Cause Of Back Pain Including Cauda equina Flashcards
What are UMN signs?
Hypertonic Reduced power Hypereflexia Positive babinski Clonus Positive Hoffmann sign Positive Romberg test
What are LMN signs?
Hypotonia Reduced power Diminished reflexes Negative babinski Absent clonus Absent Hoffmann Negative Romberg
What would you expect on examination of someone with cervical myelopathy?
UMN signs
Gait abnormalities
Hand function reduced
Progressive sensory loss
What investigation is used to confirm the diagnosis of cervical myelopathy?
Cervical MRI
CT myleography
X-ray if trauma history
What are the causes of cervical myelopathy?
Facet joint degenerative arthritic changes - most common
Disk prolapse
At what diameter do pts show clinical symptoms in spinal stenosis of cervical myelopathy?
<7mm
What is the pattern of progression of cervical myelopathy?
Step-ladder progression - most common
Acute
Progressives over time
What is the conservative management for cervical myelopathy?
Analgesia -neuropathic painkillers
Physio
Steroids
Cervical nerve root blocks
What is the surgical management for cervical myelopathy?
Decompression - anterior(1/2 levels), posterior(more the 2 levels)
+ stabilisation
What are the red flags for mechanical back pain?
History of malignancy Systemic signs Age<20 or >50 History of osteoporosis IV drug use Widespread neurology Trauma Weight loss Immunocompromised -HIV Prolonged steroid use Inflammatory pain -Persisting severe restriction on lumbar flexion
What investigations would you do for mechanical lower back pain with red flags?
MRI
X-ray if history of trauma
What are the two types of mechanical back pain?
Non-specific - disc degeneration, facet joint degeneration, myofasical/postural
Specific - spondylolithesis(instability) - disc prolapse, trauma, tumour,infection - surgery offered
What is the conservative management for mechanical back pain?
Analgesia + physio
Psychological - CBT
Pain management programme - steroid injection, RF ablation
What are the causes of cauda equina syndrome?
Disc herniation - 99% of cases Haematoma Tumor Abscess Trauma
What is the difference between cauda equina compression and cauda equina syndrome?
Cauda equina compression is the radiological finding
Cauda equina syndrome is a set of symptoms + the radiological findings
What would you do on examination of a patient with suspected cauda equina syndrome?
Look for obvious deformities
ROM
Feel - red flags
LMN signs - neurological exam - ASIA sheet
What are the red flags for cauda equina syndrome?
Perianal/saddle anaesthesia Loss of anal tone Urinary retention/incontinace - reversible if only retention Bowel incontinence Bilateral sciatica Impotence Hyporeflexia
What investigations would you do for suspected cauda equina syndrome?
PR exam
Pre and post void bladder scan - >200ml = cauda equina syndrome
Lumbar-sacral spine MRI - GOLD standard - T2 weighted
What is the management for cauda equina syndrome?
Early neurosurgical review
Surgical decompression - 48 hrs
Rehab - bladder + bowel function after surgery - incontinence clinic
How does someone with lumbar disk prolapse present?
LMN signs with history of lifting something heavy
Pain on straight leg raise
How do you manage lumbar disk prolapse?
- physio + analgesia
- nerve root black
- surgery - discectomy
What is the cause of lumbar canal stenosis?
Facet joint arthritis + ligament flavum inflammation
What must you do if you suspect lumbar canal stenosis?
Neurovascular examination
MRI
What is the management for lumbar canal stenosis?
Conservative - physio, analgesia, activity modification
Surgical decompression
What is the MRC grading and what are the grades?
Medical research councils scale for assessment of muscle power in a neurological examination
0 - no contraction
1 - flicker or trace of contraction
2 - active movement with gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and resistance
5 - normal power
