Spinal Pathology Flashcards

1
Q

Most common cause of back pain?

A

Mechanical.

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2
Q

Give an example of a factor that contributes to mechanical back pain?

A
  • Obesity.
  • Lack of exercise.
  • Strain on paraspinal muscles.
  • Facet joint osteoarthritis.
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3
Q

Mechanical back pain is most common in patients between which ages?

A

20 and 55 y/o.

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4
Q

Symptoms of mechanical back pain?

A
  • Morning stiffness that resolves with movement.

- Pain worse on prolonged sitting or when rising from seated position.

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5
Q

Hypertrophied facet joints may cause referred pain mimicking what condition?

A

Sciatica - except that pain will not radiate below the knee.

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6
Q

Red flags for low back pain?

A
  • > 60 or <20 y/o.
  • Pain not improved by rest.
  • Pain that WAKES the patient at night.
  • Urinary retention/incontinence and faecal incontinence.
  • Saddle anaesthesia.
  • History of malignancy.
  • Unexplained weight loss.
  • Fever, immunosuppression or IV drug abuse.
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7
Q

Most common locations for lumbar disc herniation?

A

L4/5 and L5/S1.

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8
Q

What happens in a disc herniation?

A

Nucleus herniates through tear in annulus ring and compresses adjacent nerve roots.

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9
Q

Herniated discs are more common in whom and why?

A
  • “Young” patients due to carrying heavy loads.

- Older patients due to vertebrae degeneration or spondylosis.

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10
Q

Most common direction of disc prolapse?

A

Paramedian/posterolateral herniated disc.

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11
Q

Describe a paramedian/posterolateral disc herniation.

A

Typically compresses traversing nerve i.e. nerve root that exits below the level of prolapsed disc.

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12
Q

A paramedian/posterolateral herniated disc at L4/L5 will compress which nerve?

A

L5.

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13
Q

A far lateral (extraforaminal) herniated disc typically does what?

A

Compresses exiting nerve i.e. nerve that exits at level of disc prolapse.

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14
Q

A far lateral (extraforaminal) herniated disc at L4/5 damages which nerve?

A

L4.

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15
Q

A central/medial herniation may cause what?

A
  • Lumbar stenosis.

- If large enough, Cauda Equina.

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16
Q

What is radiculopathy?

A

Nerve root dysfunction causing dermatomal sensory deficit + weakness of muscle groups supplied by that nerve.

17
Q

What is sciatica?

A

Pain along sciatic nerve usually due to nerve root compression (L4-S3).

18
Q

Symptoms of sciatica?

A
  • Sciatica pain pattern.
  • Numbness/tingling along affected nerve distribution.
  • Weakness.
  • Positive straight leg raise test.
19
Q

Describe a positive straight leg raise test.

A

Patient lies on back, lift leg with knee straight. If sciatic pain is elicited at <45o then test is positive.

20
Q

Describe the sciatic pain pattern.

A

Shooting pain radiating from buttocks down to posterior knee/leg. May be exaggerated by coughing or sneezing.