Back Problems

Question 1

What is spondylosis?

Answer 1

inteverterbal discs lose water content with age which results in increased pressure on the facet jointsand can cause a crack in the pas interarticularis or osteoarthrtits
- stiffness and pain in neck, shoulders and occiput

Question 2

What is spondylothesis?

Answer 2

a crack in the pas interarticularis that allows the vertebrae to slide on the one below potentially causing nerve damage

Question 3

What is the treatment for spondylothesis?

Answer 3

analgesia and physiotherapy

spinal stabilisation

Question 4

What is sciatica?

Answer 4

pain and reduced power radiating down the leg past the knee - most commonly from a L4, L5 or S1 nerve root entraptment

Question 5

What is the presentation of a disc prolapse? What causes it?

Answer 5

sciatica and neurological disturbances due to an annulus tear, impaired disc nutrition or root compression which causes a loss of disc height and facet arthropathy.
The pain is worse on coughing

Question 6

What is an annulus tear?

Answer 6

occurs in the outer annulus fibrosis of an intervertebral disc which classically ruptures after lifting a heavy object

Question 7

What is the treatment for an annulus tear?

Answer 7

analgesia and physiotherapy

takes 2-3 months to settle

Question 8

What is the treatment for a disc prolapse?

Answer 8

Physiotherapy
Gabapentin for neuropathic pain
80-90% spontaneously resolve within 2-3 months
surgery if it doesnt resolve

Question 9

How is a disc prolapse investigated?

Answer 9

MRI

Question 10

What is Cauda Equina syndrome?

Answer 10

due to very large central disc prolapse that compresses all of the nerve roots of the cauda equina (control bladder and bowel)
EMERGENCY

Question 11

How does cauda equina present?

Answer 11

saddle parasthesia
bilateral leg pain
incontinence

Question 12

How is cauda equina investigated?

Answer 12

MRI

PR - mandatory

Question 13

What is spinal stenosis?

Answer 13

cauda equina of the lumbar spine has become compressed or irritated due to having less space- nerve root pain

Question 14

What is spinal stenosis due to?

Answer 14

buldging discs
buldging ligamentum flavum
osteophytes

Question 15

In what age group does spinal stenosis commonly occur?

Answer 15

> 60s with claudication

Question 16

What is the management of spinal stenosis?

Answer 16

physiotherapy and weight loss

if no help then decompression surgery

Question 17

What is an osteoporotic crush fracture?

Answer 17

severe osteoporosis leading to crush fracture of the vertebral body presenting with acute pain and kyphosis then chronic pain

Question 18

What is an osteoporotic crush fracture treated with?

Answer 18

balloon vertebroplasty

Question 19

What tumours commonly metastestise to the spine?

Answer 19

Breast
Bronchus
Prostate
Thyroid 
Kidney

Question 20

What mnenomic can be used to remember the tumours that commonly metastestise to the spine?

Answer 20

Bad boys pee through kidneys

Question 21

What are the red flags for back pain? IMPORTANT

Answer 21

back pain in younger patient <20
new back pain in older patient >60
constant severe back pain, worse at night
systemic upset - fevers, night sweats, fatigue, malaise
history of malignancy

Question 22

What are children with Down Syndrome at risk of developing?

Answer 22

spinal instabiltiy at C1/C2

Question 23

How can spinal instability be diagnosed?

Answer 23

flexion extension xray

Question 24

How can spinal instability be treated?

Answer 24

collar to prevent flexion or decompression