Low Back Pain

Question 1

define non-specific low back pain

Answer 1

pain not due to any specific or underlying disease that can be found

Question 2

define mechanical low back pain

Answer 2

pain after abnormal stress and strain on the vertebral column

Question 3

define nerve root pain (sciatica)

Answer 3

pain radiating to the lower limbs with or without neuralgic symptoms

Question 4

causes of low back pain

Answer 4

mechanical: disc herniation/degeneration, annular tears, facet joint OA
tumour, infection, spondyloarthropathy
pars interarticularis injury, compression fracture, visceral

Question 5

indicators for sciatica from history or physical examination

Answer 5

unilateral leg pain greater than lower back pain
pain radiating to foot or toes
numbness/paraesthesia in same distribution
straight leg raising test induces more leg pain
localised neurology

Question 6

conservative treatment for sciatica

Answer 6

analgesia
anti-inflammatory drugs
manipulation
acupunture
massage
allow time to pass ( most get better spontaneously)
bed rest doesn’t result it faster recovery

Question 7

red flags for low back pain

Answer 7

weight loss
fever
night pain
under 19 years of age

Question 8

red flags for leg pain

Answer 8

bowel or bladder dysfunction
saddle anaesthesia
profound neurological deficit

Question 9

for what conditions is waiting too long to diagnose very dangerous?

Answer 9

metastases
inflammatory arthropathy
myeloma
tuberculosis of the spine

Question 10

why can early diagnosis be so important?

Answer 10

sometimes essential for effective treatment

risk of disease progression e.g. fractures, paralysis

Question 11

primary imaging investigation for low back pain

Answer 11

MRI

Question 12

secondary imaging investigation for low back pain

Answer 12

radiographs

CT

Question 13

pros and cons to radiographs

Answer 13

pro: cheap, readily available, traditional
con: radiation, overlooks most important diseases

Question 14

what important diseases could be missed on a radiograph?

Answer 14

pagets sarcoma
anorexia nervosa
adolescent disc prolapse
lesions
osteoid osteoma

Question 15

what type of diseases will show up on limited MRI?

Answer 15

80% degeneration

20% other e.g infection, tumour, pars defects, spondyloarthropathy, insufficiency fracture, aortic aneurysm

Question 16

pain therapy for low back pain

Answer 16

wait
physical therapy
analgesia
facet injections (local and steroid, denervation)
root block
epidural injection
neurostimulation

Question 17

describe administration of facet injection

Answer 17

approach: oblique, posterior
21g needle
local: marcain 0.5% 1ml
steroid: triamcinolone 20mg
one level at a time
follow up
inside or around the joint

Question 18

describe administration of root block

Answer 18

contrast in root sheath
1ml local only
follow up

Question 19

root block can be done with what imaging?

Answer 19

CT guided

MRI-ultrasound fusion w/ VNav needle guidance

Question 20

epidural anasthetic

Answer 20

interlaminar
transforaminal
caudal

Question 21

surgery for low back pain

Answer 21

decompression of nerve roots
decompression of spinal stenosis
disc replacement
fusion