

IV disc collapse

Question 29

clinical presentation of sciatica

Answer 29

unilateral leg pain that is greater than in the back sharp, shooting, electrical pain radiates to the foot numbness/paraesthesia

Question 30

suppostive management of sciatica

Answer 30

NSAIDs and analgesia

Question 31

what is spinal stenosis

Answer 31

narrowing of the central spinal canal

Question 32

what usually causes spinal stenosis

Answer 32

degenerative joint disease in middle age- elderly patients

Question 33

what is central stenosis

Answer 33

compression of all the nerve roots passing through

Question 34

what is lateral recess stenosis

Answer 34

compression of the transitioning nerve root

Question 35

what is foraminal stenosis

Answer 35

compression of the exiting nerve root

Question 36

clinical presentation of spinal stenosis

Answer 36

pain on walking (claudication)

Question 37

who usually presents with spinal claudication

Answer 37

>60

Question 38

how does spinal claudication differ to vascular

Answer 38

burning pain rather than cramping spinal extension exacerbates symptoms reserved pedal pulses

Question 39

what causes spinal extension

Answer 39

standing or walking downhill

Question 40

investigation for spinal stenosis

Answer 40

MRI

Question 41

conservative management of spinal stenosis

Answer 41

analgesia, physio

Question 42

surgical management of spinal stenosis

Answer 42

decompression

Question 43

why does decompression help spinal stenosis

Answer 43

leaves more space for the cauda equina

Question 44

what is cauda equina syndrome

Answer 44

dysfunction of multiple lumbar and sacral nerve roots

Question 45

most common cause of cauda equina syndrome

Answer 45

large central lumbar disc herniation at the L4/L5 and L5/S1 level

Question 46

clinical presentation of cauda equina syndrome

Answer 46

bilateral leg pain urinary retention, incontinence saddle anaesthesia widespread motor weakness in the legs

Question 47

clinical sign of cauda equina

Answer 47

loss of anal sphincter tone on PR exam

Question 48

investigation for cauda equina syndrome

Answer 48

urgent MRI bladder scan

Question 49

management of cauda equina syndrome

Answer 49

urgent discectomy

Question 50

when is back pain chronic

Answer 50

>3 months

Question 51

red flags for neck pain

Answer 51

headache fever stiffness

Question 52

red flags for back pain

Answer 52

neuro deficit systemic features: fever, chills, night sweats PWID travel to countries with TB trauma osteoporosis pain at rest/ at night

Question 53

how does cervical spondylosis present

Answer 53

slow onset stiffness and pain in the neck can radiate to shoulders and the occiput

Question 54

management of cervical spondylosis

Answer 54

physio + analgesia

Question 55

complication of RA on the spine

Answer 55

atlanto-axial subluxation leading to chord compression

Question 56

conservative management of atlanto-axial subluxation

Answer 56

collar to prevent flexion

Question 57

surgical management of atlanto-axial subluxation

Answer 57

surgical fusion

Question 58

what is spondylolisthesis

Answer 58

anterior subluxation of one vertebra on another

Question 59

management of isthmic spondylolisthesis

Answer 59

decompression + fusion

Question 60

what is cervical radiculopathy

Answer 60

dysfunction of cervical nerve root

Question 61

name some causes of cervical radiculopathy

Answer 61

disc prolapse, vertebral osteophytes, compressive lesions e.g. tumours

Question 62

clinical presentation of cervical radiculopathy

Answer 62

pain radiating from the neck into the arm numbness/weakness in the upper extremity

Question 63

investigation for cervical radiculopathy

Answer 63

MRI

Question 64

general management of cervical radiculopathy

Answer 64

analgesia + physio

Question 65

what is cervical myelopathy

Answer 65

dysfunction of the cervical spinal chord

Question 66

clinical presentation of cervical myopathy

Answer 66

slow, progressive symptoms clumsiness of hands and feet mild gait disturbances paraesthesia

Question 67

surgical management of cervical myopathy

Answer 67

discectomy or laminectomy

Question 68

what is scoliosis

Answer 68

spinal deformity with sideways or coronal curve

Question 69

what is associated with scoliosis

Answer 69

vertebral rotation

Question 70

what are the 4 classifications of scoliosis

Answer 70

congenital juvenile adolescent idiopathic scoliosis adult

Question 71

when is scoliosis classed as juvenile

Answer 71

<10 yrs

Question 72

when is scoliosis classed as adolescent

Answer 72

10-18 yrs

Question 73

clinical presentation of scoliosis

Answer 73

visible spinal deformity pain prominent rib hump, asymmetry of shoulders

Question 74

imaging for scoliosis

Answer 74

XR, MRI

Question 75

what is management of scoliosis based on

Answer 75

skeletal maturity, severity of deformation and progression of deformity

Question 76

what is kyphosis

Answer 76

spinal deformity with excessive convex curvature of the spine

Question 77

where in the spine is most commonly affected by kyphosis

Answer 77

thoracic spine