Spine and back

Question 1

Define spondylosis

Answer 1

Interverterbral discs lose water content with age -> less cushioning and increased pressure on facet joints -> secondary OA

Question 2

What can cause “mechanincal back pain”

Answer 2

Obesity, poor posture, poor lifting technique, depression

Question 3

Define “mechanical back pain”

Describe the pain

Answer 3

Recurrent relapsing and remitting back pain with no neurological symptoms

Worse on movement and improved by rest

Question 4

How is “mechanical” back pain/acute disc tear managed?

Answer 4

Physio and analgesia

Question 5

Patient with back pain that worsens on coughing?

Answer 5

Acute disc tear

Question 6

Where does a disc tear occur in the spine?

What does it typically occur after?

Answer 6

Outer annulus fibrosis of intervertebral disc

Heavy lifting

Question 7

What can happen as a result of a disc tear in lumbar spine?

Describe how a patient will complain?

Answer 7

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

Question 8

What is the name for “disc prolapse”/”slipped disc” that affects the sciatic nerve?

Answer 8

Sciatica

Question 9

Apart from disc tear what could also cause nerve root symptoms and sciatica?

Answer 9

Osteophytes impinging on exiting nerve roots

Occuring seocndary to OA of facet joints

Question 10

What is the differences between claudication caused by PVD and claudication caused by spinal stenosis?

Answer 10

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

Question 11

What causes spinal stenosis?

Answer 11

A combination of spondylosis, bulging discs, bulging ligamentum flavum -> cauda equina has less space -> compressed/irritated nerve roots

Question 12

What causes cauda equina syndrome?

Why is this a surgical emergency?

Answer 12

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

Question 13

What patient presentation is cauda equina syndrome until proven otherwise?

Answer 13

Bilateral leg symptoms/signs with suggestion of altered bowel/bladder function

Question 14

What examination MUST be done if cauda equina is suspected?

Answer 14

PR exam - determine anal tone

Question 15

How is cauda equina diagnosed?

What occurs immediately after diagnosis?

Answer 15

URGENT MRI

URGENT discetomy

Question 16

What are the 4 red flags of back pain?

Answer 16

1. Back pain in patient <20
2. New back pain in patient >60
3. Constant severe pain, worse at night
4. Systemic upset (weight loss, fever, night sweats, malaise)

Question 17

In severe osteoporosis spotnaeous crush fractures can occur what does this lead to?

Answer 17

Acute pain and kyphosis

Question 18

Where can cervical spondylosis radiate to?

Answer 18

Shoulders and occiput (back of head)

Question 19

In what conditions can cervical spine instability occur?

Why is it so dangerous?

Answer 19

Downs syndrome and RA

Can cause subluxation (misalignment) of atlas and axis -> spinal cord compression -> fatal

Question 20

Why does RA cause cervical instability?

Answer 20

Damage to the synovial joint between the dens and axis and destruction of the transverse ligament of atlas

Question 21

Define spinal shock.

When are symptoms predicted to resolve?

Answer 21

Physiological LOSS of motor, sensory and reflexes distal from site of injury

within 24hrs

Question 22

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?

Answer 22

Neurogenic

Reduced HR + BP
Priapism - permanent and painful erection

IV fluids (should resolve in 24-48hrs)

Question 23

How do you define what level the spine is damaged from?

Answer 23

The lowest spinal level with FULL function

Question 24

What sign differentiates complete from incomplete spinal cord injury?

Answer 24

Sacral sparing

• preservation of perianal sensation
• voluntary anal contraction
• big toe flexion

Question 25

A patient with complete spinal cord injury will still have their reflexes. True or false?

Answer 25

True

Question 26

What reflex is used to test for spinal shock?

Answer 26

Bulbocavernous reflex - external anal sphincter reflexly contracts on squeeze of glans penis or clit

Question 27

Pain in what region of the back is a red flag symptom?

Answer 27

Thoracic

Question 28

A lateral Xray of the cervical spine is enough for being able to identify fracture. T/F?

Answer 28

T