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Neurology > Lower back pain and sciatica > Flashcards

Lower back pain and sciatica Flashcards

1
Q

What defines acute lower back pain?

A

Anything less than 6 weeks

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2
Q

What should be evaluated in someone with LBP?

A

Determine is pain is intrinsic and not referred from elsewhere; AAA
Rule out life threatening disease; in children screen for cancer
Determine whether root compression is present

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3
Q

General red flags in back pain?

A

Failure to improve after 4-6 weeks
Unrelenting night pain or pain at rest
Progressive motor or sensory deficit

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4
Q

Cancer red flags

A

Age >50
Unintended wt loss
Hx of ca
Pain at night and in recumbency

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5
Q

Infection red flags

A 
Fever/chills
Recent infection
Immunosuppression
IVDU
Dental status; 60-70% of brain and spinal abscesses have a dental origin
Foreign travel
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6
Q

RF for #

A

Age >50
Osteoporosis
Significant trauma
Chronic steroid use

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7
Q

Sy for CES

A 
Bilateral sciatica
Urinary incontinence
Leg weakness
Absent anal tone
Loss of perianal sensation; most sensitive indicator
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8
Q

Sy of AAA

A

Age >60
Male
Abdo pulsating mass
Pain at rest

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9
Q

LL neurological exam

A

SLR
Muscle strength
Sensation; light touch, pin prick, vibration
Deep tendon reflexes

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10
Q

Nerve root for flexion of hip

A

L2,3

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11
Q

Nerve root for extension of hip

A

L4,5

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12
Q

Nerve root for extension of knee

A

L3,4

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13
Q

Nerve root for flexion of knee

A

L5,S1

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14
Q

Nerve root fo plantarflexion

A

S1,2

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15
Q

Nerve root for dorsiflexion

A

L4,5

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16
Q

Nerve root for eversion

A

L4

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17
Q

Nerve root for inversion

A

L5,S1

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18
Q

Nerve root for shoulder abduction

A

C5

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19
Q

Nerve root for shoulder adduction

A

C6,7

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20
Q

Nerve root for elbow flexion

A

C5,6

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21
Q

Nerve root for elbow extension

A

C7,8

22
Q

Nerve root for wrist flexion and extension

A

C6,7

23
Q

Nerve root for finger abduction

A

C8,T1

24
Q

Nerve root for finger flexion

A

C7,8

25
Q

Nerve root for finger extension

A

C7,8

26
Q

Nerve root for supination

A

C6

27
Q

Nerve root for pronation

A

C7,8

28
Q

When should you request an x-ray in LBP?

A

Young men; SI-joints to exclude ank spon

Elderly; exclude vertebral collapse, # or malignancy

29
Q

What is a CT good for in terms of localisation of pathology of the spine?

A

Bony pathology; trauma, tumour, infection
Foreign bodies
Implants
Spinal fusion planning

30
Q

What is an MRI good for in terms of localisation of spinal pathology?

A

Soft tissue; tumours, infection
Bone oedema
Can see spinal cord MUCH better

31
Q

What modality of imagine should be used for spinal pathologies that have red flags or neurological si/sy?

A

MRI

32
Q

What will radionucleotide scans show?

A

Increased bone turnover; #, osteomyelitis, paget’s, ank spon
Mets
Tumours; osteoid osteoma

33
Q

When should lab tests be utilised in LBP?

A

Malignancy; PSA, acid phosphate, monoclonal bands
Infection
Metabolic; alk phos, calcium, phosphate, HLA B-27

34
Q

When should LBP be investigated?

A

No improvement after 4-6 weeks

Red flags

35
Q

When should LBP be referred to secondary care?

A

Intractable pain
Serious pathology suspected or suggested initial imaging
Neurological deficit

36
Q

What are risk factors for back pain?

A

Previous back pain
Heavy lifting/ frequent bending
Repetitive work with exposure to vibration

37
Q

What is the most effective preventative measure for back pain?

A

Exercise

38
Q

What are differential diagnosis for sciatica?

A

Root compression by other degenerative disease: bony spurs, canal stenosis, spondylolisthesis, facet hypertrophy
Root compression of sinister cause: tumour, fracture, TB
Root compression from outwith the spine: piriformis syndrome, endometriosis, pelvic disease, peroneal compression (painless foot drop)
No root compression: arachnoiditis, peripheral neuropathy

39
Q

What commonly causes an increase in pain with a disc prolapse?

A

Coughing
Sneezing
Twisting

40
Q

What are the examination signs of a L5/S1 disc prolapse?

A

Reduced forward flexion and extension (all disc prolapses)
Calf pain
Weak foot plantar flexion
Reduced pin prick over sole of foot and back of cald
Reduced ankle jerk

41
Q

Examination findings in an L4/L5 disc prolapse

A

Hallux extension weak

Reduced sensation on outer dorsum of foot

42
Q

What causes CES?

A

Central prolapse of lumbar disc

43
Q

When is a discectomy indicated?

A

CES
Progressive muscular weakness
Continuing pain

44
Q

What is spondylolisthesis?

A

Displacement of one lumbar vertebrae on another usually L5 on S1

45
Q

What can cause spondylothesis?

A

Spondylosis (age related degeneration with osteophyte formation)
Congenital malformation
OA of facet joints

46
Q

What causes lumbar spinal stenosis and lateral recess stenosis?

A

Generalised narrowing of lumbar spinal canal or its lateral recesses causing nerve ischaemia
Facet joint OA and osteophytes

47
Q

What are the symptoms of spinal stenosis and lateral recess stenosis?

A

Pain worse on walking
Pain on extension
Negative SLR
Few CNS signs

48
Q

Yellow flags for back pain

A

Belief that pian and subsequent activity are harmeful
Pain behaviour
Over-reliance on passive treatments
Depression, anxiety, personality disorders
Unsupportive home environment or over-protective family
Inappropriate expectations and failing to actively engage with tx

49
Q

Typical causes of back pain in those 15-30yrs?

A 
Prolapsed disc
Trauma
#
Ank spon 
Spondylolisthesis
Pregnancy
50
Q

Typical causes of back pain in those >30yrs?

A

Prolapsed disc

Malignancy (lung, breast, prostate, thyroid kidney)

51
Q

Typical causes of back pain in those >50yrs?

A 
Degenerative disc
Osteoporosis
Paget's 
Malignant 
Myeloma
Lumbar artery atheroma

Neurology (48 decks)

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