The Spine

Question 1

is most back pain self-limiting?

Answer 1

yes

Question 2

cardinal rules of back pain management

Answer 2

image early
educate
reassure
avoid bedrest
continue movement

Question 3

red flags of back pain

Answer 3

age <20 and >55
non-mechanical, constant
history of cancer, steroids, HIV, immunocompromised
systemic symptoms e.g. malaise, fever, weight loss
structural deformity
saddle anaesthesia
severe pain for >6 weeks

Question 4

yellow flags of back pain

Answer 4

low mood
high level pain/disability
belief that activity is harmful
obesity
secondary gain (compensation)

Question 5

what is mechanical back pain?

Answer 5

back pain that is worse with movement and relieved by rest

Question 6

causes of mechanical back pain

Answer 6

obesity
poor posture
poor lifting technique
lack of exercise

Question 7

management of mechanical back pain

Answer 7

analgesia and reassure

physiotherapy

Question 8

what is spondylosis

Answer 8

spinal osteoarthritis

Question 9

why does spondylosis happen in the elderly?

Answer 9

intervertebral discs lose water content leading to wear and tear and overload at facet joints

Question 10

what is a severe fracture that can happen in osteoporosis?

Answer 10

crush fractures of the vertebral body

Question 11

presentation of spondylosis

Answer 11

pain worse with extension

cervical spine= stiffness and pain in neck which radiates to shoulder and occiput

Question 12

diagnosis of spondylosis

Answer 12

MRI

Question 13

management of spondylosis

Answer 13

facet joint injections

localised fusion if one or two segments affected

Question 14

what is an acute disc tear?

Answer 14

acute tear in annulus fibrosis

Question 15

where are acute disc tears most common?

Answer 15

L4/5

L5/S1

Question 16

presentation of acute disc tears

Answer 16

pain, especially on coughing due to rich innervation of outer annulus

Question 17

acute disc tear management

Answer 17

most settle by 3 months
physio
analgesia

Question 18

what can spinal stenosis cause?

Answer 18

nerves to be compressed by osteophytes and hypertrophied ligaments (OA)

Question 19

presentation of spinal stenosis

Answer 19

radiculopathy or burning leg pain on walking

pedal pulses are preserved (distinguish from vascular claudication)

Question 20

what is neurogenic claudication?

Answer 20

radiculopathy/ burning leg pain on walking

Question 21

when is there less neurogenic claudication in spinal stenosis?

Answer 21

when walking uphill as flexion creates more space

Question 22

diagnosis of spinal stenosis

Answer 22

MRI

Question 23

management of spinal stenosis

Answer 23

conservative= physio and weight loss

surgical decompression

Question 24

what conditions can cervical spine instability occur in?

Answer 24

Down’s syndrome

RA

Question 25

presentation of cervical spine instability

Answer 25

atlanto-axial subluxation due to destruction of synovial joint and rupture of ligaments
wide based gait
weakness
increased tone

Question 26

management of cervical spine instability

Answer 26

collar to prevent flexion

surgical fusion

Question 27

what is cauda equina syndrome?

Answer 27

pressure, usually from a prolapsed disc, on all lumbosacral nerve roots that control bowel and bladder function

Question 28

presentation of cauda equina

Answer 28

bilateral lower motor neuron signs
bladder and bowel dysfunction
saddle anaesthesia and loss of anal tone

Question 29

diagnosis of cauda equina syndrome

Answer 29

PR

MRI

Question 30

management of cauda equina

Answer 30

urgent discectomy/ decompression

Question 31

what is sciatica?

Answer 31

the nucleus pulposis can herniate or prolapse through the tear and impinge on a nerve root

Question 32

presentation of sciatica

Answer 32

neuralgic burning or tingling down back of thigh below the knee
altered sensation in dermatomal distribution
reduced muscle power in myotomal distribution

Question 33

diagnosis of sciatica

Answer 33

positive sciatica stretch test (30-70 degrees)

Question 34

management of sciatica

Answer 34

analgesia
mobility
physiotherapy
surgical if doesn’t settle in 3 months (beware of secondary gain)