Back Pain Conditions Flashcards
What is the cause of simple lower back pain?
Muscular strain or degenerative disease
What is this a presentation of?
Lower back pain with normal neurological exam and no nerve root signs.
Simple lower back pain
What is the treatment for simple lower back pain?
Self-limiting, physio, analgesia, keep warm, CBT, diazepam if spasm.
What is this a presentation of?
Weak hallux extension, reduced sensation over dorsum of foot.
L4/L5 disc prolapse
What is this a presentation of?
Calf pain, weak plantarflexion, reduced sensation of sole and back of calf, reduced ankle jerk.
L5/S1 disc prolapse
How is suspected disc prolapse investigated?
MRI
What is the treatment for disc prolapse?
Early mobilisation, analgesia, physio, self-limiting, discectomy in continuing pain.
Which discs most commonly prolapse and what exacerbates pain?
- L4/L5 and L5/S1
2. Sneezing and coughing
What is spondylolisthesis and where does it commonly happen?
- Forward displacement of one lumbar vertebrae on one below.
- Usually L5 onto S1
What is this a presentation of?
Adolescent with back pain with/without sciatica, hamstring tightness causing a waddling gait.
Spondylolisthesis
How is suspected spondylolisthesis investigated?
MRI
What is the treatment for spondylolisthesis?
Curative treatment involves spinal fusion
What causes lumbar spinal stenosis?
Typically facet joint osteoarthritis
What is this a presentation of?
Back pain with lower leg pain, worse on walking, aching/heaviness in one or both legs, pain on extension (prefer to walk uphill and cycle), few CNS signs.
Lumbar spinal stenosis
How is suspected lumbar spinal stenosis investigated?
MRI
What is the treatment for lumbar spinal stenosis?
Decompressive laminectomy
What are the causes of inflammatory back pain?
Ankylosing spondylitis, rheumatoid arthritis, SLE
What is this a presentation of?
Onset of back pain over months, early morning stiffness, pain improves with activity, worsens on rest, other system involvement.
Inflammatory back pain (spondyloarthropathies)
What is this a presentation of?
Localised back pain following trauma or background of osteoporosis.
Vertebral fracture
How is a suspected vertebral fracture investigated?
Plain x-ray
What are the causes of a spinal tumour?
- Primary
- Secondary to breast, lung, thyroid, prostate, kidney cancer commonly.
- Secondary to lymphoma or myeloma
What is this a presentation of?
LMN signs in upper half of body and UMN signs and sensory loss in lower half, bowel and bladder dysfunction.
Spinal tumour
How is a suspected spinal tumour investigated?
- Identify causative cancer
2. Plain x-ray, MRI, CT
What is the treatment for a spinal tumour?
Refer to neurosurgery
What is the cause and what are the risk factors for pyogenic spine infection?
- Secondary to other septic foci
2. Diabetes mellitus, immunosuppression, urinary catheterisation
What is this a presentation of?
Pain episodically with movement restricted by spasm, no fever, no tenderness, no raised WCC, raised ESR.
Pyogenic spine infection
How is a suspected pyogenic spine infection investigated?
- X-ray
2. Technetium bone scan and MRI better
What is the treatment for pyogenic spine infection?
IV vancomycin and IV cefotaxime for 6 weeks (staphylococcal usually)
What is Pott’s disease and where does it occur?
- Spinal TB
2. Most commonly T10-L1
What is this a presentation of?
Young adult, systemic symptoms (potential HIV infection), gradual onset localised back pain, stiffness of all back movements.
Pott’s disease (spinal TB)
How is suspected Pott’s disease (spinal TB) investigated?
- ESR, culture synovial fluid/bone
2. MRI, x-ray for pulmonary TB
What is the treatment for Pott’s disease (spinal TB)?
6 months of rifampicin, isoniazid, pyrazinamide.
