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MSK > Back Pain > Flashcards

Back Pain Flashcards

1
Q

What is vertebral osteomyelitis?

A

Infection of the vertebrae

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2
Q

How does bacteria spread in the body in VO?

A

Mostly haematogenous, most commonly staph. aureus

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3
Q

What is VO often associated with? What does this lead to?

A
  • May be associated with abscess ( epidural, psoas)
  • As the vertebral end plates weaken, vertebrae may collapse leading to kyphosis or vertebra plana (flat vertebra) and disc space may reduce
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4
Q

What are risk factors for VO?

A
  • PWID
  • Poorly controlled diabetes
  • IV site infections
  • GU infections
  • SSTI
  • Post operative
  • Primary bacteraemia in the elderly
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5
Q

What are symptoms of VO?

A
  • Insidious onset of back pain (most commonly lumbar)
  • Pain is constant and unremitting
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6
Q

What are clinical signs of VO?

A
  • Paraspinal muscle spasm
  • Spinal tenderness
  • May have fever and/or systemic upset
  • Severe cases may have an associated neurological deficit
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7
Q

What will bloods show in VO?

A
  • Raised CRP
  • Cultures: indicate the causative organism (usually Staph. aureus including MRSA but atypical infections can occur in the immunocompromised)
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8
Q

What will MRI show in VO?

A

Extent of infection and any abscess formation (also psoas sign)

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9
Q

What does psoas sign indicate?

A

Spondylodiscitis

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10
Q

What warning sign should you look out for with VO?

A

Consider endocarditis - look for clubbing, splinter haemorrhages, murmur, consider ECHO

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11
Q

What is 1st line treatment for VO?

A
  • High dose IV antibiotics after CT guided biopsy to obtain tissue culture
  • Antibiotics may be required for several months and response is assessed clinically by serial CRP
  • Around half of all patients go on to spontaneous fusion and resolution
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12
Q

What are the indications of surgery in VO?

A
  • Inability to obtain cultures by needle biopsy
  • No response to antibiotic therapy
  • Progressive vertebral collapse and progressive neurological deficit
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13
Q

What does surgery for VO involve?

A

Surgery involves debridement, stabilization and fusion of adjacent vertebrae

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14
Q

What is cauda equina syndrome?

A

Compression of the nerve roots caudal to the level of spinal cord termination

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15
Q

What is the most common cause of cauda equina syndrome?

A

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

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16
Q

What are symptoms of cauda equina syndrome?

A
  • Classically bilateral leg pain, can be unilateral or with no leg symptoms
  • Loss of motor or sensory function of bowel/bladder
    • Loss of control/awareness (NOT constipation or increased urinary frequency)
  • Perineal/saddle anaethesia
  • Widespread or progressive motor weakness in the legs or gait distribution
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17
Q

What clinical signs indicate cauda equina syndrome?

A

PR exam - loss of anal sphincter tone

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18
Q

What investigations can you do for cauda equina?

A

Urgent MRI to determine level of prolapse

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19
Q

How do you treat cauda equina?

A

Urgent discectomy

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20
Q

What are some complications of cauda equina?

A
  • Prolonged compression can cause permanent nerve damage requiring colostomy and urinary diversion
  • Even with prompt surgical intervention, significant number of patients have residual nerve injury with permanent bladder and bowel dysfunction
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21
Q

What is spinal stenosis and claudication?

A

Narrowing of the central spinal canal, intervertebral foramen and/or lateral recess causing progressive nerve root compression

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22
Q

What is spinal stenosis and claudication caused by?

A

Degenerative joint disease in middle aged to elderly individuals

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23
Q

What causes the cauda equina to have less space?

A

Spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis

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24
Q

Who is spinal stenosis and claudication common in?

A

Generally patients over 60

25
Q

What is a clinical sign of spinal stenosis?

A

Claudication (pain in legs on walking)

26
Q

How is spinal claudication different from vascular claudication?

A
  • The claudication distance is inconsistent
  • The pain is burning (rather than cramping)
  • Spinal extension (standing or walking downhill) exacerbates symptoms while back flexion (sitting or walking uphill) improves symptoms (creates more space for the cauda equina)
  • Pedal pulses are preserved
27
Q

How is spinal stenosis diagnosed?

A

Clinically

28
Q

How to treat spinal stenosis with claudication?

A
  • Conservative management - analgesia, physiotherapy, weight loss if indicated
  • If symptoms fail to resolve with conservative management and there is MRI evidence of stenosis, surgery may be performed (decompression to increase space for the cauda equina) to help alleviate symptoms
29
Q

What is mechanical back pain?

A

Recurrent relapsing and remitting back pain with no neurological symptoms

30
Q

What is vertebral TB (Potts disease)?

A

Vertebral body osteomyelitis and intervertebral discitis from tuberculosis (TB)

31
Q

What type of vertebral TB can patients have?

A
  • 1/2 have skin and soft tissue infection
  • Less than half have pulmonary TB
  • Immunosuppression/HIV
32
Q

How does vertebral TB usually present clinically?

A
  • Often no systemic symptoms
  • Characteristically slow and insidious
  • Back pain
  • Lower limb weakness/paraplegia
  • Kyphotic deformity
33
Q

What investigations for vertebral TB?

A
  • Imaging - x-ray, MRI
  • Check for immunosuppression/HIV
35
Q

What investigations can you do for vertebral TB?

A
  • Imaging - x-ray, MRI
  • Check for immunosuppression/HIV
36
Q

How do you treat vertebral TB?

A
  • Treat TB
  • Analgesics
  • Surgery (immobilisation of spine region, drainage of spinal abscesses)
37
Q

What is Acute Disc Tear/Discogenic Back Pain?

A

An acute tear can occur in the outer fibrosis of an intervertebral disc

38
Q

When do acute disc tears usually happen?

A

After lifting a heavy object (e.g. lawnmover)

39
Q

When does acute disc tear pain get exacerbated? Why?

A
  • Worse on coughing (coughing increases disc pressure)
40
Q

What investigations should you do for acute disc tear?

41
Q

What treatments for acute disc tear?

A
  • Analgesia and physiotherapy
  • Symptoms usually resolve but can take 2-3 months to settle
42
Q

What is sciatica?

A

Characteristic pain felt in the lower back, buttocks and the posterior and lower leg that

43
Q

What causes sciatica?

A

Compression of any of the 5 nerve roots that contribute to the sciatic nerves most, commonly L5/S1

44
Q

What are symptoms of sciatica?

A
  • Frequently described as unilateral leg pain that is greater than the back pain
  • Some patients may not have any back pain
  • Sharp, shooting, electric pain
  • Pain radiates to foot
  • Numbness and parasthesia in same distribution
45
Q

What are clinical signs of sciatica?

A
  • Nerve irritation signs
  • Motor, sensory, or reflex changes in one nerve root
46
Q

How do you diagnose sciatica?

A

Clinical diagnosis

47
Q

How do you treat sciatica?

A
  • 50% recover from acute attack in 6 weeks, 90% within 3 months
  • NSAIDs and analgesia
  • Consider surgery if unremitting/recurrent symptoms
48
Q

What is Bony Nerve Root Entrapment?

A

OA of the facet joints can result in osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica

49
Q

How can you treat Bony Nerve Root Entrapment?

A
  • Surgical decompression, with trimming of the impinging osteophytes, may be performed in suitable candidates
50
Q

What are Osteoporotic Crush Fractures?

A

Withsevereosteoporosis,spontaneouscrushfracturesofthevertebralbodycanoccur leading to acute pain and kyphosis

51
Q

How do you treat Osteoporotic Crush Fractures?

A
  • Usually conservative
  • Balloon vertebroplasty - results not yet fully evaluated, small risk of neurological injury
52
Q

What is a complication of Osteoporotic Crush Fractures?

A

Aminorityofpatientsgoontohavechronicpainduetoalteredspinal mechanics

53
Q

What is cervical spondylosis?

A

As with the rest of the spine, spondylosis can occur with disc degeneration leading to increased loading and accelerated OA of the facet joints

54
Q

How does cervical spondylosis present clinically?

A
  • Slow onset stiffness and pain in the neck
  • Pain can radiate to shoulders and the occiput
55
Q

How do you treat cervical spondylosis?

A

Physiotherapy and analgesics

56
Q

What are complications of cervical spondylosis?

A
  • Osteophytes can also impinge on the exiting nerve roots resulting in a radiculopathy involving the upper limb dermatomes and myotomes
  • May require decompression for severe symptoms resistant to conservative management
57
Q

What is a cervical disc prolapse?

A

Acute and degenerative disc prolapse can also occur in the cervical spine producing neck pain and potentially nerve root compression

58
Q

How does a cervical

A
  • With nerve root compression, patients complain of shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes depending on the nerve root affected
  • Typically, the lower nerve root is involved (i.e. C7 root for C6/7 disc, C8 root for C7/T1 disc)
  • A large central prolapse can compress the cord leading to a myelopathy with upper motor neurone symptoms and signs

MSK (12 decks)

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