[31] Back Pain

Question 1

What causes mechanical pain of the back?

Answer 1

Soft tissue injury leads to dysfunction of the whole spine, which leads to muscle spasm and main

Question 2

What may cause mechanical back pain?

Answer 2

An inciting event, e.g. lifting

Question 3

Who should mechanical back pain be suspected in?

Answer 3

Younger patients with no sinister features

Question 4

What is involved in the conservative management of mechanical back pain?

Answer 4

Max 2days bed rest 
Education - keep active, how to lift etc
Physiotherapy
Address psychosocial issues regarding chronic pain and disability
Warmth

Question 5

What is involved in the medical management of mechanical back pain?

Answer 5

Analgesia

Muscle relaxant

Question 6

What analgesia is used in the medical management of mechanical back pain?

Answer 6

Paracetamol
NSAIDs
Codeine

Question 7

What muscle relaxant is used in medical management of mechanical back pain?

Answer 7

Low-dose diazepam

Question 8

What is the limitation of diazepam in the management of mechanical back pain?

Answer 8

It is only for short-term use

Question 9

What happens in disc prolapse?

Answer 9

Herniation of nucleus pulposus through annulus fibrosis

Question 10

Which nerve roots are most commonly compressed in disc prolapse?

Answer 10

L5 and S1

Question 11

What disc prolapse compresses the L5 root?

Answer 11

L4/5

Question 12

What disc prolapse compresses the S1 root?

Answer 12

L5/S1

Question 13

How might disc prolapse present?

Answer 13

As severe pain on sneezing, coughing, or twisting a few days after a low back strain

Question 14

What is lumbago?

Answer 14

Lower back pain

Question 15

What is sciatica?

Answer 15

Shooting radicular pain down buttock and thigh

Question 16

What are the signs of a disc prolapse on examination?

Answer 16

Limited spinal flexion and extension
Free lateral flexion
Lesague’s sign

Question 17

What is Lesague’s sign?

Answer 17

Pain on straight-leg raise

Question 18

What might a lateral herniation cause?

Answer 18

Radiculopathy

Question 19

What might a central herniation cause?

Answer 19

Corda equina syndrome

Question 20

What examination signs might be seen in a disc prolapse causing L5 root compression?

Answer 20

Weak hallux extension, with or without foot drop

Decreased sensation on the inner dorsum of the foot

Question 21

How can foot drop due to L5 radiculopathy be distinguished from peroneal nerve palsy?

Answer 21

Weak inversion in L5 radiculopathy

Question 22

What examination signs might be seen in a disc prolapse causing S1 root compression?

Answer 22

Weak foot plantarflexion and eversion
Loss of ankle-jerk
Calf pain
Decreased sensation over the sole of the foot and back of calf

Question 23

How is a suspected disc prolapse investigated?

Answer 23

MRI

Question 24

When does the MRI need to be done as an emergency in suspected disc prolapse?

Answer 24

If cauda equina

Question 25

What is involved in the conservative management of a disc prolapse?

Answer 25

Brief rest Mobilisation Physiotherapy

Question 26

What is involved in the medical management of disc prolapse?

Answer 26

Analgesia | Transforaminal steroid injection

Question 27

In what % of patients is brief rest, analgesia, and mobilisation effective?

Answer 27

>90%

Question 28

What is involved in the surgical management of disc prolapse?

Answer 28

Discectomy or laminectomy

Question 29

When might the surgical management of disc prolapse be required?

Answer 29

Cauda equina syndrome | Continuing pain or muscle weakness

Question 30

What is the most common surgical procedure done for disc prolapse?

Answer 30

Lumbar microdiscetomy

Question 31

What happens in a lumbar microdiscectomy?

Answer 31

Microscopic resection of the protruding nucleus pulposus

Question 32

What approach is taken in a lumbar microdiscectomy?

Answer 32

Posterior approach, with the patient in the prone position | May be performed endoscopically

Question 33

What is spondylolisthesis?

Answer 33

Displacement of one lumbar vertebra on another

Question 34

What direction does spondylolisthesis usually occur?

Answer 34

Forward

Question 35

What vertebra is usually affected in spondylolisthesis?

Answer 35

L5 onto S1

Question 36

How can spondylolisthesis sometimes be detected?

Answer 36

May be palpable

Question 37

What are the causes of spondylolisthesis?

Answer 37

Congenital malformation Spondylosis Osteoarthritis

Question 38

When does spondylolisthesis present?

Answer 38

In adolesence or early adulthood

Question 39

How does spondylolisthesis present?

Answer 39

Pain, worse on standing, with or without sciatia, hamstring tightness, and abnormal gait

Question 40

How is spondylolisthesis diagnosed?

Answer 40

Plain radiography

Question 41

How is spondylolisthesis managed?

Answer 41

Corset Nerve release Spinal fusion

Question 42

What causes spinal stenosis?

Answer 42

Developmental predisposition, with or without facet joint osteoarthritis leads to generalised narrowing of lumbar spinal canal

Question 43

How does spinal stenosis present?

Answer 43

Spinal claudication | Pain on spine extension

Question 44

Describe the features of spine claudication

Answer 44

Aching or heavy buttock and lower limb pain on walking Rapid onset May come with parasthesia/numbness Pain eased by leaning forwards

Question 45

How is spinal stenosis investigated?

Answer 45

MRI

Question 46

How is spinal stenosis managed?

Answer 46

Corsets NSAIDs Epidural steroid injection Canal decompression surgery

Question 47

What are the neurosurgical emergencies?

Answer 47

Acute cord compression | Acute cauda equina compression

Question 48

What are the symptoms of acute cord compression?

Answer 48

Bilateral pain in the back and radicular area LMN signs at compression level UMN signs and sensory disturbance level below compression Sphincter disturbance

Question 49

What are the symptoms of acute cauda equina compression?

Answer 49

Alternating or bilateral radicular pain in legs Saddle anaesthesia Loss of anal tone Bladder and bowel incontinence

Question 50

How is acute cord compression/acute cauda equina compression managed if caused by large prolapse?

Answer 50

Laminectomy/discectomy

Question 51

How is acute cord compression/acute cauda equina compression managed if caused by tumours?

Answer 51

Radiotherapy and steroids

Question 52

How is acute cord compression/acute cauda equina compression managed if caused by abscesses?

Answer 52

Decompression