Spine Coretext

Question 1

What is meant by “ Mechanical Back pain”?

Answer 1

Recurrent, relapsing and remitting back pain with no neurological symptoms

Question 2

What is spondylosis?

Answer 2

It is when the intervertebral discs loose water content

Question 3

How do you treat mechanical back pain?

Answer 3

Reassurance

Weight loss

Physiotherapy

Activity

Analgesia

Question 4

What is an accute disc tear?

Answer 4

A tear of the outer annulus fibrosis.

Question 5

What activity classicly results in an acute disc tear?

Answer 5

Lfiting a heavy object

Question 6

What un related symptom exacerbates the pain of acute disc tears?

Answer 6

coughing

Question 7

What is the prognosis for an acute disc tear?

Answer 7

Resolve after 2-3 months

Question 8

What is Sciatica?

Answer 8

Herniating disc pressing on a exiting nerve root.

Question 9

What are the symptoms of nerve impingement?

Answer 9

Altered sensation in the dermatomal distribution along with reduced power in the myotomal distribution

Question 10

Where do herniated discs usually occour?

Answer 10

L4, L5, S1

Question 11

Which root will be affected in the follwing cases?

L3/4 prolapse

L4/5 prolapse

L5/S1 prolapse

Answer 11

L4 root entrapment

L5 root entrapment

S1 root entrapment

Question 12

What is the first line treatment for sciatica?

Answer 12

Analgesia

maintain mobility

Physiotherapy

Question 13

What drug can be used if Sciattica pain is very severe?

Answer 13

Gabapentin

Question 14

What are boney nerve root entrapments of the spine and how are they fixed?

Answer 14

OA of the facet joints resulting in osteophytes impinging on exiting nerve roots

Surgical decompression with trimming of osteophytes

Question 15

What is spinal stenosis?

Answer 15

Spondylosis, bulging discs and osteophytosis results in the cauda equina having less space - multiple nerve roots become compressed

Question 16

What symptom to people with spinal stenosis present with?

Answer 16

Limb claudication

Question 17

In what way is the character of limb claudication experianced in spinal stenosis different to that of peripheral vascular disease?

Answer 17

• Claudication distance is inconsistant
• Pain is burnin rather than cramping
• Pain is less walking up hill ( Spine flexion makes space)
• Peal pulses are preserved

Question 18

What is the management plan for spinal stenosis?

Answer 18

Conservative management

Physiotherapy

Weight loss

decrompresion surgery if neccessary

Question 19

What is Cauda Equina Syndrome?

Answer 19

Disc prolapse compresing all of the nerve roots of the caudia equina including the sacral nerve roots

Question 20

Why is cauda equina syndrome a medical emergancy?

Answer 20

S4 and S5 nerve roots are involved with control urination and defication.

Permanent nerve damage must be avoided

Question 21

How do people with Cauda Equina Syndrome usually present ?

Answer 21

Bilateral leg pain

Saddle anaesthesia

Incontenence or constipation

Question 22

What is the management pathway for a patient with suspected Cauda Equina Syndrome

Answer 22

Urgent MRI

Urgent disectomy

Question 23

What are the “red flags” in relation to the Lumbar Spine?

Answer 23

1. Back pain in younger patient <20
2. New back pain in older patient >60
3. Nature of pain - constant, severe pain worse at night
4. Systemically unwell

Question 24

What are Osteoporotic Crush fractures?

Answer 24

Spontaneous crush fractures of a vertebral body as a result of severe osteoporosis

Question 25

What symptoms are associated with Cervical Disc prolapse?

Answer 25

Shooting neuralgic pain down a dermatomal distribtion and loss of refluxes

Question 26

What kinds of people are at higher risk of cervical spine instability?

Answer 26

People with Downs Syndrome