Spine Flashcards
Function of the spine
Protects the cord and nerves
Posture and locomotion
Supports BW above pelvis
Partial rigidity for head to pivot on
Back pain impact
8/10 affected
leads to most sick days
2nd most common reason for primary care visit
high cost to NHS
What are the pain producing structures
Nucleus pulposus, Annulus fibroses, Facet joints and Synovium of facet capsule, Ligaments, Muscles, Nerves, Meninges
Red flags for neck and back pain
> 50/ <20 yo
fever and night sweats
travel/ TB contacts
immune suppression
IVDU
Recent bact infection or surgical procedure
Morning stiffness
Saddle anaesthesia/ bladder/ bowel [cauda equina]
Sexual dysfunction, disturbed gait, progressive neuro deficits
Uncontrolled pain
Thoracic pain
Yellow flags for neck and back pain
Negative attitude, depression, social withdrawal
Fear avoidance and reduced activity levels
Belief that passive rather than active treatment will be beneficial
social/ financial problems
Masquaraders of neck and back pain
AAA, Renal (e.g. pyelonephritis)
NICE Guidelines (2018) Treatment for back pain
STaRT Back Screening Tool
Self-management advice
- Daily activity
- Cold/heat therapy
- psychological support
Medication
- NSAIDS (not paracetamol alone)
- Codeine as weak opioid
- Diazepam for muscle spams (Short course)
NICE Guidelines (2018) Treatment for back pain - SCIATICA
Neuropathic meds
- Amitriptyline, Duloxetine, Gabapentin
- Tramadol –> Acute rescue therapy
- Capsaicin cream (local)
+ NRB
+ Decompression surgery
Cord Compression
Cord, conus, or cauda
Causes:
- tumour/ lesions
- trauma
- spinal stenosis
- infection/ inflammation
Characteristics of acute cord compression
Above conus/ cauda UMN signs back pain > leg infection and Ca risk => Oncological/ orthopaedic emergency
Cauda Equina Syndrome
LBP + unil or bilat radicular pain saddle anaesthesia/ parasthaesia bowel dysfunct, loss of anal sphincter tone perianal/ perineal sensory losss bladder dysfunction, incontenence sexual dysfunction progressive neurological deficit
Mx: Surgical emergency - decompression
Cancer/ Infection
Night pain systemic Sx, fever, septic thoracic pain (DDx thoracic aneurysm) IVDU Hx of cancer or recent infection immunosuppression postural deformity point tenderness +/- neurology
Ix - MRI gold standard, plain radiograph to exclude fracture
Mx - Rx cause, Abx, Referral to ortho or oncology
Fracture
Severe pain - rest + night
Assess for risk factors e.g. osteoporosis, Ca
Specific sports - rowing => pars stress fracture, synchronised swimmers => sacral stress fracture
Mx - pain control by ortho, surgery if unstable/ deformity/ ongoing pain; vertebroplasty/fusion
Inflammatory causes of back pain
Medical acute back pain presenting with morning stiffness (>30min), common in young
insidious onset and chronic
other inflammatory features
Sacroilitis as initial presentation (MRI gold stand)
Ix:
- FABER (Patrick’s) test - positive with pain at hip, lumbar, sacroiliac joint
- Palpate SIJ
- Seronegative + bloods
- XR/ MRI
Mx: Rheumatology + NSAIDs
Facet Joint Pain
Discogenic!
Mostly lumbar +/- nerve root involvement
>35yo (degenerative changes)
Clinical Sx correlate image => adjust treatment