Spinal Disorders Flashcards
Investigations and management for mechanical back pain?
No investigations required unless differential dx suspected.
Patients with short history (<6 weeks) do not need investigations!
Prolonged symptoms/red flags: FBC, ESR, LFT’s, bone profile, myeloma screen, CRP.
Management: Patient education, simple analgesia, early return to normal activities, self referral to physio
Causes of mechanical back pain?
Muscle or ligament sprain,
Facet joint dysfunction,
Sacroiliac joint dysfunction,
Herniated disc,
Spondylolisthesis (anterior displacement of the vertebrae)
Scoliosis,
Degenerative changes.
Causes of neck pain?
Muscle or ligament strain (e.g., poor posture or repetitive activities)
Torticollis (waking up with a unilaterally stiff and painful neck due to muscle spasm)
Whiplash (typically after a road traffic accident)
Cervical spondylosis (degenerative changes to the vertebrae)
Presentation of L3 nerve root compression?
Sensory loss over anterior thigh.
Weak hip flexion, knee extension, hip abduction.
Reduced knee reflex.
Positive femoral stretch test.
Presentation of L4 nerve root compression?
Sensory loss over anterior aspect of knee and medial malleolus.
Weak knee extension and hip abduction.
Reduced knee reflexes.
Positive femoral stretch test
Presentation of L5 nerve root compression?
Sensory loss over dorsum of foot.
Weakness in foot and big toe dorsiflexion.
Reflexes intact.
Positive sciatic nerve stretch test.
Presentation of S1 nerve root compression?
Sensory loss posterolateral aspect of leg and lateral foot.
Weakness in plantar flexion of foot.
Reduced ankle flexion.
Positive sciatic nerve stretch test.
Investigations for nerve root impingment?
Indications for MRI scanning
Straight leg raising test and Lasegue sign.
Indications for MRI:
- Radicular pain > 6 weeks (passmed 4-6wks) with failed conservative measures.
- Patients who develop neurological deficit.
- Bilateral lower limb deficit/peroneal symptoms.
Management of nerve root impingement?
Indications for surgical managmenet?
Physiotherapy,
Analgesia,
Short course of muscle relaxants.
Absolute indications for surgery - Cauda equina syndrome and progressive neurological deficit.
Relative indications for surgery - intractable redicular pain, neuro deficit which doesnt improve with conservative measures and recurrent sciatic following successful trial of conservative measures.
Red flag symptoms for back pain?
Age < 18 or > 50 at onset.
Bilateral radicular leg pain.
Limb weakness.
Alternation of bladder and/or bowel function.
Perianal numbness.
History of cancer.
Constitutional symptoms or weight loss.
Trauma.
Thoracic pain.
History of immunosuppresion or prolonged steroid use.
What are the clinical features of cauda equina syndrome, the investigations and managmenet?
Low back pain,
Bilateral sciatica,
Reduced sensation/pins-and-needles in perianal area.
Reduced anal tone.
Urinary dysfunction
Ix - Urgent MRI spine.
Rx - Surgical decompression.
Presentation and causes of discitis/vertebral osteomyelitis?
Presentation - Back pain, general features (pyrexia, rigors, sepsis), and neurological features
Causes - Bacterial (STAPHYLOCOCCUS AUREUS), viral, TB or aseptic.
Investigations, treatment and complications of discitis/osteomyelitis?
Investigations - MRI imaging +/- CT guided biopsy, blood cultures and transthoracic ECHO to look for endocarditis.
Treatment - 6-8 weeks of IV antibiotic therapy.
Complications - sepsis and epidural abscess
Features of spinal tumours?
Presentation - unrelenting lumbar back pain, any thoracic/cervical back pain, worse when sneezing/coughing/straining, nocturnal, associated with tenderness.
May present with malignant spinal cord
Ix - MRI whole spine, serum calcium
Presentation of spinal injuries?
Clinical examination - bony midline tenderness, clinical deformity or palpable step, boggy swelling or bruising, neurological compromise. May present with spinal shock
