Spine Coretext Flashcards
What is meant by “ Mechanical Back pain”?
Recurrent, relapsing and remitting back pain with no neurological symptoms
What is spondylosis?
It is when the intervertebral discs loose water content
How do you treat mechanical back pain?
Reassurance
Weight loss
Physiotherapy
Activity
Analgesia
What is an accute disc tear?
A tear of the outer annulus fibrosis.
What activity classicly results in an acute disc tear?
Lfiting a heavy object
What un related symptom exacerbates the pain of acute disc tears?
coughing
What is the prognosis for an acute disc tear?
Resolve after 2-3 months
What is Sciatica?
Herniating disc pressing on a exiting nerve root.
What are the symptoms of nerve impingement?
Altered sensation in the dermatomal distribution along with reduced power in the myotomal distribution
Where do herniated discs usually occour?
L4, L5, S1
Which root will be affected in the follwing cases?
L3/4 prolapse
L4/5 prolapse
L5/S1 prolapse
L4 root entrapment
L5 root entrapment
S1 root entrapment
What is the first line treatment for sciatica?
Analgesia
maintain mobility
Physiotherapy
What drug can be used if Sciattica pain is very severe?
Gabapentin
What are boney nerve root entrapments of the spine and how are they fixed?
OA of the facet joints resulting in osteophytes impinging on exiting nerve roots
Surgical decompression with trimming of osteophytes
What is spinal stenosis?
Spondylosis, bulging discs and osteophytosis results in the cauda equina having less space - multiple nerve roots become compressed
What symptom to people with spinal stenosis present with?
Limb claudication
In what way is the character of limb claudication experianced in spinal stenosis different to that of peripheral vascular disease?
- Claudication distance is inconsistant
- Pain is burnin rather than cramping
- Pain is less walking up hill ( Spine flexion makes space)
- Peal pulses are preserved
What is the management plan for spinal stenosis?
Conservative management
Physiotherapy
Weight loss
decrompresion surgery if neccessary
What is Cauda Equina Syndrome?
Disc prolapse compresing all of the nerve roots of the caudia equina including the sacral nerve roots
Why is cauda equina syndrome a medical emergancy?
S4 and S5 nerve roots are involved with control urination and defication.
Permanent nerve damage must be avoided
How do people with Cauda Equina Syndrome usually present ?
Bilateral leg pain
Saddle anaesthesia
Incontenence or constipation
What is the management pathway for a patient with suspected Cauda Equina Syndrome
Urgent MRI
Urgent disectomy
What are the “red flags” in relation to the Lumbar Spine?
- Back pain in younger patient <20
- New back pain in older patient >60
- Nature of pain - constant, severe pain worse at night
- Systemically unwell
What are Osteoporotic Crush fractures?
Spontaneous crush fractures of a vertebral body as a result of severe osteoporosis
What symptoms are associated with Cervical Disc prolapse?
Shooting neuralgic pain down a dermatomal distribtion and loss of refluxes
What kinds of people are at higher risk of cervical spine instability?
People with Downs Syndrome
