Back Pain

Question 1

Saddle anasthesia

Answer 1

Loss of sensation in the buttocks, perinium and inner thighs

Question 2

Back pain red flag

Answer 2

• If pain is not mechanical, i.e not associated with activity/specific timing
• Systemic upset
• Major, new, neurological deficit
• Saddle anaesthesia +/- bladder or bowel upset

Question 3

Saddle anasthesia with bladder or bowel upset is a what?

Answer 3

Surgical emergency

Question 4

Schobers method

Answer 4

Make a little mark 10cm above and 5 cm below the dimples. On forward flexion the normal movement is to about 21cm. Older patients less, younger a bit more. Less than 18cm is pathologically stiff, more than about 24cm is hypermobile.

Question 5

Nerve irritation tests

Answer 5

Nerve irritation tests include the straight leg raise and variants for the sciatic nerve roots and the femoral stretch test for the femoral roots.

Question 6

Overt pain behaviour

Answer 6

Guarding
Bracing
Rubbing
Grimacing
Sighing

Question 7

Spondylolysis

Answer 7

Defect in the pars interarticularis of the vertebra

Question 8

Defect in the pars interarticularis of the vertebra

Answer 8

Spondylolysis

Question 9

Spondylolisthesis

Answer 9

Forward slippage of one vertebra on another

Question 10

Indications for spondylolisthesis surgery

Answer 10

When conservative treatment has failed
Adolescent with > 50% slip
Progressive neurological deficit
Postural deformity

Question 11

Worst red flag?

Answer 11

Previous history of cancer

Question 12

Back pain red flags

Answer 12

Age  50  -  first  back  pain
Non – mechanical,  constant  pain
History  of  cancer
History  of  steroids
General  malaise,  fever,  unexplained  weight  loss
Structural  deformity
Saddle  anaesthesia / paraesthesia  +/-  loss  of  bowel  or  bladder  control
Severe  pain  longer  than  6  weeks

Question 13

X-ray for cervical spine

Answer 13

Make sure it shows C7/T1 !!

Question 14

Most common thoracolumbar level of injury?

Answer 14

T12/L1

Question 15

Most common form of incomplete spinal cord injury?

Answer 15

Central cord

Question 16

Frankel/ASIA grading

Answer 16

I or A - complete motor and sensory loss
II or B - complete motor and incomplete sensory
III or C - incomplete motor – no practical use
IV or D - useful motor and incomplete sensory
V or E - normal motor and sensory function

Question 17

Central cord injury

Answer 17

• Typically a hyperextension injury
• Arms worse than legs
• prognosis variable but generally good

Question 18

Which type of spinal cord injury are you likely to get with a hyperextension injury?

Answer 18

A central cord injury

Question 19

Brown-sequard

Answer 19

Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Best prognosis

Question 20

Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Best prognosis

Answer 20

Brown-sequard

Question 21

Typically a hyperextension injury

• Arms worse than legs
• prognosis variable but generally good

Answer 21

Central cord injury

Question 22

Motor  loss
Loss  of  pain  and  temperature  sense
Deep  touch, position  and  vibration  preserved
May have  traumatic  or  vascular  cause
Prognosis  poor

Answer 22

Anterior cord injury

Question 23

Anterior cors injury

Answer 23

Motor  loss
Loss  of  pain  and  temperature  sense
Deep  touch, position  and  vibration  preserved
May have  traumatic  or  vascular  cause
Prognosis  poor

Question 24

Causes of secondary cord damage

Answer 24

Stretching
Compression
Undue  movement
Hypotension
Inappropriate  surgery
Infection

Question 25

Which surgical route would you take for decompression (thoracolumbar fracture, partial cord damage)

Answer 25

Anterior route

Question 26

What is a thoracolumbar burst?

Answer 26

Vertebral fracture with compromise of the anterior and middle vertebral column