Spine and back Flashcards
What are the indications for imaging in non specific back pain?
Likely pathology e.g. malignancy
Result of imaging likely to change management
What imaging is used for back pain?
MRI
What is the management of non specific back pain?
Encourage self management
1st line= NSAIDs- co-prescribe PPI if >45
Exercise
What is myelopathy?
Compression of spinal cord
What are common causes of myelopathy?
Spondylosis
Spinal stenosis
Where is the most common area for myelopathy
CErvical spine
What is the presentation of myelopathy?
UMN signs
Back pain > limb pain
What investigation is done fr myelopathy?
MRI
What is radiculopathy?
Compression of nerve root
What is the presentation of radiculopathy?
Limb pain>back pain
Root tension- using muscles supplied exacerbates pain
Root compression- weakness and changes in sensation
What is the management of radiculopathy?
Analgesia and physio
Referral if persistent
What is spinal stenosis?
Central canal of spinal cord narrowed
What can cause spinal stenosis?
Degenerative= most common
Tumour
Disc prolapse
Congenital
What is the presentation of lumbar spinal stenosis?
Back pain Neuropathic pain of legs- better when leaning forward or walking uphill Weakness and numbness Gradual onset Severe= incntinence
What is the investigation of spinal stenosis?
MRI
What is the management of lumbar spinal stenosis?
Laminectomy
What is the most common cervical stenosis?
Degenerative cervcal myelopathy
What are the risk factors for degenerative cervical myelopathy?
Smoking
Occupation
FH
What is the presentation of degenerative cervical myelopathy?
Pain in neck and all 4 limbs Loss of dexterity, weakness, gait imbalance Numbness, paraestoesia Severe= incontinence Hoffman's sign
What is Hoffman’s sign?
Flick 1 finger and other fingers will move in response
What investigation is done for cervical degenerative myelopathy?
MRI= disc degeneration, ligament hypertrophy, spinal cord change
What is the management of degenerative cervical myelopathy?
Urgent referral for assessment
Decompressive surgery
What is spondylosis?
Degenerative changes of spine, essentially OA
Very common
What is disc prolapse?
Tearing of annulus fibrosis, causing nucleus pulposis to protrude, compression the cord or nerve root
What are th types of disc prolapse?
Bulge= common, majority asymptomatic
Protrusion
Extrusion
Sequestration= desiccated disc material free in canal
Where is disc prolapse common?
C5/6
T11/12
L4/5
S1
What is the presentation of disc prolapse?
Asymptomatic
Often produces clear dermatomal pattern
CEntral= myelopathy
Lateral= radiculopathy
What is the management of disc prolapse?
Analgesia, physiotherapy
Persistent= refer for MRI
Who are the most spinal cord injuries seen in?
Males > females
20-29yo
What are the common causes of spinal cord injury?
Trauma- most comon= fall, RTC, sports Degenerative orthopaedic Spinal cord infarct Transverse myelitis Thoracoadbsominal aortic aneurysm
What is the classification used for spinal cord injury?
ASIA
What are the ASIA classifications?
A= no sensory/motor in S4/5 B= sensory but no motor below neurological level C= Motor function preserved below level but grade <3 D= Motor function preserved below level and grade >3 E= normal
What are some patterns of spinal cord injury?
Quadraplegia Paraplegia Central cord syndrome Anterior crd syndrome Brown-Sequard syndrome
What is quadriplegia?
Loss of motor/sensory function in cervical segments of spinal cord
Partial or total loss of use of all 4 limbs and trunk- spastic weakness in all limbs
Resp failure if above C5
What is paraplegia?
Impaired or loss of motor/sensory function in T/L or S spine
Partial or total loss of use of lower limbs, arms spared but trunk may be involved
Spastic weakness if Above L1
Bladder and bowel can be affected
What is central cord syndrome?
Hypertextension injury to neck where cervical tracts are more involved
What is the presentation of central cord syndrome?
Older patient
Weakness of arms, with perianal and lower extremities power preserved
What is anterior cord syndrome?
Hyperflexion injury causes anterior compression fracture and damaged anterior spinal artery
What is the presentation of anterior cord syndrome?
Profound weakness
Vibratory sense, fine discrimination ad proprioception preserved
What is Brown-Sequard syndrome?
Paralysis and loss of proprioception and fine discrimination ipsilateral below lesion
Loss of pain and temperature sensation on contralateral below lesion
What causes Brown-Sequard?
Hemisection of cord, out often due to penetrating injury
What are the types of shock affecting the spine?
Neurogenic shock
Spinal shock
What is neurogenic shock?
Injury above T6 causing disruption to sympathetic outflow –> hypotension, bradycardia and hypothermia
What is spinal shock?
Transient depression of cord function below level of injury
Flaccid paralysis and areflexia
Can last hours to days
What is the urgent management of spinal cord injury?
ABCD
Imaging- MRI and XR
What is the long term management of spinal cord injury?
Spinal cord injury unit Physio OT Psych Urological and sexual counselling
What is the management of unstable spinal fractures?
Usually pedicle screws from posterior
What is cauda equina syndrome?
Compression of caudal equina
What can cause cauda equina?
Central lumbar disc prolaps= most common Tumours Trauma Spinal stenosis Infection Iatrogenic- epidural, spinal surgery
What is the presentation of cauda equina?
Bilateral buttock and leg pain
Varying dysaethesia and weakness
Saddle anaesthesia
Urinary retention +/- incontinence
What is the management of cauda equina?
Urgent MRI
Operation within 48 hours of onset
What are some complications of cauda equina?
Delay= permanent bladder and anal sphincter dysfunction
~30% never go back to “normal”
