Back/Spine

Question 1

Majority of acute lower back pain is caused by…

Answer 1

Muscle and/or ligament damage

Question 2

2 most common types of lower back injury

Answer 2

• Muscle strain

- Lumbar ligament sprain

Question 3

Whiplash causes…

Answer 3

Cervical strain

Question 4

Is pain from back strain radicular?

Answer 4

NO

Question 5

Cauda equina syndrome

Answer 5

RARE

Large midline disk herniation that compresses nerve roots

Question 6

Sx of cauda equina syndrome

Answer 6

Severe low back pain w/ B/B incontinence

Question 7

How to diagnose cauda equina syndrome

Answer 7

STAT MRI

Decreased rectal tone

Question 8

Does cauda equina syndrome require surgery?

Answer 8

YES–surgical emergency, decompression (laminectomy)

Question 9

Herniated nucleus pulposus: types (2) and which vertebrae are affected

Answer 9

Cervical: usually posterolateral at C5-C6, C6-C7
Lumbar: L5-S1 (most common), L4-L5

Question 10

Sx of cervical herniated nucleus pulposus

Answer 10

Pain in arm/shoulder, numbness/tingling, pain at rest

Question 11

How to differentiate between rotator cuff and cervical herniated nucleus pulposus?

Answer 11

Rotator cuff=no pain at rest

Cervical herniated nucleus pulposus=pain at rest

Question 12

Sx of lumbar herniated nucleus pulposus
Relieved by?
Exacerbated by?

Answer 12

Sudden onset pain radiates below knee
Relieved w/ bed rest
Exacerbated by coughing, sitting, straining, straight leg raise

Question 13

Diagnostic imaging for herniated nucleus pulposus

Answer 13

MRI (noncontrast for lumbar)

Question 14

Tx of herniated nucleus pulposus

Answer 14

NSAIDs, muscle relaxants, epidural steroids

FAIL meds=surg

Question 15

Ankylosing spondylitis

Answer 15

Chronic inflam progressing to fusion of vertebrae

Question 16

Does pain of ankylosing spondylitis get worse with activity?

Answer 16

NO, it gets better

Question 17

What do labs for ankylosing spondylitis look like?

Answer 17

[+] HLA-B27 gene
Increased CRP and ESR
[-] RF

Question 18

What is typical of ankylosing spondylitis on films?

Answer 18

“Bamboo spine”–squaring of vertebral bodies and loss of curvature

Question 19

What is the leading dx for pts >65 who have spine surg?

Answer 19

Spinal stenosis

Question 20

Sx of spinal stenosis

Answer 20

Dull back pain radiating to LE pain w/ walking or wt bearing, relieved by rest

Question 21

What position relieves pain of spinal stenosis?

Answer 21

“Shopping cart sign”

Question 22

What can cause progressive kyphosis?

Answer 22

TB of spine (Pott’s dz)

Question 23

What age is scoliosis typically diagnosed? More common in male or female?

Answer 23

9-15, female