Spinal Column Pain, Sciatica, C-Spine, Whiplash

Question 1

Describe the normal curvatures of the spine

Answer 1

Cervical lordosis

Thoracic Kyphosis

Lumbar lordosis

Sacral kyphosis

Question 2

In which location does spinal column pain generally occur + 3 reasons why?

Answer 2

Generally centred in the lumbar region because

1. under higher mechanical stresses and strains
2. upper body loads the lumbar spine region
3. In upright posture, there is: loading of IV discs, vascular compression and avascular discs from early age

Question 3

What is the effect of osteoporosis on vertebrae?

Answer 3

Osteoporosis causes vertebrae to lose height

Question 4

List some possible causes of back and neck pain?

Answer 4

Question 5

How can we avoid missing serious causes of back pain (vs musculoskeletal/simple)?

Answer 5

Question 6

What is the main investigation for spinal pathologies

Answer 6

MRI scan

• XR not useful outside of the trauma setting (fractures/alignment)
• CT also more useful in trauma setting

* Investigation not required for simple back pain/no red flags

Question 7

How do we treat back pain?

Answer 7

Note: reffer if you suspect more than ‘simple’ back pain

Question 8

What surgery may help with segmental causes of back pain?

Give 2 negatives about this surgery

Answer 8

Spinal fusion

Negatives:

• Pain relief at the expense of movement
• May have progression of movement pain later at levels above and below.

Question 9

What is Sciatica?

Answer 9

Pain in the leg in the distribution of the sciatic nerve caused by nerve root compression or irritation.

It is a nerve root pain (aka Radicular).

Question 10

List 4 potential causes of Sciatica

Answer 10

1. compression by herniated (slipped) disc
2. spinal stenosis
3. trauma due to retro pulsed bone fragments
4. tumour (rare- remember red flags)

Question 11

What investigation is used for Sciatica?

Answer 11

MRI of lumbar spine

Question 12

How do we treat sciatica?

Answer 12

Analgesia and advise patient to remain active. Most sciatica spontaneously resolves with time

If persistant pain, and MRI corresponds to dermatomal distribution of symptoms, then discectomy can be considered

Question 13

What is Whiplash?

Answer 13

Flexion-extension injury to neck

Question 14

List 4 symptoms of Whiplash

Answer 14

1. Neck pain and stiffness
2. Tenderness over the neck muscles
3. Reduced and painful neck movements
4. Headaches

Question 15

What is the onset of whiplash symptoms after an accident?

Answer 15

It can take up to 6-12 hours for the symptoms to develop.

Neck pain and stiffness is often worse on day 2, and may continue to get worse for several days

Question 16

How do we diagnose whiplash?

Answer 16

History and Examination (muscle spasm, neck tenderness, ROM)

* Imaging not usually required

Question 17

How do we treat whiplash?

Answer 17

Question 18

List the 3 ways we can view the C-spine on an X-ray

Answer 18

• AP
• Lateral Skull base - T1
• • Open Mouth View

Question 19

In a lateral C Spine X-Ray how do we assess the following:

• Adequate film
• Alignment
• Bone
• Spacing
• Soft tissues

Answer 19

Question 20

In a AP C Spine X-Ray how do we assess the following:

• Adequate film
• Alignment
• Bone
• Spacing
• Soft tissues

Answer 20

Question 21

In a open mouth (odontoid peg) X-ray of the C Spine, how do we assess adequacy of film

Answer 21

Question 22

List 5 fractures we can have of C1 (Atlas)

Answer 22

Question 23

List the 3 fractures of C2 (Axis)

Answer 23

1. Odontoid fractures: type 1, 2, 3
2. Hangman’s fractures: type 1, 2, 3
3. Miscellaneous C2 fractures

Question 24

How do we classify odontoid (peg) fractures?

Answer 24

Question 25

How do we treat each of the 3 types of Odontoid fractures?

Answer 25

Type I – Neck brace 6-12 weeks Type II – Screw fixation (if displaced) Type III – Neck brace or halo orthosis 6-12 weeks.

Question 26

What is a Hangman’s fracture?

Answer 26

Caused by forced hyperextension usually in a high energy injury It is a bilatereal fracture of pars intra-articularis of C2 High correlation with spinal cord damage, often fatal ➞ above C3-4-5 therefore can cause quadriplegia, and inhibits diaphragm

Question 27

What is a Sub-Axial C-spine fracture?

Answer 27

Facet joint dislocation which can be Uni-lateral (\<50% translation) or Bi-lateral (\>50% translation)

Question 28

What is the treatment of facet joint dislocations

Answer 28

Relocation with in line traction, may require surgical instrumentation

Question 29

List the 3 types of sub axial fractures and dislocations

Answer 29

Question 30

What is the treatment of sub axial fractures

Answer 30

Determine stability of the fracture (often requires specialist spinal surgeon opinion) Most are stable and can be treated with a collar for 6-12 weeks, some require instrumentation (anterior or posterior)