CORTEXT 4 - Spine

Question 1

What is mechanical back pain?

Answer 1

Recurrent back pain with no neurological symptoms

Question 2

What is spondylosis?

Answer 2

Intervertebral discs lose water content with age
Less cushioning and increased pressure on facet joints
Secondary OA

Question 3

Mx Mechanical back pain

Answer 3

Analgesia and Physiotherapy

Question 4

Cause of an acute disc tear and what happens

Answer 4

Lift a heavy object

Tear in the outer annulus fibrosis of an intervertebral disc

Question 5

Symptoms of acute disc tear?

Answer 5

Very painful (due to periphery of the disk being richly innervated) 
Pain is worse on coughing

Question 6

Mx of acute disc tear?

Answer 6

Symptoms usually take 2-3 months to resolve but in meantime: Analgesia & Physiotherapy

Question 7

How does Sciatica occur?

Answer 7

When the gelatinous nucleus pulposis ‘herniates’ through an acute disc tear (usually at level L4/5/S1)
The disc material presses on exiting nerve root
Results in pain and altered sensation in a dermatome distribution
In this case, it radiates down to back of thigh and below knee

Question 8

Mx Sciatica

Answer 8

Analgesia , Physiotherapy, Maintain mobility
Drugs for neuropathic pain
Surgery if pain still hasn’t resolved after physio

Question 9

Bony nerve entrapment:
What is it
Mx

Answer 9

OA of facet joints results in osteophytes impinging on exiting nerve roots
Mx = Surgical decompression

Question 10

Spinal stenosis - How does it form?

Answer 10

Spondylosis (discs lose water) + Bulging discs etc
Leaves less space in the cauda equina of the lumbar spine
Multiple nerve roots can be compressed

Question 11

Symptoms of Spinal stenosis

Answer 11

Pain is ‘burning’

Pain IMPROVES when walking uphill (spine flexion creates more space for the cauda equine)

Question 12

Mx of Spinal stenosis

Answer 12

Conservative - weight loss & physiotherapy

Surgical - decompression to increase space to help alleviate symptoms

Question 13

How does Cauda Equina Syndrome form?

Answer 13

When a very large disc prolapses which compresses ALL the nerve roots of the cauda equine

Question 14

What big nerve does Cauda Equina Syndrome affect and what are the consequences?

Answer 14

Sciatic Nerve (S4-S5)
Controls defecation and urination so they will have no control over when they poop or pee 
They will have 'saddle anaesthesia' (numb bum)

Question 15

Ix & Mx: Cauda Equina Syndrome

Answer 15

Rectal Exam & MRI

Mx = Surgery

Question 16

Red flags of back pain

Answer 16

1. Back pain in young patient (<20)
2. New back pain in older patient (>60)
3. Nature of pain - Constant + Severe + Worse at night
4. Systemic upset

Question 17

Osteoporotic crush fractures - explain

Answer 17

Patient has severe osteoporosis.

Spontaneous crush fractures of the vertebral body can occur leading to acute pain and kyphosis S

Question 18

Symptoms of cervical spondylosis

Mx?

Answer 18

Slow onset stiffness and pain in neck radiating to shoulders and occiput
Analgesics and physiotherapy

Question 19

Cervical disc prolapse
What happens where
Mx

Answer 19

Cause nerve root compression - neuralgic pain down dermatome distribution
C6/7/8/T1
Conservative

Question 20

What 2 diseases cause atlanto-axial subluxation commonly?

Answer 20

Down’s syndrome and RA

Question 21

Subluxation of cervical spine - what happens?

Answer 21

destruction of the synovial facet joints

potential for cord compression

Question 22

Subluxation of cervical spine Mx

Answer 22

Mild = Collar to prevent flexion 
Severe = Fusion