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MSK > Back pathology > Flashcards

Back pathology Flashcards

1
Q

What is spondylosis?

A

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

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2
Q

How many lumbar vertebrae are there?

A

5

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3
Q

What is the function of the lumbar spine?

A

Weight bearing and movement

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4
Q

What are the red flags of back pain?

A 
Age <25 or >60
Constant/severe pain worse at night
Previous cancer
Cauda Equina syndrome
Systemic upset
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5
Q

Where does true lumbar back pain radiate?

A

Buttocks and thighs but not below knee.

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6
Q

What is cauda equina syndrome?

A

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

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7
Q

What are the symptoms of cauda equina syndrome?

A

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

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8
Q

How do you diagnose and treat cauda equina syndrome?

A

PR exam, MRI and discectomy.

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9
Q

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

A

Mechanical back pain

Osteoporotic Crush Fractures

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10
Q

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

A

Recurrent, Relapsing and Remitting.

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11
Q

What age group is most susceptible to mechanical back pain?

A

20-60 YO

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12
Q

What can cause mechanical back pain?

A

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

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13
Q

How do you treat mechanical back pain?

A

Physio and analgesia for all. Keep moving and reassure

Spinal stabilization in a few cases

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14
Q

How do you diagnose mechanical back pain?

A

History

Must have no red flags!

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15
Q

What causes osteoporotic crush fractures?

A

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

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16
Q

How do you treat osteoporotic crush fractures?

A

Conservatively or potentially balloon vertebroplasty for chronic pain.

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17
Q

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

A 
Cauda Equina Syndrome
Acute disk tear
Sciatica
Nerve root impingement
Spinal stenosis and claudications
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18
Q

What is an acute disk tear?

A

Tear in the annulus fibrosus of the disk.

19
Q

What causes acute disk tears?

A

Lifting heavy objects

20
Q

How do acute disk tears present?

A

Severe pain which is worse on coughing.

21
Q

How do you treat acute disk tears?

A

Analgesia and physio. Will heal with time.

22
Q

What is sciatica?

A

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

23
Q

How does sciatica present?

A

Loss of sensation/muscle strength at level affected.

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

24
Q

How do you treat sciatica?

A

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

25
Q

What is nerve root impingement?

A

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

26
Q

How does nerve root impingement present?

A

Similar to sciatica.

27
Q

How do you treat nerve root impingements?

A

Surgical decompression (trim away osteophytes)

28
Q

What is spinal stenosis?

A

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

29
Q

How does spinal stenosis and claudications present?

A

Claudications on walking (usually in >60YO)

Pain less on going uphill and changes place. Burning pain with pulse present.

30
Q

How do you treat spinal stenosis and claudications?

A

Physio and weight loss

Decompress in rare cases.

31
Q

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

A

Cervical spondylosis
Cervical disk prolapse
Cervical spine instability

32
Q

How many vertebrae are there in the cervical spine?

A

7

33
Q

What is special about the atlantoaxial joint?

A

Only synovial joint in spine

34
Q

What is cervical spondylosis?

A

Spondylosis of C spine

35
Q

How does cervical spondylosis present?

A

Slow onset stiffness and pain radiating to shoulders and eye.

36
Q

How do you treat cervical spondylosis?

A

Physio and analgesia.

In rare cases decompress

37
Q

What is a cervical disk prolapse?

A

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

38
Q

How does a cervical disc prolapse present?

A

Roots- dermatomal weakness and deficiencies. C7/8/T1

Centrally- Damages upper motor neurons

39
Q

How do you treat a cervical disc prolapse?

A

Physio and analgesia. Rarely discectomy.

40
Q

What is cervical spine instability?

A

An atraumatic instability of the C spine allowing for subluxation .

41
Q

What two groups do cervical spine instability usually occur?

A

Down’s Syndrome children

RA sufferers

42
Q

Describe cervical spinal instability in Down’s syndrome children.

A

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

43
Q

Describe cervical spinal instability in RA sufferers.

A

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

44
Q

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

A

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

MSK (17 decks)

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