Spine Conditions Flashcards
What is mechanical back pain?
back pain with no neurological symptoms that is worse when moving and relieved by rest
What is spondylosis?
osteoarthritis in the spine
How does spondylosis develop?
Intervertebral discs lose water with age which puts extra load on the facet joints -> this leads to OA in these joints
Will it be more painful to lean forwards or backwards in spondylosis and why?
more painful to lean backwards bc putting even more load onto the facet joints
What is spinal stenosis?
Compression of nerve roots leaving the spinal cord due to Osteoarthritis
What causes spinal stenosis?
osteophytes and thickened ligaments in the vertebrae due to osteoarthritis (spondylosis)
How does spinal stenosis present?
Neurogenic claudication -> burning pain in legs when exercising
What makes neurogenic claudication in spinal stenosis better/worse?
better = walking uphill worse = walking downhill
What happens in an intervertebral disc prolapse?
the nucleus pulposus pops out of the annulus fibrosis and compresses nerve roots
Which regions in the back are lumbar intervertebral disc prolapses most likely to occur in?
L4/5
L5/S1
Back pain that is worse when coughing is a sign of what?
Intervertebral disc prolapse
How long does it take most disc prolapses to get better by?
3 months
Which nerve root would be affected in:
Lateral L4/5 disc prolapse
Posterior L4/5 disc prolapse
Lateral = exiting L4 nerve root Posterior = transverse L5 nerve root
What is altered bladder and bowel function a red flag for?
Cauda equina syndrome
What investigation should always be done if cauda equina syndrome is suspected? What would be found?
PR exam - loss of anal tone
What is cauda equina syndrome?
compression of all sacrolumbar nerve roots due to a prolapsed disc
Management of cauda equina syndrome?
Urgent surgical decompression
What is scoliosis?
lateral spinal curvature with secondary vertebral rotation, Cobbs angle >10
Give 3 causes of scoliosis?
idiopathic (most common)
congenital (wedges of vertebra don’t develop properly)
neuromuscular (muscles dont work so spine is pulled to the side)
What is Cobbs angle?
Measurement of curvature of the spine in degrees
Does growth make scoliosis better or worse?
Worse - it will accentuate the curve
How can mild scoliosis be made more obvious on examination?
asking the patient to lean forward
Management of scoliosis?
conservative: physio, bracing, corrective exercises
surgery: for cosmetics and breathing difficulties
What is kyphosis?
excessive curvature in the saggital plane of the spine (>40 degrees) - hunchback
Give 3 things that can cause kyphosis?
Spinal TB (developing world v common) Congenital deformity Severe osteoporosis
When is kyphosis operated on and why?
when the curve gets to 70 degrees or worse - surgery is v risky and has lots of complications so want to avoid if possible
What is spondylolysis?
Stress fracture of the isthmus of the vertebral arch
What can spondylolysis progress to?
Spondylolisthesis
what is spondylolisthesis?
anterior displacement of one lumbar vertebrae on the one below - basically a slipped vertebrae
At what level do spondylolisthesis usually occur?
L5/S1
A patient presents with sudden onset lower back pain, sciatica and a waddling gait. Their lumbar spine looks flat. Most likely diagnosis?
Spondylolisthesis
Why do people present with a waddling gait in spondylolisthesis?
their hamstrings are tight due to supporting the lower back and compensating for the slipped vertebrae
Management of spondylolisthesis?
conservative management first
if unsuccessful then spinal fusion (happens in 50%)
What is cervical spondylosis?
OA in facet joints of the cervical spine
Typical presentation of cervical spondylosis?
slow onset stiffness and pain in the neck
pain can radiate to shoulders
What can cause upper limb nerve problems in patients with cervical spondylosis?
nerve impingement due to osteophytes
What 2 conditions can atraumatic cervical spine instability occur in and which joint does it occur in?
Down syndrome
rheumatoid arthritis
Atlanta/axial joint (C1/C2)
Management of cervical spine instability?
mild = collar severe = spinal fusion
