Back Pain Flashcards
most common cause of vertebral osteomyelitis
staph. aureus
what is vertebral osteomyelitis
infection of the vertebrae
what may vertebral osteomyelitis be associated with
abscesses (epidural, psoas)
risk factors for vertebral osteomyelitis
PWID, poorly controlled diabetes, IV site infections, post operative
symptom of vertebral osteomyelitis
insidious onset of back pain (usually lumbar) which is constant and unremitting
clinical signs of vertebral osteomyelitis
paraspinal muscle spasm
spinal tenderness
may have fever
associated neurological deficit in severe cases
bloods in vertebral osteomyelitis
raised CRP
what is used to image vertebral osteomyelitis
MRI
what needs to be considered when investigating vertebral osteomyelitis
endocarditis
management of vertebral osteomyelitis
spinal stabilisation
high dose Abx after CT guided biopsy for cultures
when is surgery indicated for vertebral osteomyelitis
inability to obtain cultures by needle biopsy
no response to antibiotic therapy
progressive vertebral collapse
progressive neurological deficit
what is pott disease
vertebral body osteomyelitis and intervertebral discitis from tuberculosis
clinical presentation of symptomatic vertebral TB
slow and insidious
back pain
lower limb weakness
kyphotic deformity
imaging for vertebral TB
XR and MRI
when does mechanical back pain often present
20-55
name some risk factors for mechanical bone pain
obesity, poor posture, poor lifting technique, lack of physical activity
what is spondylosis
IV discs lose water content with age, resulting in less cushioning and increased pressure on the facet joint
what can spondylosis lead to
secondary OA
clinical presentation of mechanical back pain
pain in lumbosacral region, bum and thighs
management of mechanical back pain
restrict rather than avoid activity
lose weight
NSAIDs
physio
what usually causes an acute disc tear
lifting a heavy object
where does an acute disc tear occur
in the outer fibrosis of an intervertebral disc
symptom of acute disc tear
pain worse on coughing
imaging for acute disc tear
MRI
management of acute disc tear
analgesia and physiotherapy
what causes sciatica
compression of a nerve root
most common nerve root compressed in sciatica
L5/S1
what is the most common cause of sciatica
IV disc collapse
clinical presentation of sciatica
unilateral leg pain that is greater than in the back
sharp, shooting, electrical pain
radiates to the foot
numbness/paraesthesia
suppostive management of sciatica
NSAIDs and analgesia
what is spinal stenosis
narrowing of the central spinal canal
what usually causes spinal stenosis
degenerative joint disease in middle age- elderly patients
what is central stenosis
compression of all the nerve roots passing through
what is lateral recess stenosis
compression of the transitioning nerve root
what is foraminal stenosis
compression of the exiting nerve root
clinical presentation of spinal stenosis
pain on walking (claudication)
who usually presents with spinal claudication
> 60
how does spinal claudication differ to vascular
burning pain rather than cramping
spinal extension exacerbates symptoms
reserved pedal pulses
what causes spinal extension
standing or walking downhill
investigation for spinal stenosis
MRI
conservative management of spinal stenosis
analgesia, physio
surgical management of spinal stenosis
decompression
why does decompression help spinal stenosis
leaves more space for the cauda equina
what is cauda equina syndrome
dysfunction of multiple lumbar and sacral nerve roots
most common cause of cauda equina syndrome
large central lumbar disc herniation at the L4/L5 and L5/S1 level
clinical presentation of cauda equina syndrome
bilateral leg pain
urinary retention, incontinence
saddle anaesthesia
widespread motor weakness in the legs
clinical sign of cauda equina
loss of anal sphincter tone on PR exam
investigation for cauda equina syndrome
urgent MRI
bladder scan
management of cauda equina syndrome
urgent discectomy
when is back pain chronic
> 3 months
red flags for neck pain
headache
fever
stiffness
red flags for back pain
neuro deficit
systemic features: fever, chills, night sweats
PWID
travel to countries with TB
trauma
osteoporosis
pain at rest/ at night
how does cervical spondylosis present
slow onset stiffness and pain in the neck
can radiate to shoulders and the occiput
management of cervical spondylosis
physio + analgesia
complication of RA on the spine
atlanto-axial subluxation leading to chord compression
conservative management of atlanto-axial subluxation
collar to prevent flexion
surgical management of atlanto-axial subluxation
surgical fusion
what is spondylolisthesis
anterior subluxation of one vertebra on another
management of isthmic spondylolisthesis
decompression + fusion
what is cervical radiculopathy
dysfunction of cervical nerve root
name some causes of cervical radiculopathy
disc prolapse, vertebral osteophytes, compressive lesions e.g. tumours
clinical presentation of cervical radiculopathy
pain radiating from the neck into the arm
numbness/weakness in the upper extremity
investigation for cervical radiculopathy
MRI
general management of cervical radiculopathy
analgesia + physio
what is cervical myelopathy
dysfunction of the cervical spinal chord
clinical presentation of cervical myopathy
slow, progressive symptoms
clumsiness of hands and feet
mild gait disturbances
paraesthesia
surgical management of cervical myopathy
discectomy or laminectomy
what is scoliosis
spinal deformity with sideways or coronal curve
what is associated with scoliosis
vertebral rotation
what are the 4 classifications of scoliosis
congenital
juvenile
adolescent idiopathic scoliosis
adult
when is scoliosis classed as juvenile
<10 yrs
when is scoliosis classed as adolescent
10-18 yrs
clinical presentation of scoliosis
visible spinal deformity
pain
prominent rib hump, asymmetry of shoulders
imaging for scoliosis
XR, MRI
what is management of scoliosis based on
skeletal maturity, severity of deformation and progression of deformity
what is kyphosis
spinal deformity with excessive convex curvature of the spine
where in the spine is most commonly affected by kyphosis
thoracic spine
