The Spine

Question 1

Back pain red flags

Answer 1

<20 or > 55
Night pain 
thoracic pain 
Constant or progressive pain 
Pain worse when lying down 
BILATEAL sciatica 
Progressive neuro symptoms

Question 2

What is mechanical back pain?

Answer 2

Back pain in the absence of neuro dysfunction.

Question 3

Presentation of mechanical back pain?

Answer 3

Lumbar pain. Radiation to buttock but not below knee, sudden onset, worse on acitvity and relieved by rest. Recurrent episodes been experienced before.

X-ray if no improvement within 6-8weeks,.

Exercise after 48 hours.

Physio.

Question 4

What is sciatica?

Answer 4

Develops due to a prolapsed IV disc within the lumbar region impinging on the sciatic nerve within either the L4/L5 or L5/S1 region.

Question 5

Pain in sciatica?

Answer 5

Unilateral, sudden onset lumbar back pain with radiation to buttock and to below know.

Burning and tingling.

Positive straight leg raise test.

Question 6

What should you always do in sciaticsa

Answer 6

A PR.

Question 7

Cauda equina syndrome presentation?

Answer 7

Back with bilateral sciatica and saddle anaesthesia + alteration in bowel and bladder function that can either be retention or incontiencne.

Question 8

Dx of cauda equina

Answer 8

PR exam

Urgent MRI.

Question 9

How can you differentiate spinal stenosis from claudication?

Answer 9

Burning pain rather than cramping.

Inconsisten distances required to bring on the pain.

Pain relieved by going up hill.

Question 10

Managament of spinal stenosis?

Answer 10

Analgesia, phyiotherpay, steoroid injections,

Question 11

What are 2 conditions that predispose to C1/C2 subluxation?

Answer 11

Rheumatoid and Down syndrome.