Back Pain and Spinal Disorders Flashcards
What are the possible psychological effects of back pain?
Emotional stress
Relationship breakdown
Severe emotional distress for partners
Limitations in fulfilling family tasks
At what stage is back pain classified as chronic?
> 3 months
What structures may be the source of back pain?
Ligaments Facet joints Paravertebral muscles and fascia Discs Spinal nerve roots
What is the broad differential for back pain?
Mechanical
Systemic (infection, malignancy, inflammatory)
Referred
Compare and contrast mechanical and inflammatory back pain?
Mechanical can occur at any age, has a variable onset, <30 mins morning stiffness, exercise often worsens pain, rest often improves pain and pain may improve at night
Inflammatory usually occurs <40 years, has an insidious onset, >30mins morning stiffness, exercise improves pain with no improvement on rest and may have night pain
What are the possible causes of non-specific low back pain?
Lumbar strain/sprain Degenerative disc disease Degenerative facet joint disease Disc prolapse Spinal stenosis Compression fractures
How should non-specific low back pain be managed?
Exercise programmes
Physiotherapy
Patient education
Analgesia - but avoid opiates
Which part of the intervertebral disc herniates in a disc prolapse?
Nucleous pulposus
Leg pain is worse than back pain in disc prolapse. T/F?
True
Most disc prolapses will resolve spontaneously within how many weeks?
12 weeks
Surgery for disc prolapse helps only the back pain and not the leg pain. T/F?
False - it only helps the leg pain
What is the most common cause of caudal equina syndrome?
large disc prolapse
What are the signs/symptoms of caudal equina syndrome?
Neuropathic symptoms of bilateral sciatica and saddle anaesthesia
Bladder or bowel dysfunction with reduced anal tone
What is spinal stenosis?
An anatomical narrowing of the spinal canal which can be congenital or degeneration
Describe the typical presentation of spinal stenosis
Claudication in the legs and calves which is worse with walking and resting in the flexed position
How is spinal stenosis investigated?
X-Ray
MRI
What is spondylolithiasis?
A ‘slip’ of one vertebra on to the one below
Spondylithiasis is often asymptomatic. T/F?
True
Where does pain commonly radiate to in spondylolithesis?
Posterior thigh
Increases with extension
What groups of patients commonly get compression fractures?
Elderly patients
Where does the pain radiate to in compression fractures?
Radiates in a ‘belt’ around the chest and abdomen
What condition is associated with compression fractures?
Osteoporosis
How are compression fractures treated?
Analgesia
Calcitonin
Vertebroplasty (cement)
Kyphoplasty (balloon)
How are compression fractures investigated?
X-Ray
DEXA scan
How soon after a lumbar sprain/strain do muscle spasms usually settle?
24-48 hours
What positions or movements increase pain in degenerative disc disease?
Flexion
Sitting
Sneezing
What positions or movements increase pain in degenerative facet joint disease?
Extension
What pathologies can cause referred pain in the back?
Aortic aneurysm Acute pancreatitis Peptic ulcer disease Acute pyelonephritis / renal colic Endometriosis
What are the signs and symptoms of an aortic aneurysm?
CVS features such as increased bp and heart rate
Pulsating abdomen mass
What are the signs and symptoms of an acute pancreatitis?
Epigastric pain
Relief when leaning forwards
Unwell
What are the signs and symptoms of peptic ulcer disease?
Epigastric pain
History of PUD
Vomit
Blood/malaena
What are the signs and symptoms of acute polynephritis or renal colic?
History of UTI Unwell Radiation Haematuria Frequency
What are the signs and symptoms of infective discitis?
Fever
Weight loss
Constant back pain even at rest and at night
What is the most common causative organism of infective discitis?
S.aureus
How should possible infective discitis be investigated?
Bloods - FBC, ESR, CRP, blood cultures
X-Ray
MRI
Radiology guided aspiration
How is infective discitis treated?
IV antibiotics
Surgical debridement
What patients are most at risk of infective discitis?
Immuosuppressed
Diabetic patients
IVDUs
Malignancies of which organs can cause back pain?
Lung Prostate Thyroid Kidney Breast
Malignancy often causes constant back pain which is often worse at night. T/F?
True
In what age group does inflammatory back pain usually occur?
Patients <45 years
Describe the New York Criteria for ankylosing spondylitis?
Clinical criteria: low back pain and stiffness for more than 3 months which improves with exercise, but is not relieved by rest
Limitation of motion of the lumbar spine in both the sagittal and frontal planes
Limitation fo chest expansion relative to normal values correlated for age and sex
Sacroilitis grade >2 bilaterally or grade 3-4 unilaterally
What are the symptoms of axial spondyloarthritis?
Inflammatory back pain
Fatigue
Arthritis in other joints: hips, knees
Enthesitis: achilles tendon, plantar fasciitis
Inflammation outside the joints - uveitis, psoriasis, churn’s disease, inflammation of heart/lungs
Which gene can predispose to ankylosing spondylitis or axial spondyloarthritis?
HLA-B27 gene
How is inflammatory back pain treated?
NSAIDs Biologic drugs Education Exercise Physical therapy Rehabilitation Self-help groups
What are the red flag symptoms of back pain?
New onset <16 or >50 years Following significant trauma Previous malignancy Systemic - fevers, riggers, general malaise, weight loss Previous steroid use IV drug abuse, HIV or immuocompromised Recent significant infection Urinary retention Non-mechanical pain Thoracic spine pain
What are the red flag signs of back pain?
Saddle anaesthesia Reduced anal tone Hip or knee weakness Generalised neurological deficit Progressive spinal deformity
What are the yellow flag signs of back pain?
Bio-psycho social model to assess patients likely to develop chronicity:
Attitudes, beliefs, compensation, diagnosis, emotions, family, word relationship
