Back pain, Scoliosis and Spinal Deformity

Question 1

Back pain is a multifactorial problem, made up of what components?

Answer 1

Biological, social and psychological

Question 2

What are the worrying red flag symptoms in back pain suggestive of serious pathologies?

Answer 2

Saddle anaestesia with/without bladder or bowel upset

Past history of cancer

Question 3

What are the myotomes?

Answer 3

L1/2: Hip flexion
L3/4: Knee extension
L5: Foot dorsiflexion
S1/2: Ankle plantar flexion

Question 4

What are the myotomes tested in the ankle jerk reflex?

Answer 4

L3/4

Question 5

What are the nerve root irritation tests?

Answer 5

Straight leg raise and femoral stretch test

Question 6

What are the key imaging modalities in back pain?

Answer 6

MRI, x-ray, diagnostic facet injection, contrast enhanced CT

Question 7

What is the first line imaging modality in back pain?

Answer 7

MRI

Question 8

What are the advantages and disadvantages of MRI in imaging back pain?

Answer 8

• Symptoms and signs need to match
• Very detailed, can show too much detail
• 76% false positives
• Requires expertise to be interpreted

Question 9

Are x-rays useful in back pain investigation?

Answer 9

No, waste of time effectively

Question 10

What is sciatica?

Answer 10

Buttox and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

Question 11

What happens during vertebral disc prolapse?

Answer 11

One of the vertebral discs is damaged and compresses one of the spinal nerves

Question 12

How can you find out exactly where the disc prolapse is?

Answer 12

By the pattern of the myotomes and dermatomes due to the pattern of numbness and tingling

Question 13

What are the presenting symptoms of disc prolapse?

Answer 13

Leg pain and neurology

Then leg pain becomes dormant and the back pain may disappear entirely

Question 14

What is the treatment for disc prolapse?

Answer 14

70% will settle within 3 months and a further 90% in 18-24mnths therefore no long term benefit of surgery

Question 15

What are the considerations given to back surgery?

Answer 15

Risk of permanent neurological damage therefore symptoms need to be bad enough to justify it

Question 16

What is the best treatment for back pain?

Answer 16

Fast and active rehab, conservative treatment

Question 17

What are the side effects of surgery?

Answer 17

• Up to 25% failure rate
• Mandatory extensive counselling
• Adjacent segment disease

Question 18

What is meant by the term scoliosis?

Answer 18

”s” or “c” shaped spine instead of straight line

Question 19

What are the classifications of scoliosis?

Answer 19

Congenital, early onset idiopathic, late onset idiopathic, secondary

Question 20

What can secondary scoliosis be caused by?

Answer 20

Neuromuscular, cerebral palsy, spine bifida, tumours

Question 21

What is the non operative management of scoliosis?

Answer 21

Corrective casts, bracing, corrective exercises

Question 22

What is the surgical options for scoliosis?

Answer 22

Anterior surgery, one stage posterior surgery or combined surgery

Question 23

What is kyphosis?

Answer 23

-Excessive anterior border of spine leading to “hunch back”

Question 24

What is spondyolysis?

Answer 24

Failure of fusion, developmental defect

Question 25

What is Spondyliothesis?

Answer 25

Forward slipping of one vertebra onto another

Question 26

When should surgical management be indicated in spondliothesis?

Answer 26

When conservative treatment has failed