Clinical questions spine

Question 1

A 45 year old female presents with lower back pain that she believes started when she was lifting boxes a few weeks ago. The pain is worse on movement. She has no other symptoms. On examination there is visible, palpable muscle spasm. What is this and what treatment do you initiate?

Answer 1

Mechanical back pain
Advise that is usually self limiting
NSAIDS
Discourage bed rest and encourage normal activity
Physiotherapy in some cases

Question 2

What are the most common sites of lumbur spondylosis?

Answer 2

L5/S1

L4/L5

Question 3

An man presents to your clinic with severe back pain that came on when he was chopping wood yesterday. The pain is worse on coughing.

Answer 3

Acute disc tear

Question 4

What can lumbar spondylosis cause?

Answer 4

OA of the facet joints.

Question 5

A women presents to your clinic with lower back pain that is worse on bending backwards and when straightening from a flexed position. The pain radiates to the buttock

Answer 5

Facet joint osteoarthritis

Question 6

What occurs is a disc prolapse?

Answer 6

The nucleus polposis herniates posteriorly through the annulus fibrosis and presses on a spinal nerve.

Question 7

What causes sciatica?

Answer 7

Disc prolapse

Question 8

A lady presents to your clinic with severe pain in her buttock and down her right thigh that came on suddenly whilst lifting her dog. The pain is tingling in nature. What is this and what do you do?

Answer 8

Sciatica due to an acute lumbar disc prolapse
Treatment is with analgesia and maintaining activity though a short period of bed rest may be useful. Neuralgic pain medication such as gabapentin can also help.

Question 9

What is the weakest point of the intervertabral disc?

Answer 9

Posterolaterally

Question 10

What would you expect the result of the straight leg test to be in a patient with an acute disc tear? Describe this test

Answer 10

Positive.

Raising the straight leg above 30 degrees causes pain in the leg

Question 11

A man presents to you complaining of a burning pain in his back when he walks. He has noticed the pain is better when he walks uphill. Past medical history includes intermittent claudication.

Answer 11

Spinal stenosis

Question 12

What is the pathophysiology cause of spinal stenosis?

Answer 12

Spondylosis (progressive loss of disc height, OA of the facet joints) osteophytes and buckling of the ligamentum flavum means that the cauda equina of the spinal cord has less space. This causes multiple nerve roots to become irritated, causing pain.

Question 13

An elderly lady presents with bilateral leg pain and tingling. She has had an episode of faecal incontinence earlier today.

Answer 13

Cauda Equina syndrome

Question 14

What would you do if you suspected cauda equina syndrome in a patient?

Answer 14

Rectal examination
Refer to emergency MRI
Urgent surgical decompression

Question 15

A 70 year old female, who is taking corticosteroids for her crohns disease presents with severe acute onset back pain

Answer 15

Osteoporotic crush fracture

Question 16

A 50 year old male presents with shooting pains and weakness down his left arm arm. He hurt his neck going down a flume 3 weeks ago.

Answer 16

Cervical disc prolapse

Question 17

Name two groups of people who are at increased risk of cervical spine instability

Answer 17

Downs syndrome

Rheumatoid arthritis patients

Question 18

What specific cervical spine problem do you see in those with rheumatoid arthritis

Answer 18

Atlanto axial subluxation.

Question 19

What is spondylolisthesis?

Answer 19

A bone from the lower spine slips out of position.