Back pain Flashcards
What is mechanial low back pain
A collection of ill defined conditions presenting with low back pain. Only diagnosed when other pathological conditions ruled out
Why is mechanical lower back pain difficult to define
Pathological changes on imaging will be bresent in healthy, normal people with no symptoms
Facet joint arthritis
Degenerative disc disease
What are the two clinical scenarios of mechanical lower back pain?
Acute pain over days or weeks (can be refferred down leg, but not true radicilar pain as it does not go beyond knee)
Chronic unrelenting back pain
What are the blood tests for mechanical lower back pain
FBC, ESR, liver function, calcium/phosphate/alkaline phosphatase, myeloma screening and CRP
Should all be normal, performed to exclude sinister causes
What can x-ray show for mechanical low back pain
Normal appearances, minor disc narrowing, or osteoarthritis
What is the treatment for mechanical low back pain?
(Acute) Analgesia, NSAIDs, physiotherapy for acute, avoiding bed rest
(Chronic) Difficult, MDT. Occasionally locak facet joint injections can help
What is the central part of the intevertebral disc called
Nucleosus pulposus
What is the exterior of an intevertebral disc called
Annulus fibrosus
What is a prolapsed intevertebral disc
Wheb part of the nucleosus pulposus herniates through the annulus fibrosus and presses on a spinal nerve root
What levels do disc prolapses usually happen at
L4-L5 or L5-S1 but can occur at any level
What is sciatica
Symptom of lower lumbal or sacral nerve root irritation. Patient complains of severe pain radiationg as far down legs as the toes. May be numbness/tingling of foot.
Discomfort upon trying to sit, stand or lie down
What are the clinical signs of cauda equina syndrome
Altered bladder/anal function. Urinary retention or incontinence
Perineal paraesthesia: compression of nerves in cauda equine, which supply motor function to the bowel and bladder sphincters, and sensation to the perineum
Bilateral leg pain Bilateral paraesthesia (saddle paraesthesia)
Bilateral motor deficit
Perineal pain
Requires urgent surgical assessment and MRI
Name the treatment for prolapsed intervertebral discs
Short period of bed rest followed by NSAIDs initially.
Lumbar nerve root injection csn provide diagnosis and treatment. Only indication for urgent discectomy is cauda equina syndrome symptoms
90% settle on their own
What is spondylolisthesis
One vertebral body slipping on another
What are the clinical features of spondylolisthesis
persistent back pain in children, nerve root irritation can occur causinf sciatica.
