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1B Musculoskeletal > Lower back pain and sciatica > Flashcards

Lower back pain and sciatica Flashcards

1
Q

what is sciatica?

A

back pain radiating down leg

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2
Q

how does sciatica vary?

A

depends on which nerve affected in referred pain as to how far it travels

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3
Q

what is the recovery from sciatica?

A
  • 60% recovered in 3 months
  • 70% recovered in 12 months
  • 30% continue to have sciatica for over 1 year
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4
Q

what is non-specific low back pain?

A

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

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5
Q

what is mechanical low back pain?

A

pain after abnormal stress and strain on vertebral column

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6
Q

what is nerve root pain (sciatica)

A

pain radiating to the lower limbs with or without neuralgic symptoms

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7
Q

what are the causes of low back pain?

A
  1. Mechanical:
  2. Tumour including myeloma
  3. Infection
  4. spondyloarthropathy
  5. pars interarticularis injury (pars oedema is early sign)
  6. compression fracture
  7. visceral- pain from elsewhere in bondy
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8
Q

what are the mechanical causes of lower back pain?

A

disk degeneration

disk herniation

annular tears

facet joint osteoarthritis

instability

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9
Q

what are annular tears?

A

rips within disc- allow inner to leak out and cause irritation

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10
Q

what are the indicators for sciatica?

A
  • Unilateral leg pain greater than low back pain
  • Pain radiating to foot or toes
  • Numbness and paraesthesia in the same distribution
  • Straight leg raising test induces more leg pain
  • Localised neurology (limited to one nerve root)
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11
Q

what are the conservative treatments for sciatica?

A
  • Analgesia
  • Anti-inflammatory drugs
  • Manipulation
  • Acupuncture
  • Massage
  • Allow some time to pass
  • Bed rest does not result in faster recover (bed rest required if unstable issue!)
  • Most patients get better spontaneously
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12
Q

what are the red flags for low back pain and leg pain?

A

weight loss

fever

night pain

under 19

bowel/bladder dysfunction

saddle anesthesia

profound neurological deficits

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13
Q

what is the protocol for patient with red flag symptoms?

A

imaging

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14
Q

what is the protocol for a patient with leg and back pain without red flags?

A

wait 6-12 weeks

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15
Q

what are the risks of waitng too long to treat back pain?

A

metastases

inflammatory arthropathy

myeloma

tuberculosis of spine

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16
Q

what is the risk of metastases in back pain diagnosis?

A
  1. Early diagnostic may not impact on prognosis
  2. Risk of catastrophic fracture and paralysis
  3. Onset of symptoms to referral medial 3 months
17
Q

what is the benefit of early diagnosis of inflammatory arthropathy?

A

early diagnosis for effective treatment with biologics

investigate under 35 years after 3 months pain

18
Q

what is the benefit and meantime for diagnosis of myeloma

A
  1. Early diagnosis will catch disease at more easily treated stage

Mean delay in diagnosis- IQR 84-306 days

19
Q

what is the benefit and mean time for diagnosis of tuberculosis of spine?

A

early diagnosis essential for effective treatment

mean delay in diagnosis- 4-11 months

20
Q

what is the primary investigation for back pain?

A

MRI

  • Secondary = Radiographs & CT
  • Radiographs have negligible value in the assessment of back pain (prefered on young people with spinal deformity)
  • CT is an adjunct in a few cases
  • Low back pain is non-specific until you investigate
21
Q

what are the benefits and negatives of radiographs?

A

cheap

readily available

radiation

overlook most important diseases

22
Q

what are the methods of pain therapy for back pain?

A
  • Physical therapy
  • Analgesia
  • Facet injection
    • Local & steroid
    • Denervation
  • Root block
  • Epidural injection
  • Neurostimulation
23
Q

how are facet infections given?

A
  • Different approaches:
    • Oblique
    • Posterior
  • 21g needle
  • Local anaesthetic
  • Steroid injection that will take effect at 1 week
  • Inside or around the joint
    • Inject the posterior inferior extension of the joint
24
Q

how is a root block given?

A

contrast in root sheath

CT guided

25
Q

how does fusion imaging work?

A
  • Using sensors and magnet
  • Creates MR and US fusion images to allow guiding of needle
  • Using guide in image to insert needle
26
Q

what procedures is surgery used for in back pain?

A
  • Decompression of nerve roots
  • Decompression of spinal stenosis
  • Disc replacement
  • Fusion

1B Musculoskeletal (7 decks)

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