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T&O > Cause Of Back Pain Including Cauda equina > Flashcards

Cause Of Back Pain Including Cauda equina Flashcards

1
Q

What are UMN signs?

A 
Hypertonic 
Reduced power 
Hypereflexia 
Positive babinski 
Clonus 
Positive Hoffmann sign 
Positive Romberg test
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2
Q

What are LMN signs?

A 
Hypotonia 
Reduced power
Diminished reflexes 
Negative babinski 
Absent clonus
Absent Hoffmann 
Negative Romberg
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3
Q

What would you expect on examination of someone with cervical myelopathy?

A

UMN signs
Gait abnormalities
Hand function reduced
Progressive sensory loss

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4
Q

What investigation is used to confirm the diagnosis of cervical myelopathy?

A

Cervical MRI
CT myleography

X-ray if trauma history

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5
Q

What are the causes of cervical myelopathy?

A

Facet joint degenerative arthritic changes - most common

Disk prolapse

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6
Q

At what diameter do pts show clinical symptoms in spinal stenosis of cervical myelopathy?

A

<7mm

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7
Q

What is the pattern of progression of cervical myelopathy?

A

Step-ladder progression - most common
Acute
Progressives over time

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8
Q

What is the conservative management for cervical myelopathy?

A

Analgesia -neuropathic painkillers
Physio
Steroids
Cervical nerve root blocks

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9
Q

What is the surgical management for cervical myelopathy?

A

Decompression - anterior(1/2 levels), posterior(more the 2 levels)
+ stabilisation

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10
Q

What are the red flags for mechanical back pain?

A 
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
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11
Q

What investigations would you do for mechanical lower back pain with red flags?

A

MRI

X-ray if history of trauma

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12
Q

What are the two types of mechanical back pain?

A

Non-specific - disc degeneration, facet joint degeneration, myofasical/postural

Specific - spondylolithesis(instability) - disc prolapse, trauma, tumour,infection - surgery offered

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13
Q

What is the conservative management for mechanical back pain?

A

Analgesia + physio
Psychological - CBT
Pain management programme - steroid injection, RF ablation

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14
Q

What are the causes of cauda equina syndrome?

A 
Disc herniation - 99% of cases 
Haematoma 
Tumor 
Abscess
Trauma
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15
Q

What is the difference between cauda equina compression and cauda equina syndrome?

A

Cauda equina compression is the radiological finding

Cauda equina syndrome is a set of symptoms + the radiological findings

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16
Q

What would you do on examination of a patient with suspected cauda equina syndrome?

A

Look for obvious deformities
ROM
Feel - red flags
LMN signs - neurological exam - ASIA sheet

17
Q

What are the red flags for cauda equina syndrome?

A 
Perianal/saddle anaesthesia 
Loss of anal tone
Urinary retention/incontinace - reversible if only retention 
Bowel incontinence  
Bilateral sciatica 
Impotence 
Hyporeflexia
18
Q

What investigations would you do for suspected cauda equina syndrome?

A

PR exam
Pre and post void bladder scan - >200ml = cauda equina syndrome
Lumbar-sacral spine MRI - GOLD standard - T2 weighted

19
Q

What is the management for cauda equina syndrome?

A

Early neurosurgical review
Surgical decompression - 48 hrs
Rehab - bladder + bowel function after surgery - incontinence clinic

20
Q

How does someone with lumbar disk prolapse present?

A

LMN signs with history of lifting something heavy

Pain on straight leg raise

21
Q

How do you manage lumbar disk prolapse?

A
  • physio + analgesia
  • nerve root black
  • surgery - discectomy
22
Q

What is the cause of lumbar canal stenosis?

A

Facet joint arthritis + ligament flavum inflammation

23
Q

What must you do if you suspect lumbar canal stenosis?

A

Neurovascular examination

MRI

24
Q

What is the management for lumbar canal stenosis?

A

Conservative - physio, analgesia, activity modification

Surgical decompression

25
Q

What is the MRC grading and what are the grades?

A

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

T&O (13 decks)

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