Low Back Pain Flashcards

1
Q

define non-specific low back pain

A

pain not due to any specific or underlying disease that can be found

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2
Q

define mechanical low back pain

A

pain after abnormal stress and strain on the vertebral column

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3
Q

define nerve root pain (sciatica)

A

pain radiating to the lower limbs with or without neuralgic symptoms

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4
Q

causes of low back pain

A

mechanical: disc herniation/degeneration, annular tears, facet joint OA
tumour, infection, spondyloarthropathy
pars interarticularis injury, compression fracture, visceral

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5
Q

indicators for sciatica from history or physical examination

A

unilateral leg pain greater than lower back pain
pain radiating to foot or toes
numbness/paraesthesia in same distribution
straight leg raising test induces more leg pain
localised neurology

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6
Q

conservative treatment for sciatica

A

analgesia
anti-inflammatory drugs
manipulation
acupunture
massage
allow time to pass ( most get better spontaneously)
bed rest doesn’t result it faster recovery

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7
Q

red flags for low back pain

A

weight loss
fever
night pain
under 19 years of age

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8
Q

red flags for leg pain

A

bowel or bladder dysfunction
saddle anaesthesia
profound neurological deficit

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9
Q

for what conditions is waiting too long to diagnose very dangerous?

A

metastases
inflammatory arthropathy
myeloma
tuberculosis of the spine

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10
Q

why can early diagnosis be so important?

A

sometimes essential for effective treatment

risk of disease progression e.g. fractures, paralysis

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11
Q

primary imaging investigation for low back pain

A

MRI

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12
Q

secondary imaging investigation for low back pain

A

radiographs

CT

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13
Q

pros and cons to radiographs

A

pro: cheap, readily available, traditional
con: radiation, overlooks most important diseases

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14
Q

what important diseases could be missed on a radiograph?

A
pagets sarcoma
anorexia nervosa
adolescent disc prolapse
lesions
osteoid osteoma
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15
Q

what type of diseases will show up on limited MRI?

A

80% degeneration

20% other e.g infection, tumour, pars defects, spondyloarthropathy, insufficiency fracture, aortic aneurysm

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16
Q

pain therapy for low back pain

A
wait
physical therapy
analgesia
facet injections (local and steroid, denervation)
root block
epidural injection
neurostimulation
17
Q

describe administration of facet injection

A
approach: oblique, posterior
21g needle
local: marcain 0.5% 1ml
steroid: triamcinolone 20mg
one level at a time
follow up
inside or around the joint
18
Q

describe administration of root block

A

contrast in root sheath
1ml local only
follow up

19
Q

root block can be done with what imaging?

A

CT guided

MRI-ultrasound fusion w/ VNav needle guidance

20
Q

epidural anasthetic

A

interlaminar
transforaminal
caudal

21
Q

surgery for low back pain

A

decompression of nerve roots
decompression of spinal stenosis
disc replacement
fusion