Spine disease

Question 1

Define Cauda equina

Answer 1

Compression of the terminal nerve roots

Question 2

Symptoms of cauda equina

Answer 2

Pain (bilateral burning radiating down the leg), Urinary retention, Faecal incontinence

Question 3

Signs of cauda equina

Answer 3

Palpable bladder, Hyporeflexia, Bilateral leg weakness, Bilateral leg paraesthesia, Decreased anal tone

Question 4

Investigations for cauda equina

Answer 4

MRI

Question 5

Management of cauda equina

Answer 5

Decompression within 48hrs

Question 6

Most common site of disc herniation

Answer 6

L5/S1

Question 7

Symptoms of disc herniation

Answer 7

Pain (in the lower back radiating into the leg, worse on lifting or standing)

Question 8

Signs of vertebral disc herniation

Answer 8

Weakness, Positive straight leg raise test, Trendelenburg gait

Question 9

Describe the straight leg raise test

Answer 9

Passive raising of the leg causes pain, relieved by flexion of the knee

Question 10

Investigation for disc herniation

Answer 10

MRI

Question 11

Management for disc herniation

Answer 11

Conservative: Physiotherapy, Rest
Medical: Pain ladder, Steroid injection
Surgical: Discectomy, Laminectomy

Question 12

Causes of back pain

Answer 12

Degeneration, Malignancy, TB, trauma

Question 13

Common tumour origins for bony metasteses

Answer 13

Lung, Kidney, Breast, Prostate, Thyroid

Question 14

Red flag symptoms for back pain

Answer 14

Thoracic pain, Worse at night, Neurology, Systemic features, Past cancer, Recent infeection, Steroids, IVDU, Younger than 18, Older than 55

Question 15

Investigations for back pain

Answer 15

X-ray, MRI

Question 16

Indications for investigations for back pain

Answer 16

Red flag symptoms, > 1 month

Question 17

Management of non-specific back pain

Answer 17

Conservative: Exercise, CBT
Medical: Pain ladder, Tricyclic antidepressants
Surgical: Spinal fusion