Spine and back Flashcards
Define spondylosis
Interverterbral discs lose water content with age -> less cushioning and increased pressure on facet joints -> secondary OA
What can cause “mechanincal back pain”
Obesity, poor posture, poor lifting technique, depression
Define “mechanical back pain”
Describe the pain
Recurrent relapsing and remitting back pain with no neurological symptoms
Worse on movement and improved by rest
How is “mechanical” back pain/acute disc tear managed?
Physio and analgesia
Patient with back pain that worsens on coughing?
Acute disc tear
Where does a disc tear occur in the spine?
What does it typically occur after?
Outer annulus fibrosis of intervertebral disc
Heavy lifting
What can happen as a result of a disc tear in lumbar spine?
Describe how a patient will complain?
Prolapse of the gelatinous nucleus pulposis -> can press on nerve root (most commonly sciatic) -> sciatica
SHOOTING pain in dermatomal distribution with associated weakness + loss of reflexes
What is the name for “disc prolapse”/”slipped disc” that affects the sciatic nerve?
Sciatica
Apart from disc tear what could also cause nerve root symptoms and sciatica?
Osteophytes impinging on exiting nerve roots
Occuring seocndary to OA of facet joints
What is the differences between claudication caused by PVD and claudication caused by spinal stenosis?
Spinal stenosis
- variable distance to trigger claudication
- burning pain as opposed to cramping
- pedal pulses retained
- pain is worse when walking downhill (reduced range in the spine)
PVD
- pain worse when walking uphill
What causes spinal stenosis?
A combination of spondylosis, bulging discs, bulging ligamentum flavum -> cauda equina has less space -> compressed/irritated nerve roots
What causes cauda equina syndrome?
Why is this a surgical emergency?
Very large CENTRAL DISC prolapse -> compresses all the nerve roots of cauda equina
It compresses the sacral nerves and if left untreated can cause permanent nerve damage -> failure to control defaecation and urination
What patient presentation is cauda equina syndrome until proven otherwise?
Bilateral leg symptoms/signs with suggestion of altered bowel/bladder function
What examination MUST be done if cauda equina is suspected?
PR exam - determine anal tone
How is cauda equina diagnosed?
What occurs immediately after diagnosis?
URGENT MRI
URGENT discetomy
What are the 4 red flags of back pain?
- Back pain in patient <20
- New back pain in patient >60
- Constant severe pain, worse at night
- Systemic upset (weight loss, fever, night sweats, malaise)
In severe osteoporosis spotnaeous crush fractures can occur what does this lead to?
Acute pain and kyphosis
Where can cervical spondylosis radiate to?
Shoulders and occiput (back of head)
In what conditions can cervical spine instability occur?
Why is it so dangerous?
Downs syndrome and RA
Can cause subluxation (misalignment) of atlas and axis -> spinal cord compression -> fatal
Why does RA cause cervical instability?
Damage to the synovial joint between the dens and axis and destruction of the transverse ligament of atlas
Define spinal shock.
When are symptoms predicted to resolve?
Physiological LOSS of motor, sensory and reflexes distal from site of injury
within 24hrs
What kind of shock can occur secondary to spinal shock esp. when damage has been done to cervical and upper thoraric verterbrae.
What does this result in?
What is the way to manage this?
Neurogenic
Reduced HR + BP
Priapism - permanent and painful erection
IV fluids (should resolve in 24-48hrs)
How do you define what level the spine is damaged from?
The lowest spinal level with FULL function
What sign differentiates complete from incomplete spinal cord injury?
Sacral sparing
- preservation of perianal sensation
- voluntary anal contraction
- big toe flexion
A patient with complete spinal cord injury will still have their reflexes. True or false?
True
What reflex is used to test for spinal shock?
Bulbocavernous reflex - external anal sphincter reflexly contracts on squeeze of glans penis or clit
Pain in what region of the back is a red flag symptom?
Thoracic
A lateral Xray of the cervical spine is enough for being able to identify fracture. T/F?
T
