back pain I Flashcards
What are the primary causes of non-specific back pain?
The vast majority of cases of back pain are considered non-specific musculoskeletal pain due to strained muscles or ligaments.
What symptoms are exhibited by individuals with non-specific musculoskeletal pain?
Individuals with this condition usually have no sensory or motor deficits and typically complain about tenderness over the affected muscle or ligament.
What is the recommended treatment for non-specific musculoskeletal pain?
The treatment for these individuals involves prescribing activity as tolerated and NSAIDs for pain management.
What causes spinal osteoarthritis?
Spinal osteoarthritis can occur due to the natural aging process where the cartilage at the tips of bones wears down over time.
What changes and conditions are associated with spinal osteoarthritis?
Spinal osteoarthritis is associated with joint degeneration, ligamentous changes, disc degeneration, and eventually, deformity of the spine.
What causes spinal osteoarthritis?
Spinal osteoarthritis is primarily due to the natural aging process where the cartilage at the tips of bones wears down over time.
What changes and conditions are associated with spinal osteoarthritis?
Spinal osteoarthritis is linked with joint degeneration, ligamentous changes, disc degeneration, and ultimately, spinal deformity.
What is disk herniation and how does it occur?
Disk herniation is when the nucleus pulposus bulges out, usually posteriorly due to a relatively thinner posterior longitudinal ligament, often caused by heavy lifting.
What are the typical symptoms of sciatica?
Sciatica presents as a shocking pain shooting from the buttocks through the leg, following the course of the sciatic nerve.
What motor deficits are associated with L4-5 disk herniation?
L4-5 disk herniation can lead to motor deficits like weakness in hip abduction and foot dorsiflexion.
difficulty heel walking
What motor deficits are associated with L5-S1 disk herniation?
L5-S1 disk herniation can cause weakened foot plantar flexion and a reduced Achilles tendon reflex.
What test is commonly used to diagnose lumbar disk herniation?
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.
What is the first-line treatment for disk herniation?
Conservative treatment involving rest with activity as tolerated and NSAIDs for pain management is typically the initial approach.
When might surgical intervention be considered for disk herniation?
If symptoms persist or worsen beyond 6 weeks despite conservative treatment, surgical removal of part or all of the disk may be considered.
What typically causes vertebral fractures?
Vertebral fractures are often caused by major trauma, but in the case of compression fractures, they’re commonly seen in individuals with osteoporosis.
What characterizes compression fractures?
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.
What are the common symptoms associated with compression fractures?
Individuals with compression fractures typically present with localized back pain after minor trauma, along with kyphosis and potential height loss.
How are vertebral fractures diagnosed and treated?
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.
What are seronegative spondyloarthropathies?
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.
What are the typical symptoms of seronegative spondyloarthropathies?and complications
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.
What are the subtypes of seronegative spondyloarthropathies according to the PAIR mnemonic?
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.
What defines spinal stenosis?
Spinal stenosis involves the narrowing of the central spinal canal, intervertebral foramen, or lateral recess, causing progressive compression of nerve roots.
What is the primary cause of spinal stenosis?
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.
What are the typical clinical features associated with spinal stenosis?
It is commonly observed in patients over 60 and often presents with claudication, which is pain in the legs experienced during walking.
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.
What investigations are typically used for diagnosing spinal stenosis?
The diagnosis of spinal stenosis is usually history, examination and MRI .
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.
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.
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).
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.
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.
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.
What imaging investigation is primary for diagnosing spinal stenosis?
MRI is the primary imaging investigation used to diagnose spinal stenosis.
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.
What are some management options for spinal stenosis?
Management options include exercise and weight loss, analgesia, physiotherapy, and decompression surgery if conservative treatments fail.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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
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.
What urgent imaging is recommended for diagnosing cauda equina syndrome?
Urgent MRI is recommended to identify the level of prolapse and confirm the diagnosis.
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.
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.
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.
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.
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.
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.
What defines Pott disease?
Pott disease refers to vertebral body osteomyelitis and intervertebral discitis resulting from tuberculosis (TB) infection.
