Spinal cord and root dysfunction Flashcards
General red flag signs/symptoms of back pain?
Failure to improve after 4-6 weeks of conservative therapy
Unrelenting night pain or pain at rest
Progressive motor or sensory deficit
Malignant red flag signs/symptoms of back pain?
Age > 50
Unintended weight loss
History of cancer
Pain at night and in recumbency (at rest/reclining)
Infectious red flag signs/symptoms of back pain?
Fever/ chills
Recent infection
Immunosuppression
Iv drug use
Dental status
Foreign travel
Fracture red flag signs/symptoms of back pain?
Age > 50
Osteoporosis
Significant trauma
Chronic steroid use
CES (cauda equina syndrome) red flag signs/symptoms of back pain?
Bilateral sciatica
Urinary incontinence
(Leg weakness)
Decreased anal tone
Loss of perianal sensation
AAA (aortic abdominal aneurysm) red flag signs/symptoms of back pain?
Age > 60
Abdominal pulsating mass
Pain at rest
How many grades are present for assessing limb muscle power?
Grades 0-5
Grade 0 limb muscle power?
Complete paralysis
Grade 1 limb muscle power?
Flicker of contraction possible
Grade 2 limb muscle power?
Movement possible if gravity eliminated
Grade 3 limb muscle power?
Movement against gravity but not resistance
Grade 4 limb muscle power?
Movement possible against some resistance
Grade 5 limb muscle power?
Normal power (not normally possible to exceed normal adult power)
Common investigations for lower back pain?
Radiology
- X-ray
- CT
- MRI
- Bone scan
- PET/SPECT
Lab
- FBC, U+Es
- Inflammatory markers
When is CT scan used for lower back pain?
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
X-rays for LBP are not commonly carried out except in certain circumstances. What are these circumstances?
Young men: SI-joint to exclude ank spond
Elderly: to exclude vertebral collapse, other fractures, malignancy
Why aren’t X-rays generally used?
Not very sensitive or specific
Does not rule out serious illness
Does not show soft tissues
Causes of acute spinal cord compression?
Trauma i.e. high energy injury.
Tumours - haemorrhage or collapse
Infection
Spontaneous haemorrhage
Prolapsed intervertebral disc
Causes of chronic spinal cord compression?
Degenerative disease, mainly spinal canal stenosis.
Tumours
Rheumatoid arthritis
What spinal cord levels are the most common for disc prolapse?
L4-L5 and L5-S1, both will cause sciatica
What is sciatica?
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
