cervical and lumbar spine (adult)

Question 1

what causes cervical spine instability

Answer 1

down’s syndrome

rheumatoid arthritis

Question 2

what does cervical spine instability cause in Down’s

Answer 2

there is a risk of developing atlanto-axial instability with subluxation potentially causing spinal cord compression

Question 3

what is the treatment of cervical spine instability in down’s

Answer 3

minor instability = no high impact sports

major instability = surgical stabilisation

Question 4

what does cervical spine instability cause in rheumatoid arthritis

Answer 4

atlanto-axial subluxation due to destruction of the synovial joint between atlas and dens, and rupture of the transverse ligament

Question 5

what is the treatment of cervical spine instability in rheumatoid arthritis

Answer 5

minor = collar to prevent flexion
major = surgical fusion

Question 6

what are the symptoms of cervical spondylosis

Answer 6

slow onset stiffness

neck pain which can radiate to shoulder

Question 7

what is the treatment of cervical spondylosis

Answer 7

physio

analgesics

Question 8

what nerves are usually involved in cervical disc prolapse

Answer 8

lower root nerve (e.g. if C6/C7 disc is affected then it will be C7)

Question 9

what can a large central cervical disc prolapse cause

Answer 9

myelopathy with upper motor neurone symptoms

Question 10

what are the symptoms of cervical disc prolapse

Answer 10

shooting neuralgic pain with dermatomal distribution
weakness
loss of reflex

Question 11

what should be done before any treatment in cervical disc prolapse

Answer 11

MRI which should match clinical findings

Question 12

what is the treatment of cervical disc prolapse

Answer 12

asymptomatic = leave alone
symptomatic = surgery

Question 13

what is osteoporotic crush fracture, in what condition do they occur

Answer 13

spontaneous crush fracture of the vertebral body which occurs in severe osteoporosis

Question 14

what are the symptoms of osteoporotic crush fracture

Answer 14

acute back pain
kyphosis
chronic pain if spinal mechanisms altered

Question 15

what is the treatment of osteoporotic crush fracture

Answer 15

conservative

Question 16

what is the treatment of chronic pain in osteoporotic crush fracture

Answer 16

balloon vertebroplasty

Question 17

what is caudal equina syndrome

Answer 17

a large central disc prolapse which compresses all nerve roots of the caudal equina

Question 18

what nerve roots are effected in caudal equine syndrome

Answer 18

sacral nerve roots

mainly S4/S5

Question 19

what are nerves S4 and S5 involved in

Answer 19

defecation and urination

Question 20

what are the symptoms of caudal equine syndrome

Answer 20

bilateral leg pain
numbness (saddle)
altered urinary function
faecal incontinence and constipation

Question 21

what investigations are done in caudal equine syndrome

Answer 21

PR exam

urgent MRI

Question 22

what is the treatment of caudal equine syndrome

Answer 22

urgent surgery

Question 23

what is spinal stenosis

Answer 23

spondylosis + a bulging disc/bulging ligamentum flavum/osteophytosis which decreased the space held by the caudal equina

Question 24

what are the symptoms of spinal stenosis

Answer 24

pain on walking (burning not cramps. worse uphill)
claudication distance is inconsistence
persevered pedal pulses

Question 25

what is the cause of bony nerve root entrapment

Answer 25

OA of the facet joints which results in osteophytes impinging on nerve roots

Question 26

what is the treatment of bony nerve root entrapment

Answer 26

surgical decompression + trimming of the impugning osteophytes

Question 27

what is radiculopathy

Answer 27

pinched nerve

Question 28

what is the cause of sciatica and radiculopathy

Answer 28

disc tear which allows the nucleus pulposis to herniate/prolapse through the tear and impinge on a nerve

Question 29

what are the symptoms of sciatica and radiculopathy

Answer 29

pain (burning/tingling) beyond knee
altered sensation
reduced reflexes

Question 30

what is the treatment of sciatica and radiculopathy

Answer 30

analgesia (gabapentin)
maintain mobility
physio

Question 31

what are the symptoms of L3/4 prolapse

Answer 31

pain to medial ankle
reduced knee jerk
loss of quadratic power

Question 32

what are the symptoms of L4/5 prolapse

Answer 32

pain to dorsum of foot

reduced power of extensor halves longs and tibias anterior

Question 33

what are the symptoms of L5/S1 prolapse

Answer 33

pain to sole of foot
reduced power plantar flexion
reduced ankle jerk

Question 34

what causes discogenic back pain

Answer 34

an acute tear in the outer annulus fibrosis of the invertebral disc

heavy lifting

Question 35

what are the symptoms of discogenic back pain

Answer 35

severe pain with acute onset

pain worse on coughing

Question 36

what is the treatment of discogenic back pain

Answer 36

painkillers

physio

Question 37

what is mechanical back pain

Answer 37

recurrent, relapsing and remitting back pain with no neurological symptoms

Question 38

what are the causes of mechanical back pain

Answer 38

obesity 
poor posture
lack of activity 
degenerative disc prolapse
facet joint OA
spondylosis

Question 39

what is spondylosis

Answer 39

invertebral discs lose water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA

Question 40

what are the symptoms of mechanical back pain

Answer 40

pain is worse with movement and better on rest

no red flags

Question 41

what is the treatment of mechanical back pain

Answer 41

painkillers

physio