Back pathology

Question 1

What is spondylosis?

Answer 1

Loss of water content from intervertebral disks resulting in loss of cushioning and increased pressure on facet joints resulting in OA.

Question 2

How many lumbar vertebrae are there?

Answer 2

5

Question 3

What is the function of the lumbar spine?

Answer 3

Weight bearing and movement

Question 4

What are the red flags of back pain?

Answer 4

Age <25 or >60
Constant/severe pain worse at night
Previous cancer
Cauda Equina syndrome
Systemic upset

Question 5

Where does true lumbar back pain radiate?

Answer 5

Buttocks and thighs but not below knee.

Question 6

What is cauda equina syndrome?

Answer 6

A large disk prolapse compressing all nerve roots of cauda equina.
It is a surgical emergency!!!

Question 7

What are the symptoms of cauda equina syndrome?

Answer 7

BIlateral leg pain or numbness, saddle anaesthesia and altered bowel/urine habits.

Question 8

How do you diagnose and treat cauda equina syndrome?

Answer 8

PR exam, MRI and discectomy.

Question 9

What are the two bony/muscular pathologies associated with the lumbar spine we need to know?

Answer 9

Mechanical back pain

Osteoporotic Crush Fractures

Question 10

What three words can be used to describe mechanical back pain?

Answer 10

Recurrent, Relapsing and Remitting.

Question 11

What age group is most susceptible to mechanical back pain?

Answer 11

20-60 YO

Question 12

What can cause mechanical back pain?

Answer 12

Obesity, bad posture, bad lifting, inactivity, depression, degenerative disk prolapse, facet joint OA and spondylosis.

Question 13

How do you treat mechanical back pain?

Answer 13

Physio and analgesia for all. Keep moving and reassure

Spinal stabilization in a few cases

Question 14

How do you diagnose mechanical back pain?

Answer 14

History

Must have no red flags!

Question 15

What causes osteoporotic crush fractures?

Answer 15

Spontaneous crush of weakened bone leading to pain and kyphosis.
Can develop to chronic pain due to altered mechanics

Question 16

How do you treat osteoporotic crush fractures?

Answer 16

Conservatively or potentially balloon vertebroplasty for chronic pain.

Question 17

What are the five neuropathic lumbar back pains we need to know?

Answer 17

Cauda Equina Syndrome
Acute disk tear
Sciatica
Nerve root impingement
Spinal stenosis and claudications

Question 18

What is an acute disk tear?

Answer 18

Tear in the annulus fibrosus of the disk.

Question 19

What causes acute disk tears?

Answer 19

Lifting heavy objects

Question 20

How do acute disk tears present?

Answer 20

Severe pain which is worse on coughing.

Question 21

How do you treat acute disk tears?

Answer 21

Analgesia and physio. Will heal with time.

Question 22

What is sciatica?

Answer 22

When the nucleus pulposus herniates out of a disk tear which impinges on the nerve.
Commonly in L4/L5/S1 (sciatic nerve)

Question 23

How does sciatica present?

Answer 23

Loss of sensation/muscle strength at level affected.

Burning/tingling pain running down back of thigh and to blow knee (ankle or foot).

Question 24

How do you treat sciatica?

Answer 24

Analgesia, physio and maintain mobility.
Rarely use drugs for neuropathic pain (gabapentin)
V rarely discectomy to decompress.

Question 25

What is nerve root impingement?

Answer 25

OA in facet joints can lead to osteophytes impinging on nerve roots.

Question 26

How does nerve root impingement present?

Answer 26

Similar to sciatica.

Question 27

How do you treat nerve root impingements?

Answer 27

Surgical decompression (trim away osteophytes)

Question 28

What is spinal stenosis?

Answer 28

Stenosis vertebral foramen due to spondylosis + bulging disk/ligamentum flavum or osteophytosis compressing cauda equina

Question 29

How does spinal stenosis and claudications present?

Answer 29

Claudications on walking (usually in >60YO) | Pain less on going uphill and changes place. Burning pain with pulse present.

Question 30

How do you treat spinal stenosis and claudications?

Answer 30

Physio and weight loss | Decompress in rare cases.

Question 31

What are the three cervical spine conditions we need to know?

Answer 31

Cervical spondylosis Cervical disk prolapse Cervical spine instability

Question 32

How many vertebrae are there in the cervical spine?

Answer 32

7

Question 33

What is special about the atlantoaxial joint?

Answer 33

Only synovial joint in spine

Question 34

What is cervical spondylosis?

Answer 34

Spondylosis of C spine

Question 35

How does cervical spondylosis present?

Answer 35

Slow onset stiffness and pain radiating to shoulders and eye.

Question 36

How do you treat cervical spondylosis?

Answer 36

Physio and analgesia. | In rare cases decompress

Question 37

What is a cervical disk prolapse?

Answer 37

When a disc between C vertebrae herniates to compress nerve roots or spinal cord. Can be acute or chronic.

Question 38

How does a cervical disc prolapse present?

Answer 38

Roots- dermatomal weakness and deficiencies. C7/8/T1 | Centrally- Damages upper motor neurons

Question 39

How do you treat a cervical disc prolapse?

Answer 39

Physio and analgesia. Rarely discectomy.

Question 40

What is cervical spine instability?

Answer 40

An atraumatic instability of the C spine allowing for subluxation .

Question 41

What two groups do cervical spine instability usually occur?

Answer 41

Down's Syndrome children | RA sufferers

Question 42

Describe cervical spinal instability in Down's syndrome children.

Answer 42

Atlantoaxial instability. Mild cases- prevent activity which can further damage Severe cases- Stabilize

Question 43

Describe cervical spinal instability in RA sufferers.

Answer 43

Atlantoaxial instability due to destruction of synovial joint. Resulting subluxation can be fatal! Mild cases- Give collar Severe cases- Fuse

Question 44

What are some of the possible signs of a cervical spine instability?

Answer 44

Wide based gait, weakness, increased tone and upgoing plantar response.