Spine Flashcards
List some red flags re back pain
Age <20 or >60 - first back pain
Non – mechanical, constant pain -> raises suspicion of inflammation
History of cancer
History of steroids
General malaise, fever, unexplained weight loss
Structural deformity
Saddle anaesthesia / paraesthesia +/- loss of bowel or bladder control
Severe pain longer than 6 weeks – almost every patient seen in clinic has this
What is the most significant red flag symptom re back pain?
The only red flag which has been proven to be indicative of a serious underlying problem is a past history of cancer. The other red flags are, at most, a pale shade of pink.
Why is back pain in the under 20s a red flag?
Younger children are more susceptible to infections (osteomyelitis, discitis) whilst adolescents are the peak age for spondylolisthesis as well as some benign (e.g. osteoid osteoma) and malignant (e.g. osteosarcoma) primary bone tumours.
What deformities does the term scoliosis encompass?
Rotational component
Lateral bend component
Rib deformities
Visceral abnormalities
What are the four main categories of scoliosis?
Congenital - - the common theme is an imbalance in the number of growth plates and the greater the imbalance the worse the potential deformity.
Early onset idiopathic - sometimes the early onset idiopathic type can correct itself but no-one knows why or which ones.
Late onset idiopathic - this is a typical presentation – the patient (or her mother, or gym teacher) notices the rib asymmetry.
Secondary
What are some causes of secondary scoliosis?
Neuromuscular
Tumours
Spina bifida
Define spondylolysis and spondylolisthesis
What is the treatment for these?
Spondylolysis is a defect in the pars interarticularis of the vertebra.
Spondylolisthesis is the forward slippage on one vertebra on another. The two may co-exist, but they are not the same.
Most patients with lysis or listhesis will respond to conservative treatment with the emphasis on core stability or deep stabilisation treatments.
Who is idiopathic scoliosis most common in?
Adolescent females
What are the most common sites for Spondylolisthesis?
L4/L5 or L5/S1 level
Give some features of complete cord injury
Accurate examination essential
Saddle sparing
Progression
Ascending lesion
Give some features of central cord injury
Typically hyperextension injury
Arms worse than legs
Prognosis variable but generally good
Central cord syndrome is one of the incomplete spinal cord injury patterns. Typically an elderly patient who falls, with a hyperextension neck injury. There may be little or no evidence of bone damage.
Give some features of Brown-Sequard cord injury
Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Best prognosis
Give some features of anterior cord injury
Motor loss Loss of pain and temperature sense Deep touch, position and vibration preserved May have traumatic or vascular cause Prognosis poor
What are some important things to ask about in history of a patient with back pain?
Onset of pain Previous episodes Site and nature of pain Radiation of pain Neurological symptoms - may include numbness, paraesthesia or weakness, or may be more subtle such as temperature disturbance Social factors - age & occupation Occupational factors – job description doesn’t necessarily show what the job actually does Litigation
Myetomes
Give the movement associated with the spinal nerves at:
L1/2
L3/4
L5
S1/2
Describe the tests you would do to check each of these are intact
Hip flexion - ask the patient to push up against your hand
Knee extension - ask the patient to straighten their knee against your hand
Foot dorsiflexion & EHL - extension or dorsiflexion of the foot, and also more specifically, extension of the great toe.
Ankle plantarflexion - ask the patient to stand on tip toes
