Spinal Flashcards
typical presentation of simple backache
age 20-55
lumbosacral, buttocks, thighs
mechanical pain
describe sciatica
nerve root pain shooting pain radiating down leg and toes unilateral paraesthesia numbness
desbribe the hallmark of cauda equina
saddle anaesthesia
difficulty micturition
lost anal tone/faecal continence
progressive motor weakness
back pain red flags
<20 >55 severe night pain neurological change unexplained weight loss systemically unwell immunosuppressed, PWID, HIV. TB Thoracic pain trauma previous cancer
true/false - with mechanical back pain you should stop all exercise and rest
false - dont exercise intensely but dont stop all exercise
lifestyle advice to patient with mechanical back pain?
keep moving
stay at work if you can
restrict exercise but dont cut it out
weight control
describe how referred leg pain would feel
dull achy
poorly localised to buttock/thigh
above knee
where may referred back pain be from?
kidneys colon uterine/ovarian pancreas gallbladder PUD
what pathologies might cause a possible spinal pathology
primary/secondary tumour
inflammatory disease
fracture
infection
what conditions may cause nerve root problems
disc prolapse
spinal stenosis
what is the most common back pain and what causes it
mechanical
no underlying cause besides possibly degenerative disease
how does degenerative disc disease lead to nerve root pain?
disc degenerates leading to nerve becoming pinched as it leaves the spinal cord
what is spondylolysis
defect/fracture in pars interarticularis
what is spondylosthesis
total displacement of pars interarticularis
yellow flags for chronic back pain
low mood high levels pain/disability believing activity is harmful low education obesity problem with claims job dissatisfaction heavy lifting
what is mechanical back pain?
recurrent relapsing and remitting back pain
what is spondylosis
intervertebral discs lose water so less cushioning and increased pressure on facet joints leading to secondary OA
when would surgery be indicated for mechanical back pain
severe unrelenting disease that only affects one spinal level
an acute disc tear causes what kind of pain?
nerve root pain - shooting pain with altered sensation and unilateral reduced power
how may OA cause nerve root pain
osteophyte formation may impinge on nerve roots
pathophysiology of spinal stenosis
spondylosis, bulging discs, bulging ligamentuum flavum or osteophytosis reduce space for cauda equina so multiple nerve roots become compressed
how is spinal stenosis claudication different from PVD
pain is burning not cramping
pedal pulses preserved
distance is inconsistent
no pain uphill
true/false - PR exam in suspected cauda equina is voluntary
false - it is negligent not to do one
severe crush fractures in the vertebral body that are not traumatic may be?
osteoporotic
what risks are associated with <20 in back pain
primary tumour or infection
spondylolisthesis
what risks are associated with >55/60 in back pain
arthritis/osteoporotic crush fracture
neoplasia and metastatic disease
what risks are associated more with back pain that is worse at night?
tumour/infection
what risks are associated with back pain with systemic upset
tumour/infection
what cervical instaility does downs syndrome carry
atlanto-axial subluxation with potential cord compression
what cervical instability does RA carry
atlanto-axial subluxation due to destroyed joint between atlas and dens
ruptured transverse ligament
criteria for clinically clearing C spine?
GCS 15 with no alcohol intoxication no obvious significant head injury no hx lost consciousness no midline tenderness on palpation c spine no pain on gentle active movement
if the C spine cannot be clinically cleared what happens
c spine must be radiologically cleared with AP/lateral and odontoid peg views
above what level can a C spine fracture be fatal and why
C3 as C3,4,5 innervate diaphragm
management of C spine fracture?
stable - in a collar
unstable - surgical stabilisation and external fixation with halo vest
management of C spine dislocation/subluxation?
reduction and halo vest or operative stabilisation
what type of thoracolumbar fractures are seen in the elderly and how are they managed
osteoporotic wedge fracture
symptomatic management
cause of thoracolumbar fractures in non-elderly patient
RTA, high energy fall from height
how are stable thoracic/lumbar fractures managed
back brace to prevent kyphosis and flexion
plaster jacket for lumbar to protect lordosis
indication for spinal surgery following thoracolumbar fracture
neuro deficit
unstable injury
lost vertebral height
displacement
what types of injuries can cause spinal cord injury
laceration
compression
stretch
contusion
what is spinal shock
lost sensation and motor function and lost reflexes below level of injury
usually resolves within 24 hours with return of reflex
what reflex is absent in spinal shock and its return signifies its end
bulbocavernosus
reflex contraction of anal sphincter with squeeze of glans, tapping mons pubis or pulling catheter
what is neurogenic shock and how is it managed
temp shutdown of sympathetic outflow leading to bradycardia and hypotension usually 24-48 hours
priapism
IV fluids, vasopressors and atropine
what is complete spinal cord injury
no sensory or voluntary movement below level of injury
reflexes should return
classed by level at which there is partial function but has poor prognosis
what is an incomplete spinal injury
some neuro function distal to injury, greater the function the better the prognosis
sacral sparing, perianal sensation, big toe flexion and anal contraction signifies incomplete
true/false - in a patient with known spinal injury and hypotension the most likely cause is neurogenic shock
false - neurogenic shock is a possibility but hypovolaemic shock is most likely
