Orthopaedics & Rheumatology/ Back Injuries Flashcards
In patients under the age of 50, what is the leading cause of disability?
Lower back pain
Differentials of Lower Backpain
Mechanism and anatomy of Ankylosing spondylitis
Mechanism and anatomy of Ankylosing spondylitis
History of Spinal stenosis
History of Spinal stenosis
Mechanism and anatomy of Spinal stenosis
History of Spondylolisthesis
Mechanism and anatomy of Spondylolisthesis
History of herniated disc
Mechanism and anatomy of herniated disc
History of a backstrain
Anatomy and mechanism of a backstrain
With the exception of ankylosing spondylitis, what is the treatment for acute lower back pain without neurologic, systemic symptoms, or radicular findings?
- Conservative management:
- NSAIDs
- stretching and strengthening
- relative rest
- physical therapy.
- Surgery is rarely needed.
What is the differential diagnosis of lower back pain in children and adolescents?
- Muscle strain
- spondylolysis
- sacroiliac dysfunction
- scoliosis
- malignancy
- infection (osteomyelitis, paraspinal abscess)
- vertebral fracture
- ankylosing spondylitis
- Reiter syndrome
What is the name for lower back pain caused by an abnormally increased kyphosis of the thoracolumbar spine that doesn’t correct with hyperextension and is seen in adolescents?
Scheuermann disease
What is the radiographic finding associated with Scheuermann disease?
Greater than 5° of anterior wedging of at least three adjacent vertebral bodies
What is the treatment for mild Scheuermann disease?
Bracing and physical therapy
What is the treatment for severe Schuermann disease?
Spinal fusion
What is the preferred imaging modality to evaluate scoliosis?
PA radiographs
Is screening indicated for scoliosis in adolescents?
No
When is MRI indicated for the evaluation of scoliosis in kids?
- Onset prior to 8 years old
- rapid curve progression greater than 1° per month
- left thoracic curve
- neurologic deficit or pain
What is the location of the fracture seen in spondylolysis?
Pars interarticularis
What is the classic exam finding in spondylolysis?
Pain with extension of the back with single leg loading in the presence of normal neurologic exam
What are the risk factors for malignancy associated with lower back pain?
- Personal history of cancer
- age >50 years
- pain not relieved by rest
- pain that worsens at night or wakes patient from sleep
- symptoms longer than 4 weeks
- constitutional symptoms
In the absence of risk factors for malignancy or neurologic findings, when is imaging indicated for lower back pain?
Failure of conservative treatment for 2-4 weeks
