back pain Flashcards
where does the spinal cord end
L2
Where to take lumbar puncture
L3/4 space to avoid spinal cord
back pain overview
duration for improvement and chronic condition
Common and acute pain
better in a few days-6weeks
12+weeks=chronic back pain
mechanical back pain 4 common cause and what is it worse with
worse with movement
MOAD
-Muscular tension
-Osteoarthritis of facet joint
-Acute muscle sprain
-Degenerative disc disease
what is facet joint
small synovial joints at posterior spinal column linking each verbetra
sciatica
how is the pain
cause
pain radiating down 1 leg
cause: disc herniation contacting exiting lumbar nerve root
how disc herniation occur
nucleus pulposus pushes through and extrudes annulus fibrosus
serious cause of backpain. 5 examples
LIIFT
large disc prolapse
infection
inflammatory spondylarthropathy
fracture
tumour
examples of infection in serious back pain
discitis,
vertebral osteomyelitis,
TB-microbiology
examples of inflammatory spondyloarthropathy in serious back pain
Ankylosing spondylitis
psoriatic arthritis
IBD
examples of tumour in serious back pain
metastatic cancer /myeloma
red flags of back pain
pain at night/night sweats
constant pain
weight loss
prev malignancy
Bladder or bowel disturbance (Sphincter dysfunction)
Leg weakness or sensory loss
Age <20 or >55 yrs
thoracic pain
cauda equina syndrome what is it and what happens if left untreated
Neurosurgical emergency
Untreated = permanent lower limb paralysis and incontinence
cauda equina syndrome signs/symptoms
Saddle anaesthesia
Bladder/bowel incontinence
Loss of anal tone on PR
Radicular leg pain
Ankle jerks may be absent
cauda equina syndrome: investigation, cause and treatment
urgent MRI spine
large disc herniation, bony mets, myeloma, TB
treat- according to cause- poss surgery
investigation of back pain without red flag
usually not needed- no X-Ray/MRI to diagnose non-specific low back pain
review if symptoms persist after 3-4 weeks and reassess underlying cause
treatment for lower back pain without red flags
time
analgesia - NSAIDs
avoid bed rest
physio
investigation- bloods what does it mean if ESR
CRP
FBC
ALP
Calcium
PSA is high ?
ESR-myeloma/TB/Chronic infection
CRP-infection/inflammation
FBC-anaemia in myeloma
ALP- bony mets
Calcium- myeloma/bony mets
PSA - prostate cancer with bony mets
investigation - imaging- difference between radiograph, MRI, CT
Radiograph- cheap
CT- good for bony path/larger radiation dose
MRI- best for soft tissue (like tendons)/spinal imaging- expensive
what is a wedge fracture
osteoporotic vertebral collapse
inflammatory spondyloarthritis Extra-articular manifestations:
Anterior uveitis (iritis) – ocular inflammation
Apical lung fibrosis
Aortitis/aortic regurgitation
Amyloidosis – due to chronically serum amyloid A (SAA) depositing in organs
herniated discs treatment
normally spontaneous improvement
treatment:
1. Conservative for LBP without sciatica
-Analgesia: NSAIDs
-Physiotherapy
- Nerve root injection (local anaesthetic and glucocorticoid)
- Surgery if neurological compromise or symptoms persist
cause of dactylitis
enthesitis
where is psoriasis typically present in inflammatory spondyloarthritis
extensor surfaces
ankylosing spondylitis pathophysiology. What HLA gene/cytokines involved
Enthesitis
polygenic but mainly: HLA-B27
Cytokines:
TNF-alpha
(IL-17), (IL23)
what is enthesitis
inflammation of entheses- site where tendon and ligament join bone
untreated AS signs
-Spinal enthesitis
-Bridging syndesmophytes
(new bone growth between adjacent vertebra)
-Spinal fusion
AS management
- physio
- a) NSAIDs- ibuprofen/selective COX 2 inhibitor (celecoxib)
b) biological therapies if after trying 2 NSAIDs doesen’t work-
anti-TNF-a (infliximab)
anti-IL17
