Disease Profiles: Back Pain Flashcards
Describe the management of osteoporotic crush fractures
Usually conservative, may consider balloon vertebroplasty
Name a genetic condition that predisposes to atraumatic cervical spine instability
Down’s syndrome
Describe the examination findings of a patient with sciatica
Nerve irritation signs
Motor, sensory, or reflex changes in one nerve root
Describe the examination findings of a patient with vertebral osteomyelitis
Paraspinal muscle spasm, spinal tenderness, fever/systemic upset, neurological deficit in severe cases
When is spinal stabilisation surgery indicated for mechanical back pain?
Only indicated if a single vertebral level is affected by OA or instability, and the patient has not improved despite physio and conservative management and there are no other adverse secondary gain or behavioural issues which adversely affect outcome of surgery
When would you consider surgery for sciatica?
If unremitting/recurrent symptoms
What percentage of patients will be better within 6 weeks of mechanical back pain?
90%
Why must you ensure MRI findings correlate with clinical findings before considering surgery for a suspected cervical disc prolapse?
The number of patients with asymptomatic disc prolapse increases with age resulting in a higher rate of false positives/incidental findings on MRI scanning
What affect will walking downhill have on a patient with spinal stenosis?
Exacerbates symptoms
What investigation would you perform in suspected cauda equina syndrome?
Urgent MRI to determine level of prolapse
How would you manage a less severe atlanto-axial subluxation?
Collar to prevent flexion
Describe the management of cervical spondylosis
Physiotherapy and analgesia
How would you investigate cervical spine instability?
X-ray (flexion-extension views)
Why is spinal stabilisation surgery only suitable for a minority of mechanical back pain?
Most patients have multi‐level disease of the spine for which there is no role for surgery
Describe the non-surgical management of a patient with vertebral osteomyelitis
High dose IV antibiotics appropriate to tissue culture
Describe the usual management of mechanical back pain
Lifestyle advice - aim to walk 30 mins a day, stay at work, restrict activity rather than avoid, weight control
Analgesia - NSAIDs first line, weak opiates if needed
Physiotherapy
How would you manage a severe atlanto-axial subluxation?
Surgical fusion
What affect will walking uphill have on a patient with spinal stenosis?
Relieves symptoms
Describe the management of an acute disc tear
Analgesia and physio
Symptoms usually resolve but can take 2-3 months
What causes spondylosis?
IV discs lose water content with age, resulting in less cushioning and increased pressure on the facet joint which can lead to secondary OA
Describe the management of vertebral TB
As for pulmonary TB
Analgesia
May require surgery - immobilisation of spine region, drainage of spinal abscesses
What causes osteoporotic crush fractures?
With severe osteoporosis, spontaneous crush fractures of the vertebral body can occur leading to acute pain and kyphosis
Can lead to chronic pain due to altered spinal mechanics
What investigations would you perform in suspected vertebral osteomyelitis?
Bloods - raised CRP, blood culture
MRI - extent of infection, abscess formation
CT guided biopsy - tissue culture
Describe the clinical presentation of vertebral TB
Slow and insidious back pain, lower limb weakness/paraplegia, kyphotic deformity
1/2 have skin and soft tissue infection, less than 1/2 have pulmonary TB
Describe the clinical presentation of vertebral osteomyelitis
Insidious onset of back pain (most commonly lumbar) which is constant and unremitting
Why is back pain from an acute disc tear worse on coughing?
Coughing increases disc pressure
What investigation would you perform in a suspected cervical disc prolapse?
MRI
What is spondylosis?
Spinal osteoarthritis
How can rheumatoid arthritis cause lower cervical subluxations?
Destruction of the synovial facet joints and uncovertebral joints
Describe the management of a cervical disc prolapse
Conservative - analgesia and therapy
Surgery - consider in cases resistant to conservative management