Spinal conditions

Question 1

backache red flags

Answer 1

 Presentation under age 20 or onset over the age of 55
 Violent Trauma: eg fall from a height, car accident
 Constant, progressive, non-mechanical pain
 Thoracic pain
 History of previous cancer
 Systemic steroids
 Systemically unwell (fever, tachycardia, tachypnoea)
 Weight loss
 Persisting, severe restriction of lumbar flexion
 Widespread neurological signs and symptoms
 Structural deformity
 IV drug user; history of fever and chills (Infection)
 Bowel and bladder changes (Cauda equine syndrome)
 Night pain (infection / tumour)
 Backpain in a child

Question 2

Cauda equine syndrome

Answer 2

bilateral leg pain and weakness; saddle anaesthesia and

bowel/bladder symptoms

Question 3

backache treatment

epidural steroids

facet blocks

Answer 3

Epidural steroids
sciatica
not for back pain alone

Facet blocks
transient relief
may break pain cycle

Question 4

backache surgical treatment

Discectomy indications

Answer 4

Absolute indication: Cauda Equina Syndrome

Rest are relative: sciatica – not responding to conservative treatment neurological deficit
Aim is to free the root, therefore only partial discectomy

Question 5

symptoms of myelopathy

Answer 5

 Brisk reflexes 
 Unstable gait 
 Clumsy hands 
 Sustained clonus 
 Bakinski test (positive with extension of the great toe)

Question 6

Degenerative scoliosis results from the asymmetric degeneration of … and / or facet joints in
the spine

May occur in the … plane (scoliosis) or the sagittal plane (kyphosis/lordosis)

Answer 6

disc space

disc space

Question 7

degenerative scoliosis

4 Factors contributing to loss of sagittal plane balance

Answer 7

o Osteoporosis
o Preexisting scoliosis
o Iatrogenic instability
o Degenerative disc disease

Question 8

3 symptoms of degenerative scoliosis

Answer 8

low pack pain
- discogenic pain that’s severe

neurogenic claudication
-caused by spinal stenosis (on the concave side of the curve)

radicular leg pain and weakness

radicular leg pain and weakness

Question 9

Unlike classic neurogenic claudication, patients with scoliosis + stenosis …

Answer 9

do not obtain

relief with sitting / forward flexion