The Spine and Back Pain Flashcards
how many vertebrae are there
33
how many cervical, thoracic, lumbar, sacral and fused coccygeal vertebrae are these
7, 12, 5, 5, 4
describe the curvatures of the spine
cervical lordosis
thoracic kyphosis
lumbar lordosis
coccygeal kyphosis
what are the parts of the body of a vertebra
outer annulus fibrosis, inner nucleolus pulposus
what are the atypical vertebrae
c1, c2, c7
what is atypical about c1
“atlas” no vertebral body for head rotation
what is atypical about c2
“axis” has a dens
what is atypical about c7
“vertebrae prominens” small foramina transveraria, non-bifid for vertebral artery passage
what is the cauda equina and what vertebral level is it
L1 spinal cord ends
where do sensory neurons originate
dorsally
where do motor neurons originate
anteriorly from dorsal horn
what are mixed spinal nerves formed of
anterior & posterior roots
what is spondylosis
group term for degeneration of the spine
what is spondylolysis
stress #/defect in pars interarticularis of vertebrae at L5
what is spondylolisthesis
1 vertebra slips forward on another
what vertebrae are affected by spondylolithesis
L4/5 or L5/S1
what plane is a gibbus viewed in
saggital
what are the red flags of back pain
PH carcinoma cauda equina synd morning stiff immunocompromised non-mechanical 6 wk
what ages are is back pain more worrying
acute <20/>55
what area of the spine is back pain more worrying in
thoracic
what is the commonest cause of back pain
mechanical
what is the management of mechanical back pain
NSAID/PT/chiro
how long does mechanical back pain usually take to heal
6wk
what type of back pain is OA
mechanical
how to differentiate mechanical back pain
worse on activity, relief on rest
which vertebrae are affected by osteoporosis/spondylosis
L4/5/S1
how to distinguish back OP
pain relief on extension
what test can be done to diagnose/treat back OP
facet joint injection under fluoroscopy
what is the presentation of a lumbar disc prolapse
episodic back pain, then dominating dermatomal leg pain
what ages are affected by lumbar disc prolapses
30s-50s
what is the presentation of sciatica
dermatomal tingling/burning pain in lower leg +- bum
what is the pathology of sciatica
nucleus pulposus herniates to spinal canal; compresses L4/L5/S1, radiates on sciatic nerve
what is the initial management of sciatca
PT/analgesia/NSAID +- muscle relaxant diazepam
when to refer sciatica
if >3 months
what is done for sciatica after referral
MRI to decide if surgery is appropriate
what surgeries can be done for sciatica
discectomy or decompression
what is the pathology of spinal stenosis
osteophytes, hypertrophied ligamentum flavum & bulging discs < cauda equina space; compress nerve
what are risk factors for spinal stenosis
(>50 obese male
what is the presentation of spinal stenosis
neurogenic claudication, burning leg pain walking downhill, relief up hill/ flexing/ cycling
what is the management of spinal stenosis
sometimes decompression is appropriate
when to MRI back pain from primary care
sciatica >3mth, spinal claudication
problem with MRIs for back pain
many false +ves
how long does spinal shock last
24hr
presentation of neurogenic shock
temporary paralysis, hypotension, bradycardia
cause of a vertebral crush/wedge fracture
OP
management of a vertebral crush/wedge fracture
conservative or balloon vertebroplasty
describe discogenic pain
deep central lower back, worse end of day/flex/activity
gold standard investigation of back pain
MRI
investigation of spinal fracture
CT
