Back pain Flashcards
What does degenerative disc disease present with?
Pain with increased abdo pressure e.g. sneezing, flexion
What does degenerative facet joint disease present with?
Pain on extension
What does disc prolapse present with?
Radiculopathy causing sciatica in dermatomal distribution.
Positive straight leg test and decreased reflexes.
What does spinal stenosis present with?
UMN signs, can be leg claudication
Give gabapentin
What does spondylolisthesis present with?
Pain on extension radiating to posterior thigh
What does compression fracture present with?
Belt of pain around chest/abdomen which is sudden onset and severe.
What are the 3 causes of systemic back pain?
Infection
Malignancy
Inflammation
What is common cause of infective discitis?
Staph aureus
What are symptoms of infective discitis?
Constant back pain, fever, weight loss
Xray shows vertebral destruction with bilateral damage.
do radiology guided aspiration of disc
How is vertebral discitis treated?
IV Abx and surgical debridement
What are symptoms of malignancy?
Constant back pain worse at night
Lytic or sclerotic changes
What are the main features in inflammatory back pain?
<45, early morning stiffness for >30mins, improves with movement, waking during 2nd half of night.
What is ankylosing spondylitis?
Chronic inflammation of the spine and SI joints, associated with HLAB27.
What features are associated with ank spond?
Enthesitis, acute iritis, kyphosis, psoriasis, IBD.
How is ank spond diagnosed?
Must be radiological evidence of sacroilitis and 1 or more SpA features, or be HLAB27 +ve with 2 or more SpA features.
Imaging:
- bone marrow oedema, destructive changes, bony proliferations.
SpA features:
- general inflam autoimmune e.g. IBD, psoriasis, arthritis; raised CRP, HLAB27, response to NSAIDs
What are mimics of sacroilitis on MRI?
Infection
Insufficiency fracture
How is axSpA treated?
Stop smoking
NSAIDs
TNF alpha blockers
Hip replacement
What are red flags in back pain?
New onset at young or old age After traiuma Systemic symptoms Urinary retention Night pain Previous malignancy
Saddle anaesthesia
Reduced anal tone
Generalised neurological deficit
Progressive spinal deformity
What are yellow flags in back pain?
Attitude/beliefs about problem
Illness behaviour
Social/financial problems
Expectations
