Back Problems Flashcards
What is spondylosis?
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
What is spondylothesis?
a crack in the pas interarticularis that allows the vertebrae to slide on the one below potentially causing nerve damage
What is the treatment for spondylothesis?
analgesia and physiotherapy
spinal stabilisation
What is sciatica?
pain and reduced power radiating down the leg past the knee - most commonly from a L4, L5 or S1 nerve root entraptment
What is the presentation of a disc prolapse? What causes it?
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
What is an annulus tear?
occurs in the outer annulus fibrosis of an intervertebral disc which classically ruptures after lifting a heavy object
What is the treatment for an annulus tear?
analgesia and physiotherapy
takes 2-3 months to settle
What is the treatment for a disc prolapse?
Physiotherapy
Gabapentin for neuropathic pain
80-90% spontaneously resolve within 2-3 months
surgery if it doesnt resolve
How is a disc prolapse investigated?
MRI
What is Cauda Equina syndrome?
due to very large central disc prolapse that compresses all of the nerve roots of the cauda equina (control bladder and bowel)
EMERGENCY
How does cauda equina present?
saddle parasthesia
bilateral leg pain
incontinence
How is cauda equina investigated?
MRI
PR - mandatory
What is spinal stenosis?
cauda equina of the lumbar spine has become compressed or irritated due to having less space- nerve root pain
What is spinal stenosis due to?
buldging discs
buldging ligamentum flavum
osteophytes
In what age group does spinal stenosis commonly occur?
> 60s with claudication
What is the management of spinal stenosis?
physiotherapy and weight loss
if no help then decompression surgery
What is an osteoporotic crush fracture?
severe osteoporosis leading to crush fracture of the vertebral body presenting with acute pain and kyphosis then chronic pain
What is an osteoporotic crush fracture treated with?
balloon vertebroplasty
What tumours commonly metastestise to the spine?
Breast Bronchus Prostate Thyroid Kidney
What mnenomic can be used to remember the tumours that commonly metastestise to the spine?
Bad boys pee through kidneys
What are the red flags for back pain? IMPORTANT
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
What are children with Down Syndrome at risk of developing?
spinal instabiltiy at C1/C2
How can spinal instability be diagnosed?
flexion extension xray
How can spinal instability be treated?
collar to prevent flexion or decompression
