The Spine Flashcards

1
Q

is most back pain self-limiting?

A

yes

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2
Q

cardinal rules of back pain management

A
image early
educate
reassure
avoid bedrest
continue movement
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3
Q

red flags of back pain

A

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

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4
Q

yellow flags of back pain

A
low mood
high level pain/disability
belief that activity is harmful
obesity
secondary gain (compensation)
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5
Q

what is mechanical back pain?

A

back pain that is worse with movement and relieved by rest

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6
Q

causes of mechanical back pain

A

obesity
poor posture
poor lifting technique
lack of exercise

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7
Q

management of mechanical back pain

A

analgesia and reassure

physiotherapy

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8
Q

what is spondylosis

A

spinal osteoarthritis

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9
Q

why does spondylosis happen in the elderly?

A

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

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10
Q

what is a severe fracture that can happen in osteoporosis?

A

crush fractures of the vertebral body

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11
Q

presentation of spondylosis

A

pain worse with extension

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

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12
Q

diagnosis of spondylosis

A

MRI

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13
Q

management of spondylosis

A

facet joint injections

localised fusion if one or two segments affected

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14
Q

what is an acute disc tear?

A

acute tear in annulus fibrosis

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15
Q

where are acute disc tears most common?

A

L4/5

L5/S1

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16
Q

presentation of acute disc tears

A

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

17
Q

acute disc tear management

A

most settle by 3 months
physio
analgesia

18
Q

what can spinal stenosis cause?

A

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

19
Q

presentation of spinal stenosis

A

radiculopathy or burning leg pain on walking

pedal pulses are preserved (distinguish from vascular claudication)

20
Q

what is neurogenic claudication?

A

radiculopathy/ burning leg pain on walking

21
Q

when is there less neurogenic claudication in spinal stenosis?

A

when walking uphill as flexion creates more space

22
Q

diagnosis of spinal stenosis

A

MRI

23
Q

management of spinal stenosis

A

conservative= physio and weight loss

surgical decompression

24
Q

what conditions can cervical spine instability occur in?

A

Down’s syndrome

RA

25
Q

presentation of cervical spine instability

A

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

26
Q

management of cervical spine instability

A

collar to prevent flexion

surgical fusion

27
Q

what is cauda equina syndrome?

A

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

28
Q

presentation of cauda equina

A

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

29
Q

diagnosis of cauda equina syndrome

A

PR

MRI

30
Q

management of cauda equina

A

urgent discectomy/ decompression

31
Q

what is sciatica?

A

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

32
Q

presentation of sciatica

A

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

33
Q

diagnosis of sciatica

A

positive sciatica stretch test (30-70 degrees)

34
Q

management of sciatica

A

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