Spinal Cord Disease - Back Pain

Question 1

What is Non-Specific/Mechanical Back Pain?

Answer 1

Back pain with no specific underlying disease.

Question 2

Aetiology of Mechanical Back Pain.

Answer 2

1. Muscle/Ligament Sprain.
2. Facet Joint Dysfunction.
3. Sacroiliac Joint Dysfunction.
4. Herniated Disc.
5. Spondylolisthesis.
6. Scoliosis.
7. Degenerative Changes of Discs/Joints e.g. Arthritis.

Question 3

Red Flag Causes of Back Pain (5).

Answer 3

1. Spinal Fracture - Trauma.
2. Cauda Equina.
3. Spinal Stenosis.
4. Ankylosing Spondylitis.
5. Spinal Infection.

Question 4

Investigations of Mechanical Back Pain.

Answer 4

1. Clinical Diagnosis (No Investigation).
2. X-Rays/CT Scans : Fractures.
3. Emergency MRI : Cauda Equina.
4. Bloods - Inflammatory Markers, X-Ray of Spine and Sacrum, MRI of Spine : Ankylosing Spondylitis.

Question 5

Why is MRI the most useful imaging modality in Back Pain that is not Mechanical?

Answer 5

No other imaging can see neurological/soft tissue structures.

Question 6

What is the screening tool in Back Pain?

Answer 6

STarT Back Tool - Risk of Patient Developing Chronic Back Pain from Acute Back Pain : 9 Questions (Total = 9).

Question 7

Aims of Management of Mechanical Back Pain.

Answer 7

1. Exclude Underlying Causes.
2. Safety-Net.
3. Analgesia.

Question 8

Medical Management of Mechanical Back Pain (4).

Answer 8

1. NSAIDs (1st Line) - with PPIs Above 45.
2. Neuropathic Pain Relief as with Sciatica.
3. Encourage Self-Management, Exercise.
4. Specialist Management.

Question 9

Specialist Management of Mechanical Back Pain (4).

Answer 9

1. Exercise Programme.
2. Manual Therapy.
3. Radiofrequency Denervation.
4. Epidural Injection of Local Anaesthetic or Steroid.

Question 10

What is Radiofrequency Denervation?

Answer 10

Target and damage medial branch nerves that supply sensation to the facet joints.