Spinal Conditions - Msk Focus Flashcards
Spinal pain, what % accounts for:
Red flag pathology, specific and non specific spinal pain?
Red flag - 1-2% - medical investigations needed
Specific - 5-10% - physio/surgery
Non-specific - 90% - physio, scan/x-ray unlikely needed
Spinal red flags -
Myelopathy
Cervical artery dysfunction (CAD)
Malignancy
Systemic (whole body) inflammatory disorders
Infections
Fractures
CES
Osteoporosis - more of a precaution than a red flag
Specific back pain
List some conditions we might see?
Ankylosing spondylitis
Spinal stenosis (central/formainal)
Spondylosis
Spondylolysis
Spondylolisthesis
Scoliosis
Whiplash
Radiculopathy
Specific back pain
What is ankylosing spondylitis?
Specific to spine
Inflammatory arthritis (systemic autoimmune)
Main symptom is back pain, normally starting in the SIJ
Mainly effects - entheses - where ligaments, tendons and capsules are attached to the bone
Specific back pain
Ankylosing spondylitis - X-ray and mri changes:
Risk factors:
X-ray - osteophytes and possibly fusion
MRI - inflammation
Risk factors - genetic (family history and HLA-B gene), men, age (late adolescent) avg age 24
Specific back pain
Ankylosing spondylitis, typical presentation -
Slow/gradual onset of back pain and stiffness over weeks or months rather than hours or days
Early-morning stiffness and pain, wearing off/redcing during the day with exercise
Persistence for more than 3 months
Feeling better after exercise and worse after rest
Weight loss, especially in early stages
Fatigue or tiredness
Feeling feverish and experiencing night sweats
Can affect other tendons, eyes,lungs and bowels
*not all essential to have!
Management of ankylosing spondylitis (AS) -
Meds - decease inflammation and pain. NSAID’s
Biologics - Ant-TNF therapy and IL-17A inhibitors
*smoking can make AS worse and reduce effects of biologics.
Can take meds that suppress immune system to reduce it attacking itself
Exercise and physio - help maintain good posture and reduce stiffness
Daily stretches
Walking, swimming, Pilates are all good as low impact.
What is spinal stenosis?
Canal narrowing
Can either be central or foraminal
What causes spinal stenosis? Risk factors:
Osteophytes
Disc herniation
Thinking of ligament
Tumours
Risk factor: age (normal age related changes)
Symptoms of spinal stenosis:
May give spinal pain (neck or low back are most common)
And/or nerve symptoms (if formainal)
May be ‘normal finding’ seen on scans
Not always causing symptoms
What can spinal stenosis cause?
If central cord compression in cervical spine, can cause myelopathy
If central cord compression at bottom of lumbar spine/sacral area, can cause Cauda equina syndrome
Spinal stenosis - what is often reported at making symptoms better/worse?
Often symptoms improve with flexion activities and worsen upon extension
This is because a flexed spine, canals open up more meaning there is more space
Management of spinal stenosis:
In some cases surgery may be indicated, but most do well with conservative
Physio may include:
Advice and education (pathology, prognosis, activity modification, graded exposure)
Pain management strategies
Exercise (stretching, strengthening, muscular control)
Lifestyle changes
What is spondylosis?
Generic umbrella term for osteoarthritic changes within the spine (cervical, thoracic, lumbar)
Can affect vertebra, intervertebral discs, facet joints, joints of luschka, ligamentum flavum and laminae.
Spondylosis, symptoms and risk factors:
What can it cause?
Ma not be a source of pain
Osteophyte formation may be seen on a X-ray
Risk factors: normal age related changes
Can cause spinal stenosis
Management of spondylosis:
Physio
Address individual beliefs and goals
Reassurance (normal age related changes)
Encourage normal movement and function
Increase ROM
Increase strength
Graded exposure
What is spondylolisthesis?
Anterior translation of the superior vertebra relative to the inferior vertebra
Most common L5/S1and L4/5
Often termed ‘slipped’ - be careful with this kind of language as can scare patients
Grades of spondylolisthesis:
Grade I: 0-25% - difficult to spot
Grade II: 26-50%
Grade III: 51-75%
Grade IV: 76-100%
Grade V: (spondyloptosis) >100%
Risk factors of spondylolisthesis:
Genetics
Trauma
Degeneration
Spondylolisis PARS fracture
Pathological spondylolisthesis - can be from systemic causes such as bone or CT disorders, infection, neoplasm
Management spondylolisthesis:
In some cases if high grade and severe nerve compression - surgery (stabilisation)
Most cases - conservative management
Physio
*some people will have it and have no idea.
Obvs we cannot change the position of the vertebra,what can we do instead?- reassurance, encourage normal movement etc…
Aetiology of scoliosis -
S shaped curve in the spine
May or may not cause pain
Idiopathic (80%)
Can be linked to - congenital (since birth) and neuromuscular conditions eg. Cerebral palsy, muscular dystrophy and spina bifida
Scoliosis - risk factors -
Cannot be prevented
Not linked to bad posture, exercise or diet
Genetics - normally the case
Does not necessarily get worse over time.
Management of scoliosis - (extreme)
Surgery (spinal fusion) is indicated in a small number of cases
Done if COBB angle is 45-50degrees +
