November 16, 2015 - Spine

Question 1

Prognosis of Acute Back Pain

Answer 1

Most people that have back pain WILL recover. Their pain will disappear in a matter of days to weeks.

For these patients, education and screening for red flags are the first steps.

Question 2

Yellow Flags

Answer 2

Psychosocial issues.

Could be with work or marriage.

Very important to screen for as well.

Question 3

Spine Bulges on MRI

Answer 3

52% of asymptomatic patients have them as well.

Question 4

Red Flags

Answer 4

Are extremely rare, but help screen for a sinister pathology.

Typical B-symptoms.

Question 5

Physical Function and Back Pain

Answer 5

VERY important to try to stay physically and socially active.

Don’t just sit at home, move, it will help recovery.

Question 6

Drug Treatment for Back Pain

Answer 6

Acetaminophen, NSAIDs, steroids, antidepressants, GABA antagonists, benzodiazapenes, opioids.

Question 7

Spinal Stenosis

Answer 7

Encroachment of the spinal canal as a result of degenerative changes.

Sypmtoms can include pain, loss of function, and claudation (sciatic nerve pain or pain when moving). The test to differentiate between neurological and vascular is to have the patient stand. If it is vascular, the patient will be able to stand without getting tired, but if it is neurological they will have to sit down.

Question 8

Spinal Stenosis - Treatment

Answer 8

Screen for red flags

Activity modification - make sure to stay active

Pharmaceutical management

Injections

Decompression - laminetomy (can be a good option)

Question 9

Spondylolisthesis

Answer 9

A “slip” of a vertebra

If the spinal tube slips, it becomes even more narrow and can cause compression. Usually caused by degenerative changes because facet joints are becoming arthritic.

Lumbar is often reversible, cervical is not. By the time it has happened in the cervical, often the damage is already done. Very rare, but needs immediate surgical referral.

Question 10

Scoliosis

Answer 10

Abnormal curvature of the spine

More often in girls than boys

There is often a family history, but treatment options can be very complicated

Often presents in pre-teen to early adulthood. It can be painful or painless. When the deformity has symptoms, it needs referral and an expert assessment.

Question 11

Fracture Dislocation

Answer 11

The spinal cord is pinched and damaged. These are not benign fractures and can cause permanent damage to the neurological system.

Question 12

Cauda Equina Syndrome

Answer 12

A big herniation that pinches the nerve suddenly and hard. This causes bowels to empty and be unable to empty the bladder. This is a medical emergency. This is one of the few things that will wake a spine surgeon up at night.

Typically have a 24-hour window in which the situation can be rectified and avoid permanent nerve damage. If the nerves are damaged, it is often permanent and the patient will become incontinent. Very big impact on quality of life.

Syptoms are back and/or leg pain, perianal numbness, inability to void bladder, and loss of bowel control/poor rectal tone.