spine

Question 1

back pain syndromes

Answer 1

mechanical
back pain with nerve root pain
serious pathology

Question 2

some causes of low back pain

Answer 2

disc herniation, ankylosing spondylitis, inflammatory bowel disease.

Question 3

causes of low back pain

Answer 3

spondylogenic
neurogenic
viscerogenic
vascular
psychogenic

Question 4

mechnanical back pain

Answer 4

reassurance
managed in primary care
avoid bed rest keep active
fails to settle-physiotherapy
may consider
alternative therapy
facet join injection
accupuncuture

Question 5

prolapsed intervertebral disc

Answer 5

lateral disc protusion- nerve root compression
central disc protrusion-
compressed roots within cauda equina

Question 6

intervertebral discs

Answer 6

secondary cartilaginous joint

largest a vasular structure

Question 7

ALL and PLL

Answer 7

anterior posterior longitudinal ligament
fibres of the annulus fibrosis run obliquely and alternately between layers
discs fail with twisting movements

Question 8

nucleus pulposus

Answer 8

collagen and proteoglycans (hydrophilic)

disc prolapse usually postero lateral

Question 9

normal ageing

Answer 9

decreased water content
disc space narrowing
degenerative changes
aggravated by smoking

Question 10

nerve root pain

Answer 10

limb pain worse than back pain
pain in nerve root distribution (radicular)
dermatomes
physiotherapy
strong analgesia
MRI scans

Question 11

disc problems

Answer 11

bulge
protrusion
herniation
sequestration

Question 12

most common cervical site for disc prolapse

Answer 12

C5/C6

Question 13

thoracic disc prolapse

Answer 13

very uncommon

mostly T/11/12

Question 14

lumbar

Answer 14

L4/L5 most common followed by L5/S1

posterolateral (PLL weakest)

Question 15

cauda equina syndrome

Answer 15

cauda equina compression
surgical emergency
usually due to central lumbar herniated disc
clinical feat:
precipitating event
location (bilat buttock and leg pain +dysasthesia weakness)
bowel or bladder dysfunction
saddle anaesthesia, loss of anal tone and anal reflex
HIGH SUSPICION IN SPINAL POST OP PATIENTS WITH INCREASING LEG PAIN IN URINARY RETENTION.
treatment operative

Question 16

cervical and lumbar spondylosis

Answer 16

degenerative change
-Facet joints
discs

Question 17

cervical spine

Answer 17

foramen transversarium- transmit vertebral artery, may get occluded in cervical spondylosis causing LOC
Bifid spinous process (excpt c1 & C7)
C7 vertebra prominens

Question 18

cervical spondylosis

Answer 18

treatment non operative

Question 19

facets joins (true synovial joints)

Answer 19

flexion and extension

Question 20

ligaments

Answer 20

ALL, PLL, ligamentum flavum
interspinous and supraspinous ligaments
intertranverse ligament

Question 21

distinguishing spinal from vascular claudication

Answer 21

usually bilateral
sensory dysaesthesiae
poss weakness takes several minutes to ease after stopping walking
worse walking down hill worse cause of extension

Question 22

spinal stenosis

Answer 22

lateral recess
central
foraminal

Question 23

treatment

Answer 23

non operative
nerve root injection
epidural injection surgery
(central no nerve root injection)

Question 24

spondylolysis

Answer 24

defect of pars interarticularis

Question 25

spondylolisthesis

Answer 25

anterior vetebral translation of above vertebra on below vertebra

Question 26

spondylolysis symptoms

Answer 26

low back pain

occasional radicular symptoms

Question 27

oblique radiograph indicating spondylolysis

Answer 27

scotty dog (wearing a collar at L4)

Question 28

spondylolisthesis

Answer 28

classification
radiographic (meyerding
aetiologic (wiltse)