Back Pain + Ankylosing Spondylitis

Question 1

Cancer red flags for back pain

Answer 1

History of cancer 
Unexplained weight loss 
>50 or <18 
Failure to improve with therapy 
Pain longer than 6 weeks 
Night pain or pain at rest

Question 2

Back pain: infection red flags

Answer 2

Fever 
Hx of IVDU 
Severe pain 
Lumbar spine surgery in last year
Recent infection 
Immunocompromised

Question 3

Back pain: cauda equina red flags

Answer 3

Urinary incontinence/ retention 
Saddle anaesthesia 
Anal sphincter tone decreased/ faecal incontinence 
Bilateral lower limb weakness 
Neuro deficit

Question 4

Back pain: herniated nucleus pulposus signs

Answer 4

Major muscle weakness

Foot drop

Question 5

Back pain: vertebral fracture red flags

Answer 5

Prolonged use of steroids
>70 y/o
Hx of osteoporosis
Recent trauma

Question 6

Back pain: AAA red flags

Answer 6

Abdo pulsating mass
Atherosclerotic disease
Pain at rest/ at night
>60 y/o

Question 7

What is spondyloarthritis?

Answer 7

Group of inflammatory rheumatology conditions

Question 8

What is ankylosing spondylitis?

Answer 8

Axial spondyloarthritis characterised by sacroiliitis on x ray

Question 9

What are the S+S of ankylosing spondylitis?

Answer 9

Chronic back pain + stiffness, improves with exercise 
Sacroiliac joint + spinal fusion 
Arthritis 
Dactylitis 
fatigue 
Anterior uveitis, psoriasis, IBD

Question 10

Complications of ankylosing spondylitis?

Answer 10

o	Spinal fractures.
o	Hip involvement.
o	Osteoporosis.
o	Anterior uveitis (iritis).
o	Adverse effects of treatment.

Question 11

Management of ankylosing spondylitis?

Answer 11

NSAID, refer to rheumatology
Biological DMARDs
Physio

Question 12

Indications for lumbar spine x ray

Answer 12

• No improvement after 6 weeks
• Fever
• Unexplained weight loss
• Prolonged steroid use
• Signficant trauma
• Progressive neuro deficit
• Suspicion of ankylosing spondylitis
• Hx of cancer
• Alcohol/ drug use

Question 13

Description of pattern 1 back pain + management

Answer 13

Worse with flexion
Normal neuro exam
Usually due to intervertebral discs or ligaments
Management = scheduled extension, lumbar roll

Question 14

Description of pattern 2 back pain + management

Answer 14

Worse with extension 
Never worse with flexion 
Intermittent 
Usually due to posterior joint complex 
Management = scheduled flexion, night lumbar roll

Question 15

Description of pattern 4 back pain + management

Answer 15

Predominantly leg pain, worse with activity
Improves with rest + posture changes
Usually due to neurogenic claudication
Management = abdo exercises, lumbar roll, sustained flexion, pelvic tilt