Orthopaedics (Unit 2 - Backache & Neckache)

Question 1

What are the the non-nervous tissues in the back collectively called?

Answer 1

Spondylitides

Question 2

Where can back pain be referred?

Answer 2

Buttock, thigh & leg

Question 3

Where do nerve roots emerge?

Answer 3

Vertebral foramina (surrounded by facet joints behind & IV disc in front)

Question 4

What can cause direct compression on te nerve roots?

Answer 4

Diseases affecting facet joints and discs

Question 5

How does sciatica present?

Answer 5

Pain down the back of the leg but almost always into the foot (may be exacerbated by coughing)

Question 6

How are back sprains managed?

Answer 6

Brief period of res then gradual return to activities
Anti-inflammatory drugs
Analgesia

Question 7

What are causes of mechanical back pain?

Answer 7

Spondylosis

Primary OA

Question 8

What is spondylosis?

Answer 8

Degeneration of the IV disc leading to increased loading of facet joints which then develop secondary OA

Question 9

What is spondylolisthesis?

Answer 9

Slippage of one vertebra relative to the one below

Question 10

Where is spondylolisthesis commonly seen?

Answer 10

Lumbar spine

Question 11

What is the most likely cause of an adult developing spondylolisthesis?

Answer 11

Fracture of pars interarticularis

Question 12

How is spondylolisthesis diagnosed?

Answer 12

X-ray techniques

Question 13

When is spondylolisthesis most likely to cause nerve tissue damage?

Answer 13

If it is congenital

Question 14

What management may help to relieve pain in spondylolisthesis?

Answer 14

Spinal corset

Question 15

What is spondylolysis?

Answer 15

Par interarticularis defect without a forward slipping of the vertebra

Question 16

What is the last line management for severe pain in spondylolysis?

Answer 16

Spinal fusion

Question 17

Clinical presentation of prolapsed intervertebral disc

Answer 17

Men under 40
Acute backache & legache (sometimes backache develops later)
May describe single event
Legache passes down the back of the thigh and leg TO THE FOOT

Question 18

What is a prolapsed intervertebral disc?

Answer 18

Extrusion of the nucleus pulposus material through the annulus fibrosis

Question 19

What might the prolapsed disc impinge if it extrudes backwards & laterally?

Answer 19

Nerve root

Question 20

What might the prolapsed disc impinge if it extrudes posteriorly?

Answer 20

Spinal cord, or more commonly cauda equina

Question 21

What is the management of disc prolapse?

Answer 21

Rest & progressive mobilisation

Analgesia/anti-inflammatory for sympomatic relief

Question 22

What is the management of a disc prolapse if pain persists or localising signs get more severe?

Answer 22

Surgical removal of disc material

Question 23

What investigation is used to confirm a disc prolapse?

Answer 23

Myelography (radio-opaque material will not be able to flow where disc presses on the nerve)

Question 24

What is the typical patient demographic to present with bony root entrapment?

Answer 24

Either sex
Over 40
History of mechanical backache

Question 25

Clinical presentation of bony root entrapment

Answer 25

Back sufferer who develops new symptoms of leg pain radiating to the foot, made worse by exercise

Question 26

What causes bony root entrapment?

Answer 26

Bony overgrowth around the vertebral foramina where nerve roots emerge (secondary to degenerative changes in adjacent facet joints)

Question 27

What is the management of bony root entrapment?

Answer 27

Do not remove the disc as it will make the condition worse.

Removal of bone required to free trapped nerve roots

Question 28

What is the downside of the surgery for bony root entrapment?

Answer 28

Discturbance in spinal stability may lead to a need for fusion of the affected vertebrae

Question 29

What patient demographic is most likely to present with cervical spondylosis?

Answer 29

Over 40

Females > males

Question 30

How does cervical spondylosis present?

Answer 30

Dull neckache referred to shoulders and upper arms
Tingling in arms
(can be progressive and bony nerve entrapment may occur with neuro signs)

Question 31

What is the treatment of cervical spondylosis if there are no localising neuro signs?

Answer 31

Analgesics
NSAIDs
Use of a soft collar
Physio (to relieve muscle spasm)

Question 32

What is the management if nerve entrapment is confirmed in cervical spondylosis?

Answer 32

Surgical fusion of the vertebrae and decompression of the nerve root

Question 33

How do you differentiate between the presentations of cervical disc disease & cervical spondylosis?

Answer 33

Sufferers from disc disease tend to have no previous history of neck trouble