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Flashcards in Back Pain Deck (26):
1

Saddle anasthesia

Loss of sensation in the buttocks, perinium and inner thighs

2

Back pain red flag

-If pain is not mechanical, i.e not associated with activity/specific timing
-Systemic upset
-Major, new, neurological deficit
-Saddle anaesthesia +/- bladder or bowel upset

3

Saddle anasthesia with bladder or bowel upset is a what?

Surgical emergency

4

Schobers method

Make a little mark 10cm above and 5 cm below the dimples. On forward flexion the normal movement is to about 21cm. Older patients less, younger a bit more. Less than 18cm is pathologically stiff, more than about 24cm is hypermobile.

5

Nerve irritation tests

Nerve irritation tests include the straight leg raise and variants for the sciatic nerve roots and the femoral stretch test for the femoral roots.

6

Overt pain behaviour

Guarding
Bracing
Rubbing
Grimacing
Sighing

7

Spondylolysis

Defect in the pars interarticularis of the vertebra

8

Defect in the pars interarticularis of the vertebra

Spondylolysis

9

Spondylolisthesis

Forward slippage of one vertebra on another

10

Indications for spondylolisthesis surgery

When conservative treatment has failed
Adolescent with > 50% slip
Progressive neurological deficit
Postural deformity

11

Worst red flag?

Previous history of cancer

12

Back pain red flags

Age 50 - first back pain
Non – mechanical, constant pain
History of cancer
History of steroids
General malaise, fever, unexplained weight loss
Structural deformity
Saddle anaesthesia / paraesthesia +/- loss of bowel or bladder control
Severe pain longer than 6 weeks

13

X-ray for cervical spine

Make sure it shows C7/T1 !!

14

Most common thoracolumbar level of injury?

T12/L1

15

Most common form of incomplete spinal cord injury?

Central cord

16

Frankel/ASIA grading

I or A - complete motor and sensory loss
II or B - complete motor and incomplete sensory
III or C - incomplete motor – no practical use
IV or D - useful motor and incomplete sensory
V or E - normal motor and sensory function

17

Central cord injury

-Typically a hyperextension injury
-Arms worse than legs
-prognosis variable but generally good

18

Which type of spinal cord injury are you likely to get with a hyperextension injury?

A central cord injury

19

Brown-sequard

Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Best prognosis

20

Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Best prognosis

Brown-sequard

21

Typically a hyperextension injury
-Arms worse than legs
-prognosis variable but generally good

Central cord injury

22

Motor loss
Loss of pain and temperature sense
Deep touch, position and vibration preserved
May have traumatic or vascular cause
Prognosis poor

Anterior cord injury

23

Anterior cors injury

Motor loss
Loss of pain and temperature sense
Deep touch, position and vibration preserved
May have traumatic or vascular cause
Prognosis poor

24

Causes of secondary cord damage

Stretching
Compression
Undue movement
Hypotension
Inappropriate surgery
Infection

25

Which surgical route would you take for decompression (thoracolumbar fracture, partial cord damage)

Anterior route

26

What is a thoracolumbar burst?

Vertebral fracture with compromise of the anterior and middle vertebral column