Backpain Flashcards
Function of the spine?
- The spine allows a range of movement
- The spine protects our spinal nerves
- The spine functions as a shock absorber (as do the legs)
- This occurs because the spine is flexible, and is supported by strong muscles and tendons
- If this is lost, we lose the ability to protect ourselves from abnormal shocks and vibrations
What are the 3 curves of the spine?
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
Which part of the spine is the most mobile? Why?
The cervical spine - due to having relatively thick discs in comparison to the size of the adjacent vertebrae
Diagram of intervertebral discs. What 2 components is it made up of?
- Annulus fibrosis (outer portion)
- Nucleus pulposus (inner squidy portion)
What occurs during a slipped disc?
Occurs when the intervertebral disc’s outer fibers (the annulus) are damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal.
How does the composition of the intervertebral discs change throughout the day?
- In the morning they are swollen with water so the annulus and intervertebral ligaments resist bending strongly
- More vulnerable to injury as the day progresses as discs lose up to 20% of their water and height so the spine is more supple
- Low back pain can increase during the day and with standing.
How do intervertebral discs change with age?
- Discs lose water and lose strength and become thinner
- Vertebral endplates and underlying bone structure loses strength
- Repetitive loading/trauma can result in annular tears in the discs
- Dryer, weaker discs result in slacker ligaments
- Spine is less stable
- New bone grows (osteophytes) to try to stabilise the spine
- Increased load over the facet joints
What should be told to patients with lower back pain?
Keep flexible and keep strong –> keeps back less stiff
What determines back pain?
- Genetics
- Environment
- Body weight
- Muscle strength
- Mechanical loading strengthens vertebral bodies and increases the water content within discs
- OVERloading should be avoided
What are the risk factors for low back pain (LBP) at work?
- Heavy physical jobs
- Lifting
- Driving to work
- Previous episodes of LBP
- Mental health
- Posture- laptops, seating, desk set-up
Low back pain (LBP) can either be: simple backache, nerve root involvement or even possible serious spinal pathology.
What is the history of mechanical (simple) back pain?
- First episode often sudden onset while lifting/twisting/turning
- Recurrent episodes with decreasing inter-episode frequency
- Variable pain related to position/posture
- Better lying flat
- May radiate to buttock and leg
- Often worse at the end of the day and better with lying down/resting
100% of people over 65 years have radiological changes in their spines. What are examples of these changes?
- facet arthritis
- disc narrowing
- osteophytes
What are the guidelines for LBP - early management
- Simple analgesics
- Physiotherapy if symptoms > few days
- Rest for no longer than 1-3 days
- Psychosocial management
- Work absence only if unavoidable
- Early return to work, possibly graded
- Consider secondary care referral if on going at 6 weeks
What are the drug treatments for LBP?
- Paracetamol
- NSAIDs
- Opioids
- Anti-depressants (amitriptyline, duloxetine)
- Nerve modulators (gabapentin, pregabalin)
What is sciatica?
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
What is axial spondyloarthritis? Symptoms?
Axial spondyloarthritis is an umbrella term for types of inflammatory arthritis that primarily affect the spine and the sacroiliac (SI) joints. Affects young people (men > women).
Symptoms:
- Back pain (main symptom)
- pain and stiffness in the spine
- other joint inflammation
- enthesitis
- iritis
- FH of associated diseases (IBD, psoriasis)
What is osteomalacia? What is it most often caused by? What feature can be seen in xrays?
Osteomalacia refers to a marked softening of your bones, most often caused by severe vitamin D deficiency (diet, sunlight).
Looser zones, also known as cortical infractions, are wide, transverse lucencies with sclerotic borders traversing partway through a bone and are associated most frequently with osteomalacia and rickets.
What is Paget’s disease? Symptoms?
- Paget’s disease of bone disrupts the normal cycle of bone renewal, causing bones to become weakened and possibly deformed.
- Prevalence increases with age.
- Commonest site is pelvis
- Symptoms:
- Often asymptomatic – raised alkaline phosphatase
- Pelvic/back pains.
- Can cause spinal stenosis.
