Spine Flashcards
At what height does the spinal cord terminate?
L1/L2
What are the red flags for sinister back pain?
Violent trauma Minor trauma in osteoporosis Alternating or bilateral sciatica Weak legs Weight loss or fever Systemically unwell Non-mechanical pain
How do you test for an underlying herniated intervertebral disk?
Straight leg raise aims to strech the sciatic nerve and reproduce root pain
What must you remember to do in a back exam?
Offer to do a PR to check for cauda equina
What is the difference between an exiting and a traversing nerve root?
The exiting nerve root is leaving the spinal canal so a disk herniation below this point will not compress it. A traversing root stays in the canal to traverse to a lower level before exiting so can be compressed
Where abouts are the sensory and motor nuclei located in the spinal cord cross sectionally?
Sensory nuclei are in the dorsal horn
Motor nuclei are in the anterior horn
How should patients with acute mechanical lower back pain be managed?
Most is self resolving (90% by 6 weeks)
Focus is on; pain relief, exercises to improve function and lifestyle changes to prevent recurrence
-Encourage patients to exercise within the limits of the pain
-Analgesia helps to break the pain-muscle spasm cycle
-Warmth helps
-If acute spasm try muscle relaxant e.g. diazepam
-Cognitive therapy in groups helps tackle unhelpful beliefs
What is radicular pain?
Nerve root pain that radiates into a dermatome
What are the red flag signs for cauda equina?
Saddle anaesthsia and incontinence
What are the signs of cervical myelopathy?
Pain of stiffness in neck
Paraesthesia
Loss of fine motor skills, coordination
Which discs are most likely to prolapse?
The lumbar discs
What is the typical presentation of a patient with a herniated disc?
They have severe pain on coughing, sneezing or twisting a few days after a strain
Pain may be confined to the lower lumbar region or radiate to the buttock or leg (sciatica) if there is nerve root compression
Pain worse on sitting as this increases pressure on the annular fibers
What are the signs of a herniated disc?
There is limited forward flexion
L4/5 - L5 compression causes sensory loss over dorsum of foot - weakness in foot and big toe dorsiflexion
L5/S1 - S1 compression causes sensory loss of bottom of foot and posterolateral leg, weakness in plantar flexion of foot
What are the investigations and management of disc prolapse?
Clinical history is usually enough MRI if intervention is being contenplated or if cauda equina suspected Treatment: -Brief rest with early mobilisation -Pain relief -will resolve by itself in 90%
What is spondylolisthesis?
This is the displacement (usually forward) of one of the lumbar vertebrae
What tends to cause spinal cord stenosis in the lumber region?
Usually facet joint OA and osteophytes
How do you differentiate spinal stenosis from disc herniation?
Spinal stenosis will be worse on walking and will cause spinal claudication
Pain on extension
Negative straight leg raise
Prefer to lean over
Disc herniation will be worse sitting, on flexion, positive straight leg raise
What are the investigations and treatment for spinal stenosis?
MRI is preferred
Start with NSAIDs, epidural steroids and corsets
Then decompressice laminectomy
What questions are important to ask for inflammatory back pain?
Any joint, bowel or eye involvement
What are the signs and symptoms that are seen in spinal tumours?
Can compress any part of the cord so there can be LMN, UMN, Sensory loss and bowel and bladder dysfunction.
What are the signs and symptoms of cauda equina syndrome?
This is compression below the conus medullaris and therefore causes LMN signs
Also:
-Poor anal tone
-Saddle anaesthesia
-Incontinence/retention of faeces or urine
-Paralysis
What is the clinical presentation of discitis? how is it investigated and treated?
This is a type of pyogenic spine infection and features pain and movement restricted by spasm.
It does not often have any of the signs of infection other than a raised ESR, x rays show bone erosion and joint space narrowing, bone scans and MRI
Treatment:
-Antibiotics - vancomycin
-bed rest - back brace
What is Pott’s disease and how is it treated?
This is a form of extrapulmonary TB that causes localised back pain and stiffness, spinal deformity is common
Always do CXR to check for pulmonary TB
Treat with antibiotics like osteomyelitis (vancomycin)
What is a common cause of cervical myelopathy?
Cervical spondylosis (degenerative changes)
