Back Pain

Question 1

Mechanical Causes

Answer 1

Muscular Strain
Trauma
Pregnancy
Disc Prolapse

MSCC!!
CAUDA EQUINA!!!

Question 2

RED FLAGS for Back Pain

Answer 2

Age <20 or >50

Weight loss

Pain at night, night sweats

Pain in thoracic spine

Hx of cancer or steroid use

Focal Neuro signs or sx

Cauda equina sx

Question 3

CAUDA EQUINA sx

Answer 3

Saddle anaesthesia
Decreased anal tone
Bladder/bowel disturbance
Bilateral leg pain/weakness

Question 4

Degenerative Causes

Answer 4

Vertebral Collapse
Spinal Stenosis
Spondylosis

Question 5

Inflammatory Causes

Answer 5

Ank. Spondylitis

Paget’s disease

Question 6

Malignant Causes

Answer 6

Myeloma

Metastasis

Question 7

Infectious Causes

Answer 7

TB

Discitis

Question 8

Examination

Answer 8

DRE

- Perianal sensation, anal tone

Question 9

Bloods

Answer 9

FBC, UEs, ESR, CRP,
PSA,
Bone profile, LFTs (high ALP pagets)
Serum electrophoresis (myeloma)

Blood cultures, TB assay

Question 10

Imaging

Answer 10

Whole spine CT/MRI in malignancy/compression

USS Bladder to assess for retention in cauda equina

Question 11

Special Tests

Answer 11

CT guided biopsy if infection/abscess

Nerve conduction studies

Question 12

Systems r/v

Answer 12

Bladder
Bowels
Eyes (uveitis in Ank.Spon)
Skin
CRAB sx (myeloma)

Question 13

Myeloma Sx

Answer 13

CRAB

Hypercalcaemia
Renal failure
Anaemia
Bone pain

Question 14

MSCC sx

Answer 14

Severe localised back pain, worse when lying down

Neuro:

• Weakness: tends to be symmetrical
• Sensory loss (less common than motor)

Bladder and bowel

• Retention and constipation
• Urinary and faecal incontinence