orthopaedics: back + spinal pain

Question 1

what type of joints are intervertebral ones

Answer 1

secondary cartilaginous joints

Question 2

what are facet joints

Answer 2

posterior between vertebra, synovial

Question 3

what are red flags of back pain (8)

Answer 3

younger than 20, older than 50, thoracic pain, previous carcinoma, immunocompromised, feeling unwell, weight loss, neuro, spinal deformity

Question 4

what is the most common cause of lumbar back pain

Answer 4

mechanical

Question 5

what are risk factors contributing to mechanical lumbar back pain

Answer 5

obesity, age, OA, spondylosis, no red flags

Question 6

how do you manage mechanical lumbar back pain

Answer 6

physio and analgesia

Question 7

what is not advised in mechanical lumbar back pain

Answer 7

bed rest as it can lead to stiffness

Question 8

what is spondylosis

Answer 8

degenerative process causing loss of fluid from intervertebral discs

Question 9

what joints are commonly affected in spondylosis

Answer 9

L4/5, T12/S1

Question 10

what can help manage spondylosis

Answer 10

facet joint injections

Question 11

what is an acute disc tear

Answer 11

outer annulus fibrosis of a disc ruptures

Question 12

what can cause acute disc tear

Answer 12

lifting heavy objects

Question 13

what are the symptoms of acute disc tear

Answer 13

severe pain, worse on coughing

Question 14

what can be used to manage acute disc tears

Answer 14

analgesia and physio

Question 15

what is sciatica

Answer 15

disc tear –> gelatinous nucleus herniating through tear (prolapse) and compressing sciatic nerve

Question 16

what is sciatica a type of

Answer 16

disc prolapse/ lumbar radiculopathy

Question 17

what level of the spine is the sciatic nerve

Answer 17

L4,5, S1-3

Question 18

what are symptoms of sciatica

Answer 18

pain radiating from buttocks. thighs, parasethesia, numbness, sensory/ motor changes (lower motor neurone symptoms)

Question 19

how do you manage sciatica (mild –> severe)

Answer 19

normally self-limiting, analgesia and anti inflamm, neuropathic eg gabapentin, pregablin, decompression surgery

Question 20

what is bony nerve root entrapment

Answer 20

OA of the facet joint resulting in osteophytes damaging nerve roots

Question 21

what are the symptoms of bony nerve root entrapment

Answer 21

similar to sciatica - different levels

Question 22

how do you treat bony nerve entrapment

Answer 22

surgical decompression, trimming of osteophytes

Question 23

what is spinal stenosis

Answer 23

narrowing of spinal canal causing nerve compression

Question 24

what can cause spinal stenosis

Answer 24

spondylosis, bulging discs, osteophytes

Question 25

what are symptoms of spinal stenosis

Answer 25

60+, overweight, claudication and pain on walking

Question 26

how do symptoms of spinal stenosis differ from vascular symptoms regarding pain on walking

Answer 26

pain is burning not cramping, LESS painful going uphill, pedal pulses are fine

Question 27

how do you manage spinal stenosis

Answer 27

physio, analgesia and weight loss

Question 28

what is cauda equina syndrome

Answer 28

damage to bundle of nerves at end of spinal cord (cauda eqiuna) which is a surgical emegency

Question 29

what can cause cauda eqiona

Answer 29

L1 disc prolapse/ herniation (Common), spinal stenosis, ankolysing spondylitis

Question 30

what nerve is compressed in cauda equina syndrome

Answer 30

sacral nerve

Question 31

what are the symptoms of cauda equina syndrome

Answer 31

urinary/ faecal retention and or incontinence, bilateral leg pain, numbness or paraplegia, numbness in sitting saddle area

Question 32

what investigations must always be done in cauda equina syndrome

Answer 32

MRI and PR

Question 33

what causes an osteoporotic crush fracture

Answer 33

osteoporosis

Question 34

what are the symptoms of an osteoporotic crush fracture

Answer 34

pain and kyphosis (hunchback)

Question 35

how can an osteoporotic crush fracture be managed

Answer 35

balloon vertebroplasty, injecting cement

Question 36

what happens in cervical disc spondylosis

Answer 36

disc degeneration + water loss --> faster OA

Question 37

what are the symptoms of cervical disc spondylosis

Answer 37

insidious onset of stiffness and pain in neck, worse on extension, radiation to shoulder and occiput

Question 38

what levels are normally affected in cervical disc spondylosis

Answer 38

C5-7

Question 39

what are symptoms of cervical disc prolapse

Answer 39

shooting neurological pain in dermatomal distribution, weakness in affected area, upper motor neurone signs

Question 40

what investigation is done for a cervical disc prolapse

Answer 40

MRI

Question 41

what is cervical spine instability

Answer 41

atlanto-axial subluxation due to destruction of synovial joint (can be fatal )

Question 42

who normally gets cervical spine instability

Answer 42

down syndrome and RA

Question 43

what are symptoms of cervical spine instability

Answer 43

wide gait, weakness, increased tone

Question 44

what management is done fro cervical spine instability

Answer 44

collar and surgery