Unit 2: Backache and Neckache

Question 1

To which other parts of the body may neck pain be referred?

Answer 1

Neck pain can be referred to the arm and shoulder

Question 2

List the main categories of back disorders related to spondylitides

Answer 2

Aches and sprains, mechanical back pain, spondylolisthesis

Question 3

What causes back sprains?

Answer 3

Awkward twisting or poor lifting causes muscle or ligament injuries

Question 4

Describe the features of bony root entrapment neuropathy

Answer 4

The sufferer is typically a person of either sex, usually over 40, who has a previous history of mechanical backache. These patients are usually known back sufferers who develop new symptoms of leg pain radiating to the foot, usually made worse by exercise (spinal claudication). Episodes are usually acute and recurrent against a chronic history of back pain. Episodes may remain mild or may progress to affect the patient’s lifestyle

Question 5

What is the similarity between spondylolysis and spondylolisthesis?

Answer 5

Spondylolysis and spondylolisthesis both cause pain

Question 6

Describe the cause of bony root entrapment neuropathy

Answer 6

Commonly caused by bony overgrowth around the vertebral foramina where the nerve roots emerge. The cause of the bony overgrowth would appear to be secondary to degenerative changes in the adjacent facet joints. These may degenerate from primary osteoarthritis or as a result of disc degeneration

Question 7

Describe the treatment of spondylosis

Answer 7

Most people live to learn with their bad back and learn how to try to prevent recurrences. Support should be provided by GPs with assistance from physiotherapists and orthopaedic specialists, as well as alternative medical practitioners. In the case of cervical spondylosis, treatment consists of analgesics, NSAIDs, the use of a soft collar, and physiotherapy

Question 8

Describe the cause of disc prolapse

Answer 8

Disc prolapse is caused by an abnormality in the intervertebral disc, which leads to prolapse of the nucleus pulposus material through the annulus fibrosis

Question 9

Do disc prolapses in the cervical spine usually need surgery?

Answer 9

Disc prolapses in the cervical spine do not usually require surgery

Question 10

Discuss the similarity between neckache and backache syndromes

Answer 10

Cervical spondylosis is very like the degenerative disc and joint disease seen in the lumbar spine and the aetiology is the same. Cervical disc disease has a similar pattern to the discs of the lumbar spine

Question 11

List the main categories of back disorders related to nervous tissue

Answer 11

Disc prolapse, bony root entrapment

Question 12

What is spondylosis?

Answer 12

Spondylosis is degeneration of intervertebral discs and associated wear and arthritis of facet joints in the motion segment

Question 13

Describe the anatomy of the spine

Answer 13

The spine consists of bones (the vertebrae), muscles, ligaments, and nervous tissue (nerves and spinal cord)

Question 14

Name a device which can be used in the management of spondylolysis

Answer 14

Spinal corset

Question 15

How is referred pain in the leg distinguished from sciatica?

Answer 15

Referred pain - down leg and buttock and always above knee

Root pain - down leg to foot

Question 16

What is sciatica?

Answer 16

Nerve roots emerging beneath the fourth and fifth lumbar and the first sacral vertebrae are commonly compressed by the intervertebral discs. The brain interprets pressure on a nerve root as occurring in the peripheral nerve arising from it. The peripheral nerve arising from this nerve root is the sciatic nerve

Question 17

Describe the management of disc prolapse

Answer 17

The patient may be treated by a combination of rest and gentle, progressive mobilisation. Analgesics and anti-inflammatory drugs may help relieve symptoms. Bedrest should be for a short period and traction only used to enforce rest. Most disc prolapses recover spontaneously, but if pain persists or localising signs get more severe surgical removal of the disc material is required

Question 18

List three types of pain experienced in spinal disorders

Answer 18

Local, referred and nerve root pain

Question 19

Compare and contrast bony root entrapment and disc prolapse

Answer 19

Bony root entrapment occurs in older people with degenerative disc disorders whereas disc prolapse occurs in young people where the disc material is abnormal and the disc collapses

Question 20

What is spondylolisthesis?

Answer 20

Spondylolisthesis is the slippage of one vertebra relative to the one below. It is caused by a bony abnormality which interferes with the stability of the facet joints

Question 21

Define spondylitis

Answer 21

Spondylitis is pain occurring due to disease of the discs, bones, muscles, joints or ligaments in the spine

Question 22

What are ‘localising signs’ in nerve root pain?

Answer 22

Nerve root pain may be associated with loss of sensation or muscle weakness. Such features are referred to as localising signs

Question 23

Define cervical spondylosis

Question 24

Discuss the difference between referred and nerve root pain

Answer 24

Pain occurring in the back may be ‘referred’ from the back to the buttock, thigh, and leg. Pain may be referred from the neck to the shoulder and upper arm.

Diseases affecting the facet joints and the discs may cause direct pressure on, or inflammatory reactions and swelling of the nerve roots. The brain interprets such disturbances as pain in the spinal cord originating from that particular nerve root.

Question 25

Describe the management of bony root entrapment neuropathy

Answer 25

Removal of bone is needed to free trapped nerve roots. This may result in disturbance in spinal stability and lead to a need for fusion of the affected vertebrae. The decision to operate is determined by the severity of the patient’s symptoms

Question 26

Discuss the aetiology of mechanical backache

Answer 26

The cause of mechanical back problems is unknown, although it is non-neurological. Possible causes are spondylosis and primary osteoarthritis

Question 27

When would surgery be indicated in spondylolysis?

Answer 27

Patient experiencing severe pain

Question 28

What is the difference between spondylolysis and spondylolisthesis?

Answer 28

Spondylolysis is a condition in which a vertebra or part of a vertebra is broken whereas spondylolisthesis implies slipping of one vertebra relative to another

Question 29

Describe the features of disc prolapse

Answer 29

The classical symptoms occur in people under 40, more commonly in men. They are acute backache and legache. The characteristic symptom is of legache passing down the back of the thigh and leg to the foot

Question 30

What are the spondylitides?

Answer 30

Collective term for the non-nervous tissue in the spine

Question 31

What is the pars interarticularis and why is it clinically relevant to back pain?

Answer 31

The pars interarticularis is the bony bridge that joins these two upper and lower facets. Adult forms of spondylolisthesis appear to be acquired following an acute or, more likely, a fatigue fracture of the pars interarticularis

Question 32

Define a spinal claudication

Answer 32

A spinal claudication is nerve root pain brought on by exercise