Spine Conditions Flashcards
Red flag symptoms are present with mechanical back pain. True/False?
False
What is meant by spondylosis?
Intervertebral discs lose water content with age, resulting in less cushioning
Where does acute spinal disc tear/extrusion occur (which part of the IV disc)?
Outer annulus fibrosis
What is characteristic of pain from acute IV disc tear?
Worse on coughing
Acute disc tears usually resolve by themselves. True/False?
True
Analgesia and 3 months of physio are main treatment
What is the main complication of disc tears? How is it managed?
Nucleus pulposis can herniate outwards and impinge on nerve root —> nerve root compression
Doesnt settle in 3 months = surgery (disectomy/ decompression)
Pain in sciatica follows what distribution?
Dermatomal distribution
What is meant by spinal stenosis? How is it managed?
Cauda equina has little space and nerve roots can become compressed/irritated by osteophytes
Surgical decompression and stabilisation
List contributing factors to spinal stenosis
Bulging IV discs
Bulging spinal ligaments
Osteophytosis
Claudication classically occurs with spinal stenosis. How does this differ from vascular claudication?
Burning pain (rather than cramping) Pain walking downhill Pedal pulses normal
What is cauda equina syndrome?
Large central disc prolapse can compress all the lumbosacral nerve roots of the cauda equina
Cauda equina syndrome can be managed conservatively. True/False?
False
It is a surgical emergency!
List clinical features of cauda equina syndrome
Bilateral leg pain (LMN signs)
Saddle anaesthesiae/numbness
Altered bowel habit
Loss of anal tone
What examination is mandatory in cauda equina syndrome?
PR exam
What is the urgent treatment for cauda equina syndrome?
Urgent MRI to determine level of prolapse
Disectomy
List 4 red flag symptoms of spinal disease
Back pain in young patient (<20)
New back pain in old patient (>50)
Constant, severe pain, worse at night (non-mechanical pain)
Systemic upset
Saddle anaesthesia + bladder/bowel upset
Feeling unwell/ weight loss/ Hx of carcinoma
Severe pain > 6 weeks
List clinical features of cervical nerve root compression
Shooting neuralgic pain in dermatomal patternWeakness/loss of reflexes
Which nerve root is involved for C6/C7 disc nerve root compression?
C7 root (there is no C1 nerve root)
Which nerve root is affected by C8/T1 disc nerve root compression?
C8 root
What is the first-line investigation for back pain?
MRI
Define sciatica
Buttock +/- leg pain in a dermatomal distribution accompanied by neurological disturbance
Disc prolapse is a medical emergency. True/False?
False
Only if accompanied by cauda equina symptoms
What is spondylolysis?
Defect in the pars interarticularis of the vertebra
What is spondylolisthesis?
Forward slippage of one vertebra onto another
