Back pain Clinical Relevence

Question 1

Progressive kyphosis with aging

Answer 1

Loss of lumbar disc height
Vertebral insufficiency fractures
Extensor muscle dysfunction
Spinal stenosis
Lumbar facet joint arthrosis
Vicious circle

Question 2

History for back pain

Answer 2

Onset
Duration
Uni/bi lateral
Neurological symptoms
Urinary symptoms
Bowel, Perianal History
Sexual dysfunction
Medical history
Cancer History

Question 3

Examination of the spine

Answer 3

Spine Exam:
Neurology
Per rectal examination, genital sensory exam
Bladder scan

Whole spine

Question 4

Aging changes

Answer 4

Incidence angle stays the same
Therefore
Loss of lordosis is compensated by pelvic retroversion
Inefficient compensation —> Knee flexion to maintain balance

Question 5

Investigations Of The spine

Answer 5

X-ray / MRI
As soon as possible

MRI much better

Cauda equina immediate

Question 6

Painless Head drop differentiation diagnosis

Answer 6

Isolated neck extensor myopathy
– Myasthenia gravis – Parkinson’s disease – Polymyositis
– Mitochondriopathy
– Myotonic dystrophy – Amyotrophic lateral
sclerosis
– Multi-system atrophy
– Inclusion body myositis

Question 7

Cauda equina

Answer 7

Every 12 hours loss of function

MEDICAL EMERGENCY
Compression Of Cauda equina
MRI
Surgery in 24 hours and they should regain function

Saddle anesthesia
Incompetence
Erectile dysfunction
Bilateral pain
Perianal tone lost

If caught early, outcome reasonably good

Question 8

Upper and lower motor neuron

Answer 8

Upper- brain and spinal cord- causes stiffness

Lower- not in brain or spinal cord

Question 9

Radilocupathies

Answer 9

Trapping of nerve root

Question 10

Cervical injury

Answer 10

Assessment- ATLS
Spine remain in collar and board (immobilize)
Log rolling with bead hold and turning
Hospital transfer
ABCDE and avoid secondary injury