Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthopaedics > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

What is ‘mechanical back pain’

A

recurrent relapsing and remitting back pain that involves no neurological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

presentation of mechanical back pain

A

worse on movement (mechanical) and relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

“red flag” symptoms in mechanical pain

A

There are none!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

age group that tends to be affected by mechanical back pain

A

20-60 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

causes of mechanical back pain

A 
obesity 
lack of exercise 
poor lifting technique 
depression 
degenerative disc prolapse
facet joint OA 
spondylosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tx of mechanical back pain

A

analgesia

physiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

is bed rest advised for mechanical back pain

A

No!

leads to stiffness and spasm which exacerbates symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

do patients with mechanical back pain tend to have single level disease or multi level disease

A

multi level disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what type of patient would be suitable for spinal stabilisation surgery for mechanical back pain

A

single level disease which hasn’t improved with physio and analgesia, and there is no claim/compensation involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

sections of an intervetebral disc

A

outer annulus fibrosis

inner nucleus pulposus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is an acute disc tear

A

a tear of the outer annulus fibrosis of the IV disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cause of an acute disc tear

A

typically after lifting a heavy object

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why is an acute disc tear very painful

A

the periphery of the IV disc is richly innervated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

presentation of an acute disc tear

A

history of heavy lifting
sudden onset
pain +++
pain worse on coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tx acute disc tear

A

analgesia

physiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ix for acute disc tear

A

Erect lumbar spine xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is an erect lumbar spine xray the preferred imaging modality

A

recent significant trauma
osteoporosis
age >70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is lumbar MRI the preferred imaging modality

A 
spinal malignancy 
infection 
fracture 
cauda equina syndrome 
ank spond or other inflammatory cause
19
Q

What is sciatica

A

Clinical symptoms that result from compression of the L4, L5, S1 nerve roots. Compression is due to IV disc material that herniates through a tear in the IV disc and impinges on an exiting nerve root.

Causes pain and altered sensation in a dermatomal distribution and reduced power in a myotomal distribution

20
Q

Symptoms of sciatica

A

radicular pain felt as neuralgic burning or tingling sensation, that radiates down the back of the thigh and below the knee

21
Q

symptoms of an L3/L4 disc prolapse

A

L4 nerve root entrapment
pain down to the medial ankle (L4)
loss of quadriceps power
reduced knee jerk

22
Q

symptoms of an L4/L5 disc prolapse

A

L5 root entrapment
pain down dorsum of foot
reduced power of Extensor Hallucis longus and tibialis anterior

23
Q

symptoms of an L5/S1 disc prolapse

A

S1 root entrapment
pain to sole of foot
reduced power plantarflexion
reduced ankle jerks

24
Q

Tx of disc prolapse/sciatica

A

analgesia and physiotherapy

25
Q

Generally how long does an acute disc tear/prolapse/sciatic symptoms take to settle

A

70% settle in 3 months

90% settle in 18-24 months

26
Q

What surgery is considered for disc prolapse and when is it considered

A

Discectomy
- pain is not resolving despite physio and there are localising signs suggesting a specific nerve root involvement and positive MRI evidence of nerve root compression

27
Q

What causes bony nerve root entrapment in the lumbar spine

A 
Bone growth (osteophytes) that occurs in OA. 
The osteophytes can impinge on exiting nerve roots and cause symptoms of sciatica
28
Q

Tx of bony nerve root entrapment

A

Surgical decompression and trimming of osteophytes

29
Q

what is spondylosis

A

loss of water content of IV discs with age

30
Q

consequences of spondylosis

A

less cushioning
increased pressure on facet joints
secondary OA

31
Q

what is spinal stenosis

A

narrowing of the spinal canal or neural foramina, producing nerve root compression, root ischaemia and a variable syndrome of back and leg pain

32
Q

causes of spinal stenosis

A

several - anything disease process that can narrow the space

spondylosis
bulging discs
osteophytosis

33
Q

how is spinal stenosis/claudication differentiated from vascular claudication due to PVD

A

the claudication distance is inconsistent

the pain is burning rather than cramping

pain is less walking uphill (spine flexion creates more space for the cauda equina)

pedal pulses are preserved

34
Q

Mx of spinal stenosis

A

conservative Mx - weight loss, physio

35
Q

what is cauda equina syndrome

A

a clinical syndrome resulting from a very large central disc prolapse, which compresses all the nerve roots of the cauda equina.

36
Q

why is cauda equina syndrome a surgical emergency

A

affected nerve roots include the sacral roots S4/S5 which control defecation and urination.
prolonged compression can cause permanent nerve damage requiring colostomy and urinary diversion

37
Q

clinical features of cauda equina syndrome

A

bilateral leg pain
“saddle anaesthesia” - perineal numbness
altered urinary function - urinary retention or incontinence
faecal incontinence and constipation

38
Q

Ix for cauda equina syndrome

A

PR exam - mandatory

urgent MRI

39
Q

Tx cauda equina syndrome

A

urgent discectomy

40
Q

red flags of back pain

A
  1. back pain in young patient (<20 years)
  2. new back pain in older patient (>60 years)
  3. constant severe pain worse at night
  4. systemic upset
  5. history of cancer
41
Q

in terms of lumbar spine, what is the risk for severe osteoporotic patients

A

osteoporotic crush # - basically the vertebrae cant be supported and all crush together

42
Q

symptoms of osteoporotic crush #

A

acute pain

kyphosis

43
Q

Mx of osteoporotic crush #

A

conservative Mx

Orthopaedics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions