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MSK > Spine & Back Pain > Flashcards

Spine & Back Pain Flashcards

1
Q

Mechanical pain varies according to activity and time of day, true or false?

A

False

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2
Q

Back pain should be worse at night. True/false?

A

False

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3
Q

Schober’s Method tests what?

A

Range of spinal flexion (10cm above, 5cm below)

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4
Q

What cm is normal movement in Schober’s Method?

A

21cm

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5
Q

Which cm is stiff in Schober’s Method?

A

<18cm

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6
Q

Which cm is hypermobile in Schober’s Method?

A

> 24cm

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7
Q

Hip flexion (straight leg raise) tests which nerve root vertebra?

A

L1/L2

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8
Q

Knee extension tests the nerve roots at which vertebral levels?

A

L3/L4

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9
Q

Dorsiflexion of the foot tests the nerve roots at which vertebral level?

A

L5

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10
Q

X-rays are useful in back pain investigations. True/false?

A

False - 99% of back pain will give no abnormality on x-ray

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11
Q

Disc prolapse is always painful. True/false?

A

False

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12
Q

Common presenting symptoms of disc pain include (3)

A

1) Episodic back pain
2) Leg pain becoming dominant in life
3) Specific myotome/dermatomal involvement

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13
Q

Which % of patients with disc pain will settle within 3 months?

A

70%

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14
Q

Surgery is clearly better than other management options in disc prolapse. True/false?

A

False - no clear benefit versus conservative (90% will resolve within 18-24 months)

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15
Q

Surgery should be considered if back pain does not resolve after how long?

A

> 3 months

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16
Q

First line therapy in back pain outline (4)

A

1) Short bed rest (NOT prolonged)
2) NSAIDs (with a SHORT course of muscle relaxants, i.e. a day or two)
3) Mobilisation ASAP
4) Return to normal activity ASAP

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17
Q

Second line therapy for backache (4)

A

1) Education
2) Physiotherapy
3) Osteopathy / osteopath
4) TENS / pain clinic

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18
Q

Red flags in back pain include (5)

A

1) Non-mechanical (i.e. constant)
2) History of cancer
3) Age <20 years or >60 years with first back pain
4) Saddle anaesthesia
5) Longer than 6 weeks of pain

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19
Q

Central cord injuries classical result from what type of injury?

A

Hyperextension

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20
Q

Brown-Sequard Syndrome presents how

A

Paralysis on the ipsilateral side and paesthesia on the contralateral side. Best prognosis spinal injury.

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21
Q

AS should immediately be immobilised in a collar and x-rayed. True/false?

A

False - immobilise in natural position and refer for CT immediately

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22
Q

Describe the normal spinal curves (3)

A

1) Cervical lordosis
2) Thoracic kyphosis
3) Lumbar lordosis

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23
Q

Which structure on the spinal column connects to the spinal body?

A

Pedicle

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24
Q

C1 has no vertebral body. True/false?

A

True - instead it has arches

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25
Q

What makes C2 unique?

A

Has a dens which projects into C1

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26
Q

Spinal ligaments can only be directly visualised how?

A

MRI

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27
Q

Spinal cord is shown on X-ray. True or false?

A

False

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28
Q

Spinal cord is shown on CT. True/false?

A

True - although poor. Optimal modality is MRI

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29
Q

What is the normal number of vertebra? How are they divided?

A 
33
7 Cervical
12 Thoracic
5 Lumbar
5 Sacral (fused)
4 Coccyx (fused)
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30
Q

The intervertebral discs are what kind of joint

A

Secondary fibrocartilaghinous

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31
Q

Articular joints of the spine are which type of joint

A

Synovial

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32
Q

Articular joints of the spine enable which movements (3)

A

1) Extension
2) Flexion
3) Lateral Flexion

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33
Q

Which area of the spine has the greatest ROM?

A

C-spine

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34
Q

Which area of the spine has the LEAST degree of extension/ flexion?

A

Thoracic

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35
Q

Spondyolysis causing secondary OA of the spine will be exacerbated with which movement

A

Extension (moves more pressure onto facet joints)

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36
Q

An MRI is diagnositic for disc degeneration, T/F?

A

False - 60% of people over 45 will have asymptomatic bulging spines

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37
Q

What are the commonest areas for disc prolapse?

A

L4/L5

L5/S1

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38
Q

What is the underlying pathophysiology in an acute disc tear?

A

The annulus fibrosus is torn, allowing the inner nucleus pulposus to leak out

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39
Q

Acute disc tear pain will be worsened by which movement

A

Cough (raises pressure)

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40
Q

From the spine, motor/ efferent neurones exit from the anterior or posterior horn?

A

Anterior

41
Q

From the spine, sensory / afferent neurones exit from anterior or posterior horn?

A

Posterior

42
Q

From the spine, nerves exit through which osteological structure?

A

Intervertebral foraminae

43
Q

The spinal cord ends at which level

A

L1-L2

44
Q

The exiting nerve root from a spine exits at which level?

A

Under pedicle of same level (i.e. L4 at L4)

45
Q

A transverse nerve root of the spine exits at which level?

A

Under pedicle of the level below (i.e. L5/S1 exits at S1)

46
Q

What are the nerves contained within the spine?

A

Thecal sac

47
Q

Most disc prolapses affect the exiting or transverse nerve root?

A

Transverse (i.e. level below)

48
Q

A very lateral prolapse can affect which nerve root?

A

Exiting root

49
Q

What is a radiculopathy

A

Pain and weakness down a specific dermatome with associated loss of power in the corresponding myotome & loss of appropriate reflexes

50
Q

How can mechanical back pain be confused for sciatica?

A

Mechanical back pain can radiate to the buttocks & thigh. Sciatica however must present below the knee.

51
Q

The nerve roots of which level are affected in sciatica?

A

L1, L2, and L3.

52
Q

Spinal stenosis is root compression due to…

A

Osteophyte formation (e.g. in OA) or hypertrophic ligaments (especially ligamentum flavum)

53
Q

Radiculopathy pain will be worse/ better upon walking?

A

Worse (neurogenic claudication)

54
Q

Patients with radiculopathy pain will find it easier to walk up or downhill?

A

Uphill (encourages natural flexion)

55
Q

Cauda Equina is caused by compression where?

A

On ALL lumbosacral roots

56
Q

What’s the usual cause of Cauda Equina?

A

Disc prolapse

57
Q

What are the muscles of the spine? Why are these important to know?

A

Iliocostalis, longissumus thoracis, spinalis thoracis (collectively the “erector spinae”). Important as these can be a source of sprains/strains.

58
Q

What is a Chance fracture? What is a frequent cause?

A

Fracture of the vertebral body. Often due to seatbelt injury. Very unstable.

59
Q

What vertebral level are LPs performed at?

A

L4

60
Q

What are the overt pain behaviours?

A

Guarding, bracing, rubbing, grimacing, sighing.

61
Q

X-rays are useful in diagnosis of back pain, T/F?

A

False - 99% will have no unexpected abnormality

62
Q

First-line investigation for back pain in a clinic

A

MRI

63
Q

What older imaging technique is useful for showing spinal stenosis?

A

Myelogram

64
Q

What is sciatica?

A

Buttock and/or leg pain in a specific dermatome with myotomal weakness and loss of reflexes (neurological involvement)

65
Q

Slipped discs are always symptomatic, T/F?

A

False

66
Q

What are common presentations of slipped disc?

A

Episodic pain in back/ leg with or without CNS involvement. Pain in leg becomes dominant over back pain.

67
Q

Is disc prolapse a surgical emergency?

A

Not unless cauda equina is present

68
Q

What % of disc prolapse will resolve within 18-24 months?

A

90%

69
Q

T/F: surgery has been shown to have long-term benefits for treatment of slipped disc versus conservative treatment?

A

False - the benefit is short term as outcomes at 2, 5 and 10 years are the same for surgical and conservatively managed patients

70
Q

How is back-pain treated (conservative)? (4)

A

Short bed rest (as little as possible without pain), NSAIDs +/- a day or two of muscle relaxant, early mobilisation and early return to work

71
Q

What treatment options have been discredited in management of slipped disc?

A

Longterm bed rest, narcotics >2 weeks, muscle relaxant >2 weeks, steroids.

72
Q

Describe the 2nd line treatment options for back pain

A

Education, physiotherapy, TENS & complimentary therapies

73
Q

What is a risk of surgery for back pain?

A

Chronic pain syndrome, adjacent segment disease

74
Q

What % surgeries for back pain are successful?

A

75-80%

75
Q

What % of surgeries for back pain fail?

A

Up to 25%

76
Q

What % of surgeries for back pain result in CNS damage?

A

0.5-1%

77
Q

What % of surgeries for back pain result in worse outcomes than what was present pre-surgery?

A

3-5%

78
Q

When does adjacent segment disease present after a level 2 spine fusion?

A

8-10 years

79
Q

When does adjacent segment disease present after a level 3 spine fusion?

A

18-24 months

80
Q

When does Cauda Equina need to be treated?

A

Within 24 hours

81
Q

Cauda Equina causes which kind of urinary symptom? Is it painful?

A

Painless retention with urinary overflow

82
Q

Do most Cauda Equina cases present with the same general symptoms?

A

No, most are atypical and have unusual presentation (e.g. no pathology present on imaging but symptoms present)

83
Q

Cauda Equina symptoms usually progress to Cauda Equina Syndrome, T/F?

A

False - most do not have any serious issue.

84
Q

In a suspected spine injury, what are the first 3 management tasks?

A

1) Immobilise
2) ABCDE
3) X-ray

85
Q

Assessment of spinal injuries involves which 3 processes?

A

1) X-ray (if C-spine injury suspected this MUST show C7 and T1)
2) Neurological exam (especially of the saddle area)
3) Screen for spinal cord involvement (note may not appear on X-ray, and spine cord can become involved in secondary damage e.g. due to hypoxia or oedema)

86
Q

Which level of the spine do thoracolumbar injuries tend to present at?

A

T12 or L1

87
Q

Which area of the spine should be visulised if suspected thoraco-lumbar injury?

A

Entire spine

88
Q

What are the characteristics of a complete spinal cord injury?

A

1) Saddle sparing (ANY saddle involvement means not complete)
2) Progressive weakness/numbness
3) Ascending lesion (eventually giving a “cape anaesthesia”)

89
Q

Central Cord Injury is complete/incomplete. It typically results from ____ type of injury. The prognosis is….

A

Incomplete
Hyperextension
Prognosis variable but generally good

90
Q

Brown-Sequard injury is complete/incomplete. Typical symptoms include (2). The prognosis is…

A

Incomplete.
Paralysis on ipsilateral side and loss of pain sensation on contralateral side.
Best prognosis of spine cord injuries.

91
Q

Anterior cord injury is complete/incomplete. Symptoms include (2). Prognosis is generally…

A

Incomplete.
Symptoms are: loss of pain and temperature sense BUT preserved deep touch, position and vibration.
Prognosis is very poor.

92
Q

Anterior cord injury can result from which injury type

A

Trauma or vascular injury (e.g. a complication of repair of AAA)

93
Q

When should spinal cord surgery be commenced?

A

Within 7-10 days (allows swelling to settle down).

94
Q

Is it always a good idea to surgically stabilise the spine immediately after spine cord injury detected?

A

No - the area begins to swell.

95
Q

Chance fracture is stable/unstable.

A

Unstable - requires surgery.

96
Q

What’s the key difference in managing spinal injury in patients with AS versus spinal injury in otherwise healthy patients?

A

Do NOT use collars etc. in AS as this creates a lordosis at the collar which worsens damage angle.

97
Q

In a suspected C-spine injury in patients with AS, what investigation must be done?

A

CT

98
Q

MRI should be performed in which cases? (2)

A

1) If red flags present

2) If considering surgery (e.g. for spinal stenosis)

MSK (21 decks)

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