Back pain and radiculopathy (refer to MSK week 4 flashcards on the spine)

Question 1

Go over the anatomy of the spine

Question 2

What are the main causes of lower back pain ?

Answer 2

• Truama
• Degeneration
• Infections
• Tumours
• Referred pain
• Inflammatory

Question 3

What is the 2nd most common reasons for someone to seek medical help ?

Answer 3

Back pain - hence its really really common

Question 4

What are the 3 main classifications of back pain ?

Answer 4

1. Acute
2. Sub-acute - pain lasting > 6weeks but < 3 months
3. Chronic - pain lasting > 3 months

Question 5

What are some of the traumatic causes of back pain ?

Answer 5

• Musculoligamentous trauma
• Lumbosacral trauma
• Osteoporosis suspect this as the cause if minimal trauma
• Traumatic spondylolisthesis - condition in which one bone in your back (vertebra) slides forward over the bone below it.
• Post-op

Question 6

What are some of the degenerative causes of back pain ?

Answer 6

• Disc disease - e.g. herniation or degeneration of disc
• Spondylolisthesis
• Spinal stenosis
• Facet joint arthrosis
• Scoliosis & structural

Question 7

What are the infectious causes of back pain ?

Answer 7

• Discitis
• Vertebral osteomyelitis
• Epidural abscess
• Paraspinal abscess

Question 8

What are some of the different tumours which can affect the back resulting in back pain ?

Answer 8

• Bony tumours – primary (myeloma) or metastatic (lung, breast)
• Extradural tumours – lymphoma
• Intradural extramedullary (Meningioma, neurofibroma)
• Intradural intramedullary (ependymona, astrocytoma etc..)

Question 9

What are some of the inflammatory causes of back pain ?

Answer 9

• Sacroiliitis
• Ankylosing spondylitis
• Any rheumatological condition affecting spine
• Arachnoiditis (post-meningitis, post epidural)

Question 10

Referred pain from where can cause back pain?

Answer 10

• Aortic dissection
• Retroperitoneal disease – pancreas
• Perispinal disease e.g. tumors & abscesses
• Ovarian / gynaecological

Question 11

What are the red flags of back pain ?

Answer 11

• Acute, rapidly progressive worsening
• Constitutional symptoms - weight loss, fevers, chronic pain, fatigue, dyspnea, and malaise.
• History of malignancy / ? family history
• Bladder / bowel
• Bilateral pain / weakness
• Pain on lying flat
• First time presentation

Question 12

Management of back pain

Answer 12

• NSAID’s good for inflammatory pathology
• Muscle relaxants act synergistically with NSAIDS on pathology level
• Amitryptaline / gabapentin for nerve pain
• Opiates and derivatives good for acute lower back pain. Need to monitor use. Consider rotation.

Physiotherapy & exericses

•INJECTIONS:

–Long acting anaesthetic (e.g. chirocaine) / steroid

–Facet joint injections

• –Diagnostic: ? Contribution of facet joints to back pain
• –Therapeutic: Temporary / permanent control to enable mobility

–Peri-root injections

• –Diagnostic: patient with multi-level disc protrusions, etc…
• –Therapeutic: Temporary / permanent control to enable mobility esp In unfit pts.

–Caudal epidural for non-diagnostic / L5-S1 root problems

Surgery - laminectomy, vertebroplasty, decompressive surgery (useful for radicular compression from a prolapsed disc)