Red Flags and Emergencies

Question 1

What are red flags in back pain?

Answer 1

age <20 or >60- first back pain
on-mechanical, constant pain
Hx of cancer
Hx of steroids
systemic symptoms- malaise; fever; unexplained weight loss
structural deformity
sadlle anaesthesia/parasthesai +/- loss of bowel or bladder control
severe pain longer than 6 weeks

Question 2

What are back pain emergencies?

Answer 2

cauda equina syndrome

fracture with deteriorating neurology

Question 3

What are hte symptoms of cauda equina?

Answer 3

painless retention with overflow- full bladder and dont know

Question 4

What is the problem with diagnosing cauda equina?

Answer 4

most patients present atypically- need high index of suspicion

Question 5

What is ivolved in the intial assessment of spinal fractures?

Answer 5

immobilise and x-ray and do not forget other injuries

neuro exam

Question 6

What is important in an initial neurological assessment of spinal fracture?

Answer 6

to establish a motor and sesory level and to pay particular attention to the saddle area

Question 7

What is needed in injuries to the cervical spine?

Answer 7

make sure X-ray shows C7/T1
rigid collar
rememebr other injuries

Question 8

What is needed with thoracocolumbar injuries?

Answer 8

visualise the whole spine and have a rigid spine board

Question 9

Where is the most common spinal fracture?

Answer 9

T12/L1

Question 10

What can cause secondary cord damage in fractures?

Answer 10

cord swelling; oedema; ischaemia; thrombosis of small vessels and venous obstruction
stretching; compression; undue movement; infection

Question 11

What is needed in spinal fractures to prevetn secondary cord damage?

Answer 11

make sure the pt it well perfused and oxygenated

Question 12

What is the Frankel/ ASIA grading of spinal injuries?

Answer 12

1-complete motor and sensory loss
2- complete motor and incomplete sensory
3- incomplete motor- no practical use
4- useful motor and incomplete sensory
5- normal motor and sensory function

Question 13

When is spinal surgery undertaken?

Answer 13

within 7-10days- need to let swelling and tissue perfusion improve; postural reduction; internal fixation and grafting; late reconstruction

Question 14

What needs to be monitred in children with growth plate disturbance?

Answer 14

damage to a growth plate an cause premature fusion and cessation of growth- kyphosis

Question 15

What is a chance fracture and who is it seen in?

Answer 15

in adolescents- a very unstable fracture with ligamnet disruption due to presence of growth plates and cartilaginour rims

Question 16

What should be suspected in a patient with ank, spon with any sort of back injury

Answer 16

fracture until proven otherise- soft porotic bone

Question 17

In the cervical spine in patients with ank. spon what do you have to be careful about?

Answer 17

maybe made worse by collars- as natural ank. spon position is extended rather than the fixed flexion of neck collars

Question 18

What is Heuter-Volkmann’s law?

Answer 18

increased pressure across an epiphyseal plate inhibits growth

Question 19

What can cause secondary scoliosis?

Answer 19

neuromuscular- eg muscular dystrophy
tumours
spina bifida

Question 20

What is the difference between spondylolysis and spondylolithesis?

Answer 20

spondylolysis is failure of union of various ossification centres whereass spondylolisthesis is slippage of one vetebra onto another