Neck And back pain Part 2

Question 1

Why does cauda equina occur ?

Answer 1

Occurs due to central lumbar disc prolapse

Question 2

What is the mnemonic and symptoms of cauda equina ? (4) 😭

Answer 2

LULS
Localised lower back pain radiating to both/alternate legs 
Urinary/faecal incontinence 
Lower limb weakness/tingling/numbness
Saddle anaesthesia

Question 3

What 2 examinations would you perform for cauda equina and state what you would find? 😭

Answer 3

Spinal examination: localised tenderness and stiffness + lower motor neurone signs
DRE: reduced anal tone (late)

Question 4

How would you manage a Cauda Equina ? (2)

Answer 4

1. Emergency MRI

2. Urgent referral to neurosurgery

Question 5

What is the mnemonic and the symptoms of metastatic bone disease ? (3) 😭

Answer 5

BUP

1. B symptoms ( NWF + fatigue)
2. Unremitting dull back pain, which is worse at night and sharp on weight bearing
3. Pathological fractures

Question 6

What are the 3 signs of metastatic bone disease ? 😭

Answer 6

1. Bone tenderness
2. Reduced of range movement
3. Lymphadenopathy

Question 7

State the 5 common cancers that metastasise to the spine

Answer 7

BLT KP

Breast, lung, thyroid, kidney and prostate cancer

Question 8

What are the 3 DDx for metastatic bone disease ? 😭

Answer 8

Multiple myeloma, lymphoma and osteomyelitis

Question 9

What are the investigations of metastatic bone disease with regards to the Ff:

• Bloods (4)
• basic imaging (3)
• advanced imaging (1)

Answer 9

• Bloods: FBC, CRP + tumour markers
• basic imaging: skeletal X Ray, CT/MRI, CT guided biopsy
• advanced imaging (1): skeletal radioisotope scans

Question 10

What is the management of the bone mets with regards to the Ff:

• medical (3)
• surgical (1)

Answer 10

Establish primary diagnosis

• Medical: Analgesia, bisphosphonates and chemotherapy
• Surgical: prophylactic surgical stabilisation to prevent pathological fractures

Question 11

What is the mnemonic and the signs and symptoms of multiple myeloma ?

Answer 11

BOR

1. Bone marrow infiltration: anaemia, neutropenia and thrombocytopenia
2. Osteolytic lesions: BPV: backache and bone pain, pathological # and vertebral collapse
3. Renal impairment: AKI and hypercalcaemia

Question 12

State the investigation (1) and management (2) of multiple myeloma

Answer 12

Ix: skeletal x-Ray
Mx 1. Radiotherapy for local disease control
2. Spinal decompression and fusion

Question 13

State what Discitis is and describe the symptoms?

Answer 13

A complication of spinal surgery/injection

Symptoms: localised severe back pain and systemic symptoms

Question 14

What is the management of Discitis ?

Answer 14

Abx

Question 15

Define the following terms:

• spondylolisthesis

- spondylolysis

Answer 15

spondylolisthesis: a vertebrae from the lower spine is displaced anteriorly (anterolisthesis) or posteriorly (posterolisthesis)
- spondylolysis: Degeneration of the intervertebral discs: para articularis

Question 16

State what age group are spondylolisthesis and spondylolysis common amongst and their symptoms

Answer 16

These are common in young children and symptoms similar to simple mechanical Back pain