PBL 2

Question 1

What are the red flag symptoms of serious spinal disease?

Answer 1

• Age <20 or >50
• persistant pain with serious cause suspected
• pain worse at night or morning
• associated with systemic illness, fever or weight loss
• associated with neurological symptoms or signs
• saddle anaesthesia
• urinary incontinence

Question 2

What is mechanical back pain?

Answer 2

a common symptom that is often due to trauma or work-related physical exertion. It is characterised by tension, pain and stiffness. Episodes are generally short-lived and self-limiting

Question 3

What is a disc prolapse?

Answer 3

the nucleus pulposus can be squeezed out of place and herniate through the annulus fibrosis → herniated or slipped disc

Question 4

What is the most common point for herniation of the nucleus pulposus?

Answer 4

weakest point is postereolteral

Question 5

What is the management plan for an acute lumbar disc prolapse?

Answer 5

2-3 days of bed rest lying flat for a lower disc or semi-reclining for a high lumbar disc

prescribe analgesia and muscle relaxants

Once pain is tolerable, encourage mobilization and refer to the physiotherapist for exercises and preventative advice

Question 6

What is the management plan for mechnical back pain?

Answer 6

Adequate analgesia to allow normal mobility and avoidance of bed rest is best.
Combined with physical treatments such as physiotherapy, back muscle training regimens and manipulation.