Back Pain

Question 1

How many vertebrates are there in the spine of each type?

Answer 1

C7
T12
L5
S5

Question 2

What is a red flag?

Answer 2

A symptom or sign that is seen in causes of back pain which are serious and need urgent investigation or treatment

Question 3

What are the categories of red flags in back pain?

Think of the 4 headings to help remember them

Answer 3

Is there a fracture?

• acute height loss
• recent trauma
• point spinal tenderness
• known osteoporosis

Is there infection?

• fever, night sweats
• immunocompromised
• IVDU
• Open fracture

Is it cancer?

• known active or previous cancer
• weight loss
• night pain

Are the nerves compromised?

• weakness
• sensory disturbance
• sphincters: bowel and bladder
• saddle paraesthesia
• shooting pain
• erectile dysfunction

Question 4

What are some causes of back pain?

Answer 4

Mechanical back pain: strained muscles, tendons, ligaments

Osteoarthritis

Axial spondyloarthropathies

Infection: osteomyelitis, discitis, spinal TB

Fracture
Pathological fracture

Disc herniation
Cauda equina

Spinal cord compression

Question 5

How do you differentiate between mechanical and inflammatory causes of back pain?

Answer 5

Mechanical:

• onset over 40
• can be acute or gradual onset
• worse on movement
• improves with rest

Inflammatory:

• any age of onset
• insidious, gradual onset
• eases with movement
• worse at rest
• night pain

Question 6

What are the spondyloarthropathies?

What are they also known as?

Answer 6

AKA seronegative arthritides

Ankylosing spondylitis
Reactive (after STI or GI)
Psoriatic
Enteropathic (IBD associated)

Question 7

Investigations of back pain?

Answer 7

Bloods:
FBC to look for infection, myeloma
ESR, CRP
U+E
ALP (Paget's)
Serum electrophoresis (myeloma)

Urine electrophoresis

MRI

Question 8

What conditions can result in pathological #s?

Answer 8

Osteoporosis

Cancer: primary bone tumours or mets, particularly BLTKP + myeloma

Infection: discitis, osteomyelitis, spinal TB

Question 9

What would you see in a history that would make you think discitis?

And what is discitis?

Answer 9

Staph aureus bacteraemia
IVDU

Infection and inflammation of disc

Question 10

What tests should all patients with staph aureus bacteraemia recieve?

Answer 10

MRI spine to look for discitis

ECHO to look for endocarditis

Question 11

What would you see in a history that would make you think spinal TB?

Answer 11

Recently in prison in eastern europe

High risk of TB: immigrants, homeless

Question 12

What does myeloma do to the bone?

Answer 12

Lytic bone lesions

Plasmocytomas (group of abnormal plasma cells in bone marrow)

Result in weakness in bone

Question 13

Which cancers metastasise to bone?

Answer 13

I’ll have a BLT with some KP crisps

Breast
Lung
Thyroid
Kidney
Prostate