Orthopaedics & Rheumatology/ Back Injuries

Question 1

In patients under the age of 50, what is the leading cause of disability?

Answer 1

Lower back pain

Question 2

Differentials of Lower Backpain

Answer 2

Question 3

Mechanism and anatomy of Ankylosing spondylitis

Answer 3

Question 4

Mechanism and anatomy of Ankylosing spondylitis

Answer 4

Question 5

History of Spinal stenosis

Answer 5

Question 6

History of Spinal stenosis

Answer 6

Question 7

Mechanism and anatomy of Spinal stenosis

Answer 7

Question 8

History of Spondylolisthesis

Answer 8

Question 9

Mechanism and anatomy of Spondylolisthesis

Answer 9

Question 10

History of herniated disc

Answer 10

Question 11

Mechanism and anatomy of herniated disc

Answer 11

Question 12

History of a backstrain

Answer 12

Question 13

Anatomy and mechanism of a backstrain

Answer 13

Question 14

With the exception of ankylosing spondylitis, what is the treatment for acute lower back pain without neurologic, systemic symptoms, or radicular findings?

Answer 14

• Conservative management:
  
  • NSAIDs
  • stretching and strengthening
  • relative rest
  • physical therapy.
• Surgery is rarely needed.

Question 15

What is the differential diagnosis of lower back pain in children and adolescents?

Answer 15

• Muscle strain
• spondylolysis
• sacroiliac dysfunction
• scoliosis
• malignancy
• infection (osteomyelitis, paraspinal abscess)
• vertebral fracture
• ankylosing spondylitis
• Reiter syndrome

Question 16

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?

Answer 16

Scheuermann disease

Question 17

What is the radiographic finding associated with Scheuermann disease?

Answer 17

Greater than 5° of anterior wedging of at least three adjacent vertebral bodies

Question 18

What is the treatment for mild Scheuermann disease?

Answer 18

Bracing and physical therapy

Question 19

What is the treatment for severe Schuermann disease?

Answer 19

Spinal fusion

Question 20

What is the preferred imaging modality to evaluate scoliosis?

Answer 20

PA radiographs

Question 21

Is screening indicated for scoliosis in adolescents?

Answer 21

No

Question 22

When is MRI indicated for the evaluation of scoliosis in kids?

Answer 22

• Onset prior to 8 years old
• rapid curve progression greater than 1° per month
• left thoracic curve
• neurologic deficit or pain

Question 23

What is the location of the fracture seen in spondylolysis?

Answer 23

Pars interarticularis

Question 24

What is the classic exam finding in spondylolysis?

Answer 24

Pain with extension of the back with single leg loading in the presence of normal neurologic exam

Question 25

What are the risk factors for malignancy associated with lower back pain?

Answer 25

• 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

Question 26

In the absence of risk factors for malignancy or neurologic findings, when is imaging indicated for lower back pain?

Answer 26

Failure of conservative treatment for 2-4 weeks