Spine Things Flashcards
Name some causes of SCC
trauma vertebral compression fracture disc herniation primary or secondary tumour infection degeneration e.g. spondylosis haemorrhage RA
How would an acute cord transection present?
Loss of all motor and sensory modalities below lesion
–> sensory and motor level
Initially spinal shock –> flaccid arreflexic paralysis
Upper motor neurone signs appear later
What is the name for a cord hemisection and how would it present?
Brown-Sequard syndrome
- ipsilateral motor level
- ipsilateral dorsal column sensory level
- contralateral spinothalamic sensory level (pain + temperature)
What type of injury causes central cord syndrome?
Hyperflexion or extension injury to an already stenotic neck
How does central cord syndrome present?
- distal upper limb weakness
- ‘cape-like’ spinothalamic sensory loss
- lower limb power preserved
- dorsal column preserved
Which types of cancer may be responsible for a metastatic SCC?
Lung
Breast
Prostate
Kidney
How do you manage a metastatic SCC?
Dexamethasone 16mg STAT Urgent MRI spine Surgery if fit --> decompression/stabilisation Radiotherapy Chemotherapy
What are the general back pain red flags?
Failure to improve after 4-6 weeks conservative management
Unrelenting pain at night or at rest
Progressive motor or sensory deficit
What are the back pain red flags for AAA?
Abdominal pulsating mass
Pain at rest
What are the back pain red flags for cancer?
Age over 50
Weight loss
History of cancer
Pain at night or at rest
What are the back pan red flags for infection?
Fever/chills Recent infection Immunosuppression IV drug use Foreign travel
What are the back pain red flags/risk factors for fracture?
Age over 50
Osteoporosis
Significant trauma
Chronic steroids
What are the back pain red flags for cauda equina?
Bilateral sciatica Urinary incontinence Decreased anal tone Saddle anaesthesia Leg weakness
Describe the straight leg raise and what it’s looking for
Flex hip with leg straight until resistance and/or pain
Places sciatic nerve and hamstrings on stretch
Herniating disc causing compression of sacral nerve roots –> back pain radiating to lower extremity
Pain in affected leg when contralateral leg is raised –> highly specific for nerve root entrapment
Which investigations should you do if someone presents with acute lumbar back pain?
None –> most patient do not need investigating
When is a plain x-ray useful in back pain?
Young men: S1 going to exclude ankylosing spondylitis
Elderly: to exclude vertebral collapse, other fractures, malignancy
Which investigation should you do if a patient has back pain with red flags/neurological signs +/- symptoms?
MRI
Which blood tests would be useful if a patient has back pain with red flag symptoms?
Malignancy –> PSA, acid phosphatase, monoclonal bands
Infection markers
Metabolic causes –> ALP, calcium, phosphate, HLA B-27
How do you manage back pain (without red flags)?
Exercise, keep moving Regular analgesia --> NSAIDs + gastroprotection Opiates if pain severe Physiotherapy Alternative therapies
Which levels are most common for a lumbar disc herniation and which nerve root is usually affected?
L4/5 and L5/S1
Nerve root below usually affected (so L5 and S1 respectively)
What is a radiculopathy?
Dermatomal sensory deficit + weakness of muscles supplied by that nerve root
What is sciatica?
Pain along sciatic nerve –> L4-S3
What are the clinical features of a lumbar disc herniation?
Sciatic pain –> shooting pain from buttocks down to posterior knee/leg
Exaggerated by coughing/sneezing
Numbness/tingling
Weakness
Straight leg raise positive (pain at < 45 degrees)
What is the management for lumbar disc herniation?
Physiotherapy
Analgesia
Surgery
