Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK > Back Pain > Flashcards

Back Pain Flashcards

(58 cards)

Start Studying
1
Q

What is vertebral osteomyelitis?

A

Infection of the vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does bacteria spread in the body in VO?

A

Mostly haematogenous, most commonly staph. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are symptoms of VO?

A
  • Insidious onset of back pain (most commonly lumbar)
  • Pain is constant and unremitting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What will MRI show in VO?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does psoas sign indicate?

A

Spondylodiscitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What warning sign should you look out for with VO?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does surgery for VO involve?

A

Surgery involves debridement, stabilization and fusion of adjacent vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is cauda equina syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What clinical signs indicate cauda equina syndrome?

A

PR exam - loss of anal sphincter tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations can you do for cauda equina?

A

Urgent MRI to determine level of prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you treat cauda equina?

A

Urgent discectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is spinal stenosis and claudication caused by?

A

Degenerative joint disease in middle aged to elderly individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What causes the cauda equina to have less space?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Who is spinal stenosis and claudication common in?

Study These Flashcards
A

Generally patients over 60

25
What is a clinical sign of spinal stenosis?
Claudication (pain in legs on walking)
26
How is spinal claudication different from vascular claudication?
- 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
How is spinal stenosis diagnosed?
Clinically
28
How to treat spinal stenosis with claudication?
- 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
What is mechanical back pain?
Recurrent relapsing and remitting back pain with no neurological symptoms
30
What is vertebral TB (Potts disease)?
Vertebral body osteomyelitis and intervertebral discitis from tuberculosis (TB)
31
What type of vertebral TB can patients have?
- 1/2 have skin and soft tissue infection - Less than half have pulmonary TB - Immunosuppression/HIV
32
How does vertebral TB usually present clinically?
- Often no systemic symptoms - Characteristically slow and insidious - Back pain - Lower limb weakness/paraplegia - Kyphotic deformity
33
What investigations for vertebral TB?
- Imaging - x-ray, MRI - Check for immunosuppression/HIV
34
35
What investigations can you do for vertebral TB?
- Imaging - x-ray, MRI - Check for immunosuppression/HIV
36
How do you treat vertebral TB?
- Treat TB - Analgesics - Surgery (immobilisation of spine region, drainage of spinal abscesses)
37
What is Acute Disc Tear/Discogenic Back Pain?
An acute tear can occur in the outer fibrosis of an intervertebral disc
38
When do acute disc tears usually happen?
After lifting a heavy object (e.g. lawnmover)
39
When does acute disc tear pain get exacerbated? Why?
- Worse on coughing (coughing increases disc pressure)
40
What investigations should you do for acute disc tear?
MRI
41
What treatments for acute disc tear?
- Analgesia and physiotherapy - Symptoms usually resolve but can take 2-3 months to settle
42
What is sciatica?
Characteristic pain felt in the lower back, buttocks and the posterior and lower leg that
43
What causes sciatica?
Compression of any of the 5 nerve roots that contribute to the sciatic nerves most, commonly L5/S1
44
What are symptoms of sciatica?
- 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
What are clinical signs of sciatica?
- Nerve irritation signs - Motor, sensory, or reflex changes in one nerve root
46
How do you diagnose sciatica?
Clinical diagnosis
47
How do you treat sciatica?
- 50% recover from acute attack in 6 weeks, 90% within 3 months - NSAIDs and analgesia - Consider surgery if unremitting/recurrent symptoms
48
What is Bony Nerve Root Entrapment?
OA of the facet joints can result in osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica
49
How can you treat Bony Nerve Root Entrapment?
- Surgical decompression, with trimming of the impinging osteophytes, may be performed in suitable candidates
50
What are Osteoporotic Crush Fractures?
With severe osteoporosis, spontaneous crush fractures of the vertebral body can occur leading to acute pain and kyphosis
51
How do you treat Osteoporotic Crush Fractures?
- Usually conservative - Balloon vertebroplasty - results not yet fully evaluated, small risk of neurological injury
52
What is a complication of Osteoporotic Crush Fractures?
A minority of patients go on to have chronic pain due to altered spinal mechanics
53
What is cervical spondylosis?
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
How does cervical spondylosis present clinically?
- Slow onset stiffness and pain in the neck - Pain can radiate to shoulders and the occiput
55
How do you treat cervical spondylosis?
Physiotherapy and analgesics
56
What are complications of cervical spondylosis?
- 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
What is a cervical disc prolapse?
Acute and degenerative disc prolapse can also occur in the cervical spine producing neck pain and potentially nerve root compression
58
How does a cervical
- 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions