Back pathology Flashcards
What is spondylosis?
Loss of water content from intervertebral disks resulting in loss of cushioning and increased pressure on facet joints resulting in OA.
How many lumbar vertebrae are there?
5
What is the function of the lumbar spine?
Weight bearing and movement
What are the red flags of back pain?
Age <25 or >60 Constant/severe pain worse at night Previous cancer Cauda Equina syndrome Systemic upset
Where does true lumbar back pain radiate?
Buttocks and thighs but not below knee.
What is cauda equina syndrome?
A large disk prolapse compressing all nerve roots of cauda equina.
It is a surgical emergency!!!
What are the symptoms of cauda equina syndrome?
BIlateral leg pain or numbness, saddle anaesthesia and altered bowel/urine habits.
How do you diagnose and treat cauda equina syndrome?
PR exam, MRI and discectomy.
What are the two bony/muscular pathologies associated with the lumbar spine we need to know?
Mechanical back pain
Osteoporotic Crush Fractures
What three words can be used to describe mechanical back pain?
Recurrent, Relapsing and Remitting.
What age group is most susceptible to mechanical back pain?
20-60 YO
What can cause mechanical back pain?
Obesity, bad posture, bad lifting, inactivity, depression, degenerative disk prolapse, facet joint OA and spondylosis.
How do you treat mechanical back pain?
Physio and analgesia for all. Keep moving and reassure
Spinal stabilization in a few cases
How do you diagnose mechanical back pain?
History
Must have no red flags!
What causes osteoporotic crush fractures?
Spontaneous crush of weakened bone leading to pain and kyphosis.
Can develop to chronic pain due to altered mechanics
How do you treat osteoporotic crush fractures?
Conservatively or potentially balloon vertebroplasty for chronic pain.
What are the five neuropathic lumbar back pains we need to know?
Cauda Equina Syndrome Acute disk tear Sciatica Nerve root impingement Spinal stenosis and claudications
What is an acute disk tear?
Tear in the annulus fibrosus of the disk.
What causes acute disk tears?
Lifting heavy objects
How do acute disk tears present?
Severe pain which is worse on coughing.
How do you treat acute disk tears?
Analgesia and physio. Will heal with time.
What is sciatica?
When the nucleus pulposus herniates out of a disk tear which impinges on the nerve.
Commonly in L4/L5/S1 (sciatic nerve)
How does sciatica present?
Loss of sensation/muscle strength at level affected.
Burning/tingling pain running down back of thigh and to blow knee (ankle or foot).
How do you treat sciatica?
Analgesia, physio and maintain mobility.
Rarely use drugs for neuropathic pain (gabapentin)
V rarely discectomy to decompress.
What is nerve root impingement?
OA in facet joints can lead to osteophytes impinging on nerve roots.
How does nerve root impingement present?
Similar to sciatica.
How do you treat nerve root impingements?
Surgical decompression (trim away osteophytes)
What is spinal stenosis?
Stenosis vertebral foramen due to spondylosis + bulging disk/ligamentum flavum or osteophytosis compressing cauda equina
How does spinal stenosis and claudications present?
Claudications on walking (usually in >60YO)
Pain less on going uphill and changes place. Burning pain with pulse present.
How do you treat spinal stenosis and claudications?
Physio and weight loss
Decompress in rare cases.
What are the three cervical spine conditions we need to know?
Cervical spondylosis
Cervical disk prolapse
Cervical spine instability
How many vertebrae are there in the cervical spine?
7
What is special about the atlantoaxial joint?
Only synovial joint in spine
What is cervical spondylosis?
Spondylosis of C spine
How does cervical spondylosis present?
Slow onset stiffness and pain radiating to shoulders and eye.
How do you treat cervical spondylosis?
Physio and analgesia.
In rare cases decompress
What is a cervical disk prolapse?
When a disc between C vertebrae herniates to compress nerve roots or spinal cord. Can be acute or chronic.
How does a cervical disc prolapse present?
Roots- dermatomal weakness and deficiencies. C7/8/T1
Centrally- Damages upper motor neurons
How do you treat a cervical disc prolapse?
Physio and analgesia. Rarely discectomy.
What is cervical spine instability?
An atraumatic instability of the C spine allowing for subluxation .
What two groups do cervical spine instability usually occur?
Down’s Syndrome children
RA sufferers
Describe cervical spinal instability in Down’s syndrome children.
Atlantoaxial instability.
Mild cases- prevent activity which can further damage
Severe cases- Stabilize
Describe cervical spinal instability in RA sufferers.
Atlantoaxial instability due to destruction of synovial joint. Resulting subluxation can be fatal!
Mild cases- Give collar
Severe cases- Fuse
What are some of the possible signs of a cervical spine instability?
Wide based gait, weakness, increased tone and upgoing plantar response.
