Spine

Question 1

What are some red flag causes of back pain?

Answer 1

Spinal fracture
cauda equina
spinal stenosis 
ankylosing spondylitis 
spinal infection (discitis - think if IVDU)

Question 2

What are some mechanical causes of back pain?

Answer 2

Scoliosis 
Muscle/ ligament sprain
Spondylolisthesis 
disc prolapse 
arthiritis 
facet joint dysfunction (joints between spinal bones) 
sacroiliac joint issue

Question 3

What is the anatomy and supply of the sciatic nerve?

Answer 3

L4 - S3 form, exits the pelvis and travels down back of legs where it divides into the tibial nerve and the common peroneal nerve.
It supplies sensation to the lateral lower leg and foot. Supplies motor function to the posterior thigh, lower leg and foot.

Question 4

How does sciatica present?

Answer 4

Unilateral pain from buttock, down back of leg. Is a shooting pain. May have neuro sx eg weakness, parasthesia, numbness.

Question 5

What is the test for sciatica?

Answer 5

Stretch test
Pt lies on back with legs straight, examiner lifts one leg up in air as far as possible, then dorsiflexes foot. Causes the sciatic pain.

Question 6

What is spinal stenosis? What is the most common type?

Answer 6

Narrowing of the spinal canal so cord or nerve roots are compressed. Lumbar spinal stenosis.

Question 7

What can cause spinal stenosis?

Answer 7

Denegerative/ arthirtic changes
herniated discs
thickening of the ligaments
spinal fracture 
spondylolisthesis
tumour

Question 8

How does spinal stenosis present?

Answer 8

Can be varied depending on location:

• gradual onset
• intermittent neurogenic claudication (pain back legs/ buttocks upon walking, relied when flex spine)
• radiculopathy
• cauda equina
• sciatica

Question 9

What are the Ix and Mx for spinal stenosis?

Answer 9

Ix = MRI; ABPI to rule out PAD

Mx: PT, analgesia, decompression surgery