Spinal Flashcards
List the DDx for neck pain (7)
Trauma Mechanical Fibromyalgia Ank Spon Cervical spondylosis Cervical radiculopathy Cervical myelopathy
List the DDx for mechanical back pain (6)
List the DDx for non-mechanical causes back pain (5)
Mechanical: Simple mechanical Disc prolapse Cauda equina syndrome Lumbar canal stenosis Spondylolisthesis Facet joint dysfunction
Non-mechanical: Infection Inflammatory Metabolic Neoplastic Visceral
How is a simple neck trauma (i.e. whiplash) managed?
Treat as C-Spine trauma if severe MOI / pt unstable
Otherwise: Treat as concussion but XR for ?Bony injury Analgesia Patience / early mobilisation
What are the features of cervical radiculopathy
Poss BG of cervical spondylosis (reduced RoM, painful, crepitus) Now also: • Ache from neck to arm (unilateral) • Weak pinch grip • Dermatomal sensory loss • Occasional sudden sharp pains
What are the features of cervical spondylosis
What are the causes
Reduced RoM in neck
Painful/tender cervical spine
Crepitus
Mainly Cervical OA (C5/6)
Can be precipitated by trauma / disc prolapse
What are the features of cervical myelopathy
What are the main causes
Older pts
Minimal pain (not predominant)
LMN at lesion: Hand fine motor (e.g. chopping food)
UMN below lesion: Progresses to spastic gait
Main causes:
Cervical OA (spondylosis)
Malignancy (cord compression)
What would be seen O/E in C5/6 myelopathy
- Wasting/fasciculation of deltoid/biceps
- Hypo-reflexive biceps
- Hyperreflexive triceps
- Spastic leg
- Babinski +ve
What are the features of acute lumbar disc prolapse?
Unknown triggering event
Unable to straighten up
Worse coughing/straining
Hrs: lancinating pain/paraesthesia buttocks
Days: lancinating pain/paraesthesia leg+foot (inc. foot drop)
2% to cauda equina
Outline the conservative management of lumbar disc prolapse
NB need thorough Hx (DDx referred simple back pain)
Conservative: (works in 90%) • Anti-inflamms (NSAIDs ± diazepam) • Bed rest (6wks orthopaedic mattress) w. slight knee flex • Sx persist (2wks): epidural injections • Physio
Indications for surgical management of lumbar disc prolapse
- Severe/persistent despite conservative Tx
- Recurrent attacks w. func e.g. time-off work
- Neurological deficit
What are the pathological processes behind lumbar spinal stenosis (4)
OA
Disc degen
Facet joint hypertrophy
Ligamentum flavum hypertrophy
What are the features of lumbar canal stenosis
Pain: lower back/buttocks / posterolat thigh / legs
• insidious
• cramping/burning
• bilateral (one side worse)
• intermittent, sx vary day-to-day
• exac – standing/walking
• relief – sitting forward/rest (e.g. bike)
± Weakness
± Stiffness
± Numbness
Outline the conservative / surgical management for lumbar canal stenosis
Determined by sx progressive (i.e. stable or not)
Conservative:
• activity modification
• physio
Surgical: Laminectomy
What are the causes of spondylolisthesis (4)
Spondyloysis (stress #s of pars articularis)
Facet joint OA (older)
Lumbosacral facet dysplasia (teens)
Extreme athletes
What are the features of spondylolisthesis?
+ Main complication to worry about
Intermittent backache
By exercise/strain
O/E: ‘step’ on palation
Complication: cauda equina
