Spinal cord and root dysfunction

Question 1

General red flag signs/symptoms of back pain?

Answer 1

Failure to improve after 4-6 weeks of conservative therapy

Unrelenting night pain or pain at rest

Progressive motor or sensory deficit

Question 2

Malignant red flag signs/symptoms of back pain?

Answer 2

Age > 50

Unintended weight loss

History of cancer

Pain at night and in recumbency (at rest/reclining)

Question 3

Infectious red flag signs/symptoms of back pain?

Answer 3

Fever/ chills

Recent infection

Immunosuppression

Iv drug use

Dental status

Foreign travel

Question 4

Fracture red flag signs/symptoms of back pain?

Answer 4

Age > 50

Osteoporosis

Significant trauma

Chronic steroid use

Question 5

CES (cauda equina syndrome) red flag signs/symptoms of back pain?

Answer 5

Bilateral sciatica

Urinary incontinence

(Leg weakness)

Decreased anal tone

Loss of perianal sensation

Question 6

AAA (aortic abdominal aneurysm) red flag signs/symptoms of back pain?

Answer 6

Age > 60

Abdominal pulsating mass

Pain at rest

Question 7

How many grades are present for assessing limb muscle power?

Answer 7

Grades 0-5

Question 8

Grade 0 limb muscle power?

Answer 8

Complete paralysis

Question 9

Grade 1 limb muscle power?

Answer 9

Flicker of contraction possible

Question 10

Grade 2 limb muscle power?

Answer 10

Movement possible if gravity eliminated

Question 11

Grade 3 limb muscle power?

Answer 11

Movement against gravity but not resistance

Question 12

Grade 4 limb muscle power?

Answer 12

Movement possible against some resistance

Question 13

Grade 5 limb muscle power?

Answer 13

Normal power (not normally possible to exceed normal adult power)

Question 14

Common investigations for lower back pain?

Answer 14

Radiology
- X-ray
- CT
- MRI
- Bone scan
- PET/SPECT
Lab
- FBC, U+Es
- Inflammatory markers

Question 15

When is CT scan used for lower back pain?

Answer 15

Limited application in acute LBP without red flags
Bony pathology (trauma, tumours, infection)
Good: foreign bodies, implants
Spinal fusion planning
Used when MRI contra-indicated/not available

Question 16

X-rays for LBP are not commonly carried out except in certain circumstances. What are these circumstances?

Answer 16

Young men: SI-joint to exclude ank spond
Elderly: to exclude vertebral collapse, other fractures, malignancy

Question 17

Why aren’t X-rays generally used?

Answer 17

Not very sensitive or specific
Does not rule out serious illness
Does not show soft tissues

Question 18

Causes of acute spinal cord compression?

Answer 18

Trauma i.e. high energy injury.

Tumours - haemorrhage or collapse

Infection

Spontaneous haemorrhage

Prolapsed intervertebral disc

Question 19

Causes of chronic spinal cord compression?

Answer 19

Degenerative disease, mainly spinal canal stenosis.

Tumours

Rheumatoid arthritis

Question 20

What spinal cord levels are the most common for disc prolapse?

Answer 20

L4-L5 and L5-S1, both will cause sciatica

Question 21

What is sciatica?

Answer 21

Characteristic pain felt in the lower back, buttocks and the posterior and lower leg resulting from compression of any of the 5 nerve roots contributing to sciatic nerve