spine conditions Flashcards
lower back pain red flags
- < 20 or > 55
- night pain
- thoracic pain
- constant or progressive pain
- pain worse when lying down
- bilateral or alternating sciatica
- progressive neurological symptoms
- medical history of immunosuppression or malignancy
what is mechanical back pain
back pain in absence of neurological dysfunction
mechanical back pain risk factors
- obesity
- trauma
- osteoarthritis
- disc prolapse
- acute disc tear (pain worse on coughing)
mechanical back pain presentation
- lumbar pain
- radiation to buttock but not to below knees
- sudden onset, worse on activity and relieved by rest
- recurrent episodes of similar back pain
mechanical back pain diagnosis
x-ray (if no symptomatic improvement within 6-8 weeks)
mechanical back pain management
- exercise after 48 hours
- analgesia
- physiotherapy
sciatica pathophysiology
- develops due to prolapse of IV discs within the lumbar region impinging on the sciatic nerve, with L4/L5 and the L5/S1 discs being most likely to prolapse
- results in pain and altered sensation in a dermatomal distribution and weakness in a myotomal distribution
L3/L4 disc prolapse leads to radiation of pain to where
medial ankle
L4/L5 disc prolapse leads to radiation of pain to where
dorsum of foot
L5/S1 disc prolapse leads to radiation of pain to where
sole of foot
if there is L3/L4 disc prolapse, what nerve root has been entrapped
L4
if there is L4/L5 disc prolapse, what nerve root has been entrapped
L5
if there is L5/S1 disc prolapse, what nerve root has been entrapped
S1
L3/L4 disc prolapse leads to weakness where
- knee extension
- reduced right knee jerk
L4/L5 disc prolapse leads to weakness where
- dorsal flexion
- extension of big toe
L5/S1 disc prolapse leads to weakness where
- plantar flexion
- ankle jerk
sciatica presentation
- sudden onset lumbar back pain with radiation to buttock and to below the knee
- pain that is burning and tingling
- neurological disturbance (numbness, tingling and weakness)
- reduced back movements
- positive straight leg raise
sciatica diagnosis
PR to rule out cauda equina
sciatica management
- mobilisation, analgesia and physiotherapy
- surgery only in some chronic cases
cauda equina syndrome cause
caused by large lumbar disc prolapse that compresses all of the nerve roots of the cauda equina (especially S4 and S5)
cauda equina syndrome presentation
- back pain with bilateral sciatica (leg pain, numbness, weakness and tingling)
- saddle anaesthesia
- alteration in bladder and bowel function (retention or incontinence)
cauda equina syndrome diagnosis
- PR exam
- urgent MRI
cauda equina syndrome management
- prompt surgical intervention
- surgical emergency –> prolonged compression of the nerve roots can cause permanent damage and lead to need for colostomy and urinary diversion
spinal stenosis is most common in
> 60s
