back pain I Flashcards
1
Q
What are the primary causes of non-specific back pain?
A
The vast majority of cases of back pain are considered non-specific musculoskeletal pain due to strained muscles or ligaments.
2
Q
What symptoms are exhibited by individuals with non-specific musculoskeletal pain?
A
Individuals with this condition usually have no sensory or motor deficits and typically complain about tenderness over the affected muscle or ligament.
3
Q
What is the recommended treatment for non-specific musculoskeletal pain?
A
The treatment for these individuals involves prescribing activity as tolerated and NSAIDs for pain management.
4
Q
What causes spinal osteoarthritis?
A
Spinal osteoarthritis can occur due to the natural aging process where the cartilage at the tips of bones wears down over time.
5
Q
What changes and conditions are associated with spinal osteoarthritis?
A
Spinal osteoarthritis is associated with joint degeneration, ligamentous changes, disc degeneration, and eventually, deformity of the spine.
6
Q
What causes spinal osteoarthritis?
A
Spinal osteoarthritis is primarily due to the natural aging process where the cartilage at the tips of bones wears down over time.
7
Q
What changes and conditions are associated with spinal osteoarthritis?
A
Spinal osteoarthritis is linked with joint degeneration, ligamentous changes, disc degeneration, and ultimately, spinal deformity.
8
Q
What is disk herniation and how does it occur?
A
Disk herniation is when the nucleus pulposus bulges out, usually posteriorly due to a relatively thinner posterior longitudinal ligament, often caused by heavy lifting.
9
Q
What are the typical symptoms of sciatica?
A
Sciatica presents as a shocking pain shooting from the buttocks through the leg, following the course of the sciatic nerve.
10
Q
What motor deficits are associated with L4-5 disk herniation?
A
L4-5 disk herniation can lead to motor deficits like weakness in hip abduction and foot dorsiflexion.
difficulty heel walking
11
Q
What motor deficits are associated with L5-S1 disk herniation?
A
L5-S1 disk herniation can cause weakened foot plantar flexion and a reduced Achilles tendon reflex.
12
Q
What test is commonly used to diagnose lumbar disk herniation?
A
The straight leg raise test (SLR) involves raising a straightened leg between 30 and 60 degrees; pain radiating down the leg indicates a positive test, suggesting lumbar disk herniation.
13
Q
What is the first-line treatment for disk herniation?
A
Conservative treatment involving rest with activity as tolerated and NSAIDs for pain management is typically the initial approach.
14
Q
When might surgical intervention be considered for disk herniation?
A
If symptoms persist or worsen beyond 6 weeks despite conservative treatment, surgical removal of part or all of the disk may be considered.
15
Q
What typically causes vertebral fractures?
A
Vertebral fractures are often caused by major trauma, but in the case of compression fractures, they’re commonly seen in individuals with osteoporosis.
16
Q
What characterizes compression fractures?
A
Compression fractures are a subtype of vertebral fractures, mostly observed in individuals with osteoporosis, leading to less dense bones and making them more prone to fractures.
17
Q
What are the common symptoms associated with compression fractures?
A
Individuals with compression fractures typically present with localized back pain after minor trauma, along with kyphosis and potential height loss.
18
Q
How are vertebral fractures diagnosed and treated?
A
Diagnosis involves a suggestive history, a physical exam looking for localized midline spine tenderness, and confirmation through spine X-rays. Treatment usually involves conservative methods like bracing, pain management, and addressing underlying osteoporosis. Surgery may be necessary if pain persists beyond 6 weeks or if the fracture results in neurologic deficits.
19
Q
What are seronegative spondyloarthropathies?
A
Seronegative spondyloarthropathies are a group of inflammatory conditions affecting the vertebral column, characterized by the absence of rheumatoid factor (RF) and a strong association with HLA-B27.
20
Q
What are the typical symptoms of seronegative spondyloarthropathies?and complications
A
Individuals with these conditions often complain of slowly progressive lower back pain, especially around the sacroiliac joints, worsening at night, morning stiffness lasting over 30 minutes, and improving with movement and exercise. Additionally, they might present with peripheral arthritis, enthesitis, uveitis, and dactylitis.
21
Q
What are the subtypes of seronegative spondyloarthropathies according to the PAIR mnemonic?
A
The subtypes are remembered by the mnemonic PAIR: P for postatic arthritis, A for Ankylosing spondylitis, I for Inflammatory bowel disease, and R for Reactive arthritis.
22
Q
What defines spinal stenosis?
A
Spinal stenosis involves the narrowing of the central spinal canal, intervertebral foramen, or lateral recess, causing progressive compression of nerve roots.
23
Q
What is the primary cause of spinal stenosis?
A
The primary cause is typically degenerative joint disease, often found in middle-aged to elderly individuals, resulting from spondylosis and a combination of factors like bulging discs, ligamentum flavum, and osteophytosis.
24
Q
What are the typical clinical features associated with spinal stenosis?
A
It is commonly observed in patients over 60 and often presents with claudication, which is pain in the legs experienced during walking.
25
How does claudication in spinal stenosis differ from vascular claudication?
Unlike vascular claudication (from peripheral vascular disease), claudication in spinal stenosis has an inconsistent distance of pain, a burning sensation instead of cramping, worsens with spinal extension (like standing or walking downhill), and improves with back flexion (such as sitting or walking uphill). Additionally, pedal pulses are preserved.
26
What investigations are typically used for diagnosing spinal stenosis?
The diagnosis of spinal stenosis is usually history, examination and MRI .
27
What are the management strategies for spinal stenosis?
Conservative management includes analgesia, physiotherapy, and weight loss if necessary. If symptoms persist despite conservative measures and MRI evidence confirms stenosis, surgery (decompression) might be considered to alleviate symptoms by creating more space for the cauda equina.
28
What is spinal stenosis?
Spinal stenosis is the narrowing of the spinal canal, leading to the compression of the spinal cord or nerve roots, commonly found in the cervical or lumbar spine, with the focus here on lumbar spinal stenosis.
29
What are the three types of spinal stenosis?
The three types are: Central stenosis (narrowing of the central spinal canal), Lateral stenosis (narrowing of the nerve root canals), and Foramina stenosis (narrowing of the intervertebral foramina).
30
What are some causes of spinal stenosis?
Causes include congenital spinal stenosis, degenerative changes (such as facet joint changes, disc disease, and bone spurs), herniated discs, thickening of ligamenta flava or posterior longitudinal ligament, spinal fractures, spondylolisthesis, and tumors.
31
What are the typical symptoms associated with lumbar spinal stenosis?
Symptoms include lower back pain, buttock and leg pain, leg weakness, and intermittent neurogenic claudication.
32
How does intermittent neurogenic claudication present in spinal stenosis?
It typically causes symptoms when standing and walking, but these symptoms are absent at rest and when seated. Bending forward (flexing the spine) improves symptoms, while standing straight (extending the spine) worsens the symptoms.
33
What imaging investigation is primary for diagnosing spinal stenosis?
MRI is the primary imaging investigation used to diagnose spinal stenosis.
34
What distinguishes the symptoms of intermittent neurogenic claudication from peripheral arterial disease?
The symptoms may appear similar, but in spinal stenosis, peripheral pulses or the ankle-brachial pressure index (ABPI) are normal, whereas in peripheral arterial disease, these may not be. Additionally, back pain is a more prevalent feature in spinal stenosis, unlike peripheral arterial disease.
35
What are some management options for spinal stenosis?
Management options include exercise and weight loss, analgesia, physiotherapy, and decompression surgery if conservative treatments fail.
36
What is a laminectomy in the context of spinal stenosis?
A laminectomy involves the removal of part or all of the lamina from the affected vertebra to address the narrowing of the spinal canal.
37
Are epidural injections commonly used for spinal stenosis?
No, the benefits of epidural injections with local anesthetic and corticosteroids are unclear, and they are generally not used for this condition.
38
What is the typical cause of vertebral osteomyelitis?
Vertebral osteomyelitis is primarily caused by a hematogenous spread of infections, most commonly by Staphylococcus aureus, although atypical infections can occur in the immunocompromised.
39
What are the risk factors associated with vertebral osteomyelitis?
Risk factors include intravenous drug use (PWID), poorly controlled diabetes, infections related to IV sites, genitourinary infections, skin and soft tissue infections (SSTI), post-operative infections, and primary bacteremia in the elderly.
40
What are the typical clinical symptoms of vertebral osteomyelitis?
Patients typically present with an insidious onset of constant and unremitting back pain, most commonly in the lumbar region.
41
What signs might be observed during a physical examination of a patient with vertebral osteomyelitis?
Physical signs might include paraspinal muscle spasm, spinal tenderness, night sweat, fever, systemic upset, and in severe cases, an associated neurological deficit.
42
What diagnostic investigations are commonly used for vertebral osteomyelitis?
Blood tests might show raised C-reactive protein (CRP), ESR and blood cultures might indicate the causative organism, usually Staphylococcus aureus, including Methicillin-Resistant Staphylococcus Aureus (MRSA). MRI is commonly used to assess the extent of infection and detect any abscess formation, with the "psoas sign" indicating spondylodiscitis. Consideration of endocarditis is recommended, looking for signs like clubbing, splinter hemorrhages, murmurs, and considering an echocardiogram (ECHO).
43
What is the initial treatment approach for vertebral osteomyelitis?
High-dose intravenous antibiotics are usually administered after a CT-guided biopsy to obtain tissue for culture. Antibiotics might be necessary for several months, and the response is evaluated clinically and through serial monitoring of CRP levels.
44
When is surgery considered in the management of vertebral osteomyelitis?
Surgery is considered in cases where cultures cannot be obtained by needle biopsy, there is no response to antibiotic therapy, there is progressive vertebral collapse, and in the presence of progressive neurological deficit. Surgical intervention typically involves debridement, stabilization, and fusion of adjacent vertebrae.
45
What is the outcome in around half of the patients with vertebral osteomyelitis?
Approximately half of the patients undergo spontaneous fusion and resolution of the condition.
46
What causes cauda equina syndrome?
The most common cause is the compression of nerve roots due to a large central lumbar disc herniation, often occurring at the L4/L5 and L5/S1 level.
47
What are the symptoms associated with cauda equina syndrome?
Symptoms can include saddleanesthesia (bilateral leg pain, loss of motor or sensory function of the bowel/bladder, perineal/saddle anesthesia), and widespread or progressive leg weakness or gait problems.
Loss of reflex
Paraplegia
48
What signs might be observed during a physical examination of a patient with cauda equina syndrome?
Physical examination might reveal loss of anal sphincter tone during a rectal examination.
49
What urgent imaging is recommended for diagnosing cauda equina syndrome?
Urgent MRI is recommended to identify the level of prolapse and confirm the diagnosis.
50
What is the recommended management for cauda equina syndrome?
Urgent discectomy is the standard treatment to alleviate the compression of the nerve roots in cases of cauda equina syndrome.
51
What complications can arise from prolonged compression in cauda equina syndrome?
Prolonged compression can lead to permanent nerve damage, requiring colostomy and urinary diversion. Even with prompt surgical intervention, some patients may have residual nerve injury resulting in permanent bladder and bowel dysfunction.
52
What is the definition of cauda equina syndrome?
Cauda equina syndrome is a surgical emergency characterized by the compression of the nerve roots in the cauda equina at the base of the spine, leading to potential permanent neurological dysfunction.
53
What anatomical structures does the cauda equina supply?
The cauda equina supplies sensation to the lower limbs, perineum, bladder, and rectum, and provides motor innervation to the lower limbs, anal and urethral sphincters, as well as parasympathetic innervation to the bladder and rectum.
54
What are the potential causes of nerve root compression in cauda equina syndrome?
Causes of compression include a herniated disc (most common), tumors (especially metastasis), spondylolisthesis (anterior displacement of a vertebra), abscess (infection), and trauma.
55
What are the red flags or key symptoms of cauda equina syndrome?
Red flags include saddle anaesthesia (loss of sensation around the genitals and anus), loss of sensation in the bladder and rectum, urinary retention or incontinence, faecal incontinence, bilateral sciatica, bilateral or severe motor weakness in the legs, and reduced anal tone during a per rectal examination.
56
What is the immediate management required for cauda equina syndrome?
Immediate hospital admission, emergency MRI scan to confirm or exclude cauda equina syndrome, and neurosurgical input to consider lumbar decompression surgery.
57
Why is surgery recommended as soon as possible in cauda equina syndrome?
Early surgery increases the chances of regaining function; however, even with early surgery, patients may still experience bladder, bowel, or sexual dysfunction along with persistent leg weakness and sensory impairment.
58
What distinguishes metastatic spinal cord compression (MSCC) from cauda equina syndrome?
MSCC involves compression of the spinal cord before the cauda equina, often resulting in back pain exacerbated by coughing or straining, and presenting with upper motor neuron signs.
59
What are the treatments or management options for MSCC?
Treatments for MSCC may include high-dose dexamethasone, analgesia, surgery, radiotherapy, and chemotherapy, depending on individual factors.
60
What characterizes spinal stenosis in the spinal canal and surrounding areas?
Spinal stenosis involves the narrowing of the central spinal canal, intervertebral foramen, and/or lateral recess, leading to progressive compression of nerve roots.
61
What is the primary cause of spinal stenosis, and in which age group is it most commonly observed?
Spinal stenosis is mainly caused by degenerative joint disease and is typically observed in middle-aged to elderly individuals.
62
What are the clinical features of spinal stenosis?
Patients typically over 60 years old commonly experience claudication, which is pain in the legs while walking.
63
How does the claudication in spinal stenosis differ from vascular claudication (PVD)?
In spinal stenosis, the claudication distance is inconsistent, the pain is described as burning rather than cramping, exacerbation of symptoms occurs with spinal extension (standing or walking downhill), while symptoms improve with back flexion (sitting or walking uphill), and pedal pulses are preserved.
64
What are the management options for spinal stenosis?
Conservative management involves analgesia, physiotherapy, and weight loss if indicated. If symptoms persist despite conservative measures and MRI evidence of stenosis, surgery may be performed for decompression to increase space for the cauda equina and alleviate symptoms.
65
What is spinal stenosis, and which areas of the spine does it generally affect?
Spinal stenosis is the narrowing of the spinal canal, leading to compression of the spinal cord or nerve roots, primarily affecting the cervical or lumbar spine.
66
What are the three types of spinal stenosis based on the affected areas?
The three types include central stenosis (narrowing of the central spinal canal), lateral stenosis (narrowing of the nerve root canals), and foramina stenosis (narrowing of the intervertebral foramina).
67
What are the common causes of spinal canal narrowing in spinal stenosis?
Various causes include congenital spinal stenosis, degenerative changes (facet joint changes, disc disease, bone spurs), herniated discs, thickening of ligamenta flava or the posterior longitudinal ligament, spinal fractures, spondylolisthesis, and tumors.
68
What characterizes intermittent neurogenic claudication in lumbar spinal stenosis with central stenosis?
Typical symptoms include lower back pain, buttock and leg pain, and leg weakness. Symptoms worsen with standing and walking and improve with bending forward, as it expands the spinal canal.
69
How does spinal stenosis differ from peripheral arterial disease regarding symptoms?
Patients with spinal stenosis have intermittent neurogenic claudication similar to peripheral arterial disease but lack abnormal peripheral pulses or the ankle-brachial pressure index (ABPI). Additionally, back pain is a prevalent feature in spinal stenosis, unlike peripheral arterial disease.
70
What is the primary imaging modality for diagnosing spinal stenosis?
The primary imaging investigation is MRI (Magnetic Resonance Imaging) for diagnosing spinal stenosis, providing detailed visualization of the spinal structures and areas of compression.
71
In cases where intermittent claudication is present, what investigations might be necessary to exclude other conditions?
Investigations to exclude peripheral arterial disease might involve an ankle-brachial pressure index and CT angiogram to rule out other conditions in the presence of symptoms similar to intermittent claudication.
72
What management options are available for spinal stenosis?
Management, guided by a spinal specialist and tailored to individual cases, may include exercise and weight loss (if appropriate), analgesia, physiotherapy, and decompression surgery if conservative treatments fail, albeit with varying results.
73
What surgical procedure involves the removal of the lamina from the affected vertebra?
Laminectomy involves removing part or all of the lamina from the vertebra, which constitutes the bony parts forming the spinal canal's posterior aspect, attaching to the spinous process.
74
Are epidural injections commonly used in the management of spinal stenosis?
The benefits of epidural injections with local anesthetic and corticosteroids are unclear, and they are generally not commonly used as part of the management of spinal stenosis.
75
What is the result of severe osteoporosis leading to spontaneous vertebral crush fractures?
Spontaneous crush fractures of the vertebral body can occur, leading to acute pain and kyphosis.
76
What is the primary approach in managing osteoporotic crush fractures?
The management of osteoporotic crush fractures is typically conservative, with non-surgical methods often used.
77
What medical procedure is an alternative for osteoporotic crush fractures and what is a potential risk associated with it?
Balloon vertebroplasty is an alternative treatment option. However, its results are not fully evaluated, and there's a small risk of neurological injury.
78
What is a potential long-term complication for some patients with osteoporotic crush fractures?
A minority of patients may experience chronic pain due to altered spinal mechanics following osteoporotic crush fractures.
79
What defines Pott disease?
Pott disease refers to vertebral body osteomyelitis and intervertebral discitis resulting from tuberculosis (TB) infection.
80
What are the common causes or associated conditions with vertebral TB?
Half of individuals have a skin and soft tissue infection, and less than half have pulmonary TB. Immunosuppression/HIV is also a factor.
81
What are the typical clinical features of vertebral TB?
Patients often present with slow and insidious symptoms such as back pain, lower limb weakness/paraplegia, and kyphotic deformity.
82
Which investigations are important in diagnosing vertebral TB?
Imaging studies such as X-ray and MRI are essential. It's also important to check for immunosuppression/HIV in affected individuals.
83
How is vertebral TB managed?
Treatment includes standard TB management, analgesics for pain relief, and surgery, which might involve immobilization and abscess drainage.
84
What is mechanical back pain characterized by?
Recurrent, relapsing, and remitting back pain without neurological symptoms.
85
What are the common causes or factors associated with it?
Obesity, poor posture, poor lifting technique, lack of physical activity, depression, facet joint OA, and disc prolapse.
86
What are the clinical features of mechanical back pain?
Pain typically in the lumbosacral region, buttocks, and thighs, usually with referred, non-radiating leg pain.
87
What distinguishes this type of pain from other back problems?
The pain tends to be mechanical and varies with activity, and patients rarely exhibit 'red flag' symptoms.
88
How is mechanical back pain managed?
Management includes advice on activity, analgesics (NSAIDs, weak opiates if needed), physiotherapy, and weight control.
89
What characterizes an acute disc tear?
An acute tear in the outer fibrosis of an intervertebral disc, often associated with heavy lifting.
90
How does this condition present clinically?
Pain is notably exacerbated by coughing, as coughing increases disc pressure.
91
What is the recommended investigation for acute disc cut diagnosis?
MRI is the preferred imaging modality for diagnosis.
92
How is acute disc tear or discogenic back pain managed?
Management typically involves analgesia, physiotherapy, and conservative measures, and symptoms can resolve within 2-3 months.
93
What condition is associated with bony nerve root entrapment?
Osteoarthritis (OA) of the facet joints.
94
What is the result of osteophytes impinging on nerve roots?
It causes nerve root symptoms and sciatica.
95
How is this condition typically(osteoartheritis) managed?
Surgical decompression may be performed in appropriate candidates, involving trimming the impinging osteophytes.
96
What can cause cervical spondylosis?
Spondylosis can occur due to disc degeneration, leading to increased loading and accelerated osteoarthritis (OA) of the facet joints.
97
What are the typical clinical features associated with cervical spondylosis?
Slow onset stiffness and pain in the neck, which can radiate to shoulders and the occiput.
98
How is cervical spondylosis typically managed?
It is commonly managed with physiotherapy and analgesics.
99
What complications can arise from cervical spondylosis?
Osteophytes can impinge on exiting nerve roots, causing radiculopathy, which involves upper limb dermatomes and myotomes. Severe cases might require decompression if conservative measures fail.
100
What are the typical clinical features associated with cervical disc prolapse?
Patients with nerve root compression present shooting neuralgic pain along a dermatomal distribution, weakness, and loss of reflexes based on the affected nerve root. A large central prolapse can lead to myelopathy, displaying upper motor neuron symptoms and signs.
101
Which nerve roots are commonly involved in cervical disc prolapse, and which disc levels do they correspond to?
Typically, lower nerve roots are affected, such as C7 root for a C6/7 disc or C8 root for a C7/T1 disc.
102
What investigations are crucial for diagnosing cervical disc prolapse?
Clinical findings are essential. However, MRI is the gold standard imaging, but it's important to note that asymptomatic disc prolapse can increase with age, causing false positives on imaging. Hence, clinical findings should correlate with MRI before considering surgery.
103
How is cervical disc prolapse typically managed?
Analgesia and physiotherapy are commonly utilized. Surgery might be considered in cases that do not respond to conservative management.
104
What are the typical clinical features associated with cervical disc prolapse?
Patients with nerve root compression present shooting neuralgic pain along a dermatomal distribution, weakness, and loss of reflexes based on the affected nerve root. A large central prolapse can lead to myelopathy, displaying upper motor neuron symptoms and signs.
105
Which nerve roots are commonly involved in cervical disc prolapse, and which disc levels do they correspond to?
Typically, lower nerve roots are affected, such as C7 root for a C6/7 disc or C8 root for a C7/T1 disc.
106
What investigations are crucial for diagnosing cervical disc prolapse?
Clinical findings are essential. However, MRI is the gold standard imaging, but it's important to note that asymptomatic disc prolapse can increase with age, causing false positives on imaging. Hence, clinical findings should correlate with MRI before considering surgery.
107
How is cervical disc prolapse typically managed?
Analgesia and physiotherapy are commonly utilized. Surgery might be considered in cases that do not respond to conservative management.
108
What causes atlanto-axial subluxation, and in which condition is it commonly observed?
In rheumatoid arthritis, atlanto-axial subluxation arises due to the destruction of the synovial joint between the atlas and the dens, and rupture of the transverse ligament.
109
How can lower cervical subluxations occur, and what condition is typically associated with this?
Lower cervical subluxations can occur due to the destruction of the synovial facet joints and uncovertebral joints by rheumatoid arthritis.
110
What potential complications arise from lower cervical subluxations, and what signs might manifest?
Lower cervical subluxations can lead to cord compression (myelopathy) and may present with upper motor neuron signs such as a wide-based gait, weakness, increased tone, and an upgoing plantar response.
111
What management strategies are recommended for both atlanto-axial and lower cervical subluxations?
Less severe cases observed on flexion-extension views may be managed with a collar to prevent flexion. More severe cases may necessitate surgical fusion. Conservative management, including analgesia and physiotherapy, may be used for instances that don't involve or threaten neurological structures. In more severe cases, stabilization or fusion procedures may be required.
112
What is another term for low back pain? ZTF
Lumbago.
113
What does non-specific or mechanical lower back pain refer to?
It refers to the majority of patients without a specific disease causing their lower back pain.
114
How long should acute low back pain ideally take to improve?
Acute low back pain should improve within 1-2 weeks.
115
What condition may result in a longer recovery period (4-6 weeks) for back pain?
Sciatica.
116
What challenges are associated with managing lower back pain patients?
Challenges include identifying serious underlying pathology, speeding up recovery, reducing the risk of chronic lower back pain, and managing symptoms in chronic lower back pain.
117
Name some causes of mechanical back pain.
Causes include muscle or ligament sprain, facet joint dysfunction, sacroiliac joint dysfunction, herniated disc, spondylolisthesis, scoliosis, and degenerative changes affecting the discs and facet joints.
118
List some causes of neck pain.
Causes include muscle or ligament strain, torticollis, whiplash (typically after a road traffic accident), and cervical spondylosis (degenerative changes to the vertebrae).
119
What are red-flag causes of back pain?
Red-flag causes include
spinal fracture (e.g., major trauma),
cauda equina (e.g.,
saddle anaesthesia,
urinary retention,
incontinence, or
bilateral neurological signs),
spinal stenosis (e.g., intermittent neurogenic claudication),
ankylosing spondylitis (e.g., age under 40, gradual onset,
morning stiffness, or night-time pain), and
spinal infection (e.g., fever or a history of IV drug use).
120
Besides spine-related conditions, what are some abdominal or thoracic causes of back pain?
Abdominal or thoracic conditions that can cause back pain include pneumonia, ruptured aortic aneurysms, kidney stones, pyelonephritis, pancreatitis, prostatitis, pelvic inflammatory disease, and endometriosis.
121
Which nerves come together to form the sciatic nerve?
The spinal nerves L4 – S3 come together to form the sciatic nerve.
122
What are the main causes of sciatica due to lumbosacral nerve root compression?
The main causes of sciatica are herniated disc, spondylolisthesis (anterior displacement of a vertebra out of line with the one below), and spinal stenosis.
123
What does bilateral sciatica indicate as a red flag?
Bilateral sciatica is a red flag for cauda equina syndrome.
124
What does the SOCRATES mnemonic stand for in the assessment of pain?
The SOCRATES mnemonic stands for Site, Onset, Character, Radiation, Associations, Timing, Exacerbating and relieving factors, and Severity in assessing pain.
125
What are key symptoms in the history that are associated with specific spinal conditions?
Key symptoms include major trauma (spinal fracture), stiffness in the morning or with rest (ankylosing spondylitis), age under 40 (ankylosing spondylitis), among others.
126
What are some key findings on examination that indicate potential spinal pathologies?
Localised tenderness to the spine, bilateral neurological motor or sensory signs, bladder distention implying urinary retention, reduced anal tone are notable findings.
127
How is the sciatic stretch test performed, and what does a positive result indicate?
In the sciatic stretch test, the examiner lifts one straightened leg at the ankle until hip flexion's limit is reached, then dorsiflexes the ankle. Sciatica-type pain suggests nerve root irritation.
128
What is the PoRTaBLe mnemonic used for?
The PoRTaBLe mnemonic helps recall the main cancers that frequently metastasize to bones, aiding in considering spinal metastases in a patient presenting with back pain.
129
What investigations are used for spinal fractures?
X-rays or CT scans can be used to diagnose spinal fractures.
130
When is an emergency MRI scan needed in back pain cases?
An emergency MRI scan is required in patients with suspected cauda equina, to be conducted within hours of presentation.
131
What is the STarT Back Screening Tool used for?
The STarT Back tool is utilized to stratify the risk of a patient with acute back pain developing chronic back pain.
132
What management strategies are recommended for low-risk chronic back pain?
Patients at low risk of chronic back pain can be managed with self-management, education, reassurance, analgesia, and staying active.
133
Name some additional management options for medium or high-risk chronic back pain.
Physiotherapy, group exercise, and cognitive behavioural therapy are additional options for managing medium or high-risk chronic back pain.
134
What are the recommended medications for analgesia in low back pain?
NSAIDs (e.g., ibuprofen or naproxen) are considered first-line, codeine is suggested as an alternative, and benzodiazepines (e.g., diazepam) for muscle spasm are advised for a short-term period, up to 5 days. However, the use of opioids, antidepressants, amitriptyline, gabapentin, or pregabalin for low back pain is not recommended by NICE clinical knowledge summaries.
135
What is radiofrequency denervation used for in back pain?
Radiofrequency denervation may be an option for chronic low back pain arising from facet joints, targeting and damaging the medial branch nerves supplying sensation to the facet joints associated with back pain. The procedure is done under a local anaesthetic.
136
What medications are not recommended for sciatica?
Medications like gabapentin, pregabalin, diazepam, and oral corticosteroids are not recommended for sciatica by NICE clinical knowledge summaries. They also advise against using opioids for chronic sciatica.
137
Which neuropathic medications are suggested for persistent or worsening symptoms in sciatica?
Amitriptyline and duloxetine are suggested as neuropathic medications for persistent or worsening symptoms in sciatica.
138
What specialist management options are recommended for chronic sciatica?
Epidural corticosteroid injections, local anaesthetic injections, radiofrequency denervation, and spinal decompression are among the specialist management options suggested for chronic sciatica.
