Slipped Disc

Question 1

Muscles of spine

Answer 1

Iliacus psoas - anterior
Erector spinae - posterior

Question 2

Intervertebral disc

Answer 2

Nucleus pulposus
Annulus Fibrosus

Question 3

Prime age for slipped or prolapsed disc

Answer 3

30-50
Older - disc dry out, thus less likely

Question 4

Nerve trapped in neural foramen

Answer 4

Interpreted as nerve going down leg
Sciatica

Question 5

Symptoms of sciatica

Answer 5

Paresthesia
Tingling
Numbness

Question 6

Non-specific low back pain

Answer 6

Pain not due to any specific or underlying disease that can be found

Question 7

Mechanical low back pain

Answer 7

Pain after abnormal stress and strain on the vertebral column

Question 8

Nerve root pain (sciatica)

Answer 8

Pain radiating to lower limbs with or without neuralgic symptoms (tingling etc.)

Question 9

Indications of sciatica

Answer 9

Unilateral leg pain greater than low back pain
Pain radiating to foot or toes
Numbness and paraesthesia in the same distribution
Straight leg raising test induces more leg pain
Localised neurology - that is, limited to one nerve root

Question 10

Low back pain red flag

Answer 10

Weight loss
Fever
Night pain
Under 19 years old

Question 11

Leg pain red flags

Answer 11

Bowel or bladder dysfunction
Saddle anaesthesia
Profound neurological deficit

Question 12

Red flag triage

Answer 12

Imaging immediately
If safe - wait 6-12 weeks

Question 13

Imaging for low back pain

Answer 13

Primary - MRI
Secondary - radiographs, CT

Question 14

Radiographs pros and cons

Answer 14

Cheap
Readily available
Traditional

Radiation
Overlook most important diseases
May miss lesions

Question 15

Anorexia nervosa

Answer 15

Softening disease of bone
Compression fracture
Bone mineral deficiency

Question 16

Osteoid osteoma

Answer 16

MR investigation then CT which is diagnostic

Question 17

Causes of mechanical lower back pain

Answer 17

Tumour including myeloma
Infection
Spondyloarthropathy
Pars interarticularis injury
Compression fracture
Visceral

Question 18

NICE sciatica treatments

Answer 18

Exercise
Manipulation
NSAIDS
Weak opioids
Epidural

Question 19

Conservative sciatica treatment

Answer 19

Analgesia
Anti-inflammatory drugs
Manipulation
Acupuncture

Question 20

Waiting too long metastases

Answer 20

Early diagnosis may not impact on prognosis
Risk of catastrophic fracture and paralysis - onset of symptoms to referral median 3 months

Question 21

Waiting too long inflammatory arthropathy

Answer 21

Early diagnosis for effective treatment with biologics
Investigate under 35 years after 3 months pain - mandatory whole spine MRI and sacroiliac joint MRI

Question 22

Waiting too long myeloma

Answer 22

Early diagnosis will catch disease at a more easily treated stage
Mean delay in diagnosis - interquartile range 84 to 306 days as only symptom is lower back pain

Question 23

Waiting too long tuberculosis of spine

Answer 23

Early diagnosis is essential to effective treatment
Mean delay in diagnosis - 4 to 11 months
Expansion of vertebra and paraplegia

Question 24

Pagets sarcoma

Answer 24

Bowel gas
Spine eroded on side on body
Pagetoid bone

Question 25

Pain therapy

Answer 25

Physical therapy
Analgesia
Facet injections - local and steroid/demarcation
Root block
Epidural injection - not sure which nerve affected
Neurostimulation

Question 26

Surgery treatment

Answer 26

Decompression of nerve roots
Decompression of spinal stenosis
Disc replacement
Fusion