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T&O Surgery > Back Pain and Sciatica > Flashcards

Back Pain and Sciatica Flashcards

1
Q

What is another term for low back pain?

A

Lumbago

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2
Q

How long does it take for acute back pain to improve?

A

1-2 weeks

4-6 weeks for sciatica

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3
Q

What are the causes of mechanical back pain?

A

Muscle or ligament sprain
Facet joint dysfuntion
Sacroiliac joint dysfunction
Herniated disc
Spondylolisthesis
Scoliosis
Degenerative changes

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4
Q

What is the difference between spondylosis and spondylolisthesis?

A
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5
Q

What causes neck pain?

A

Muscle or ligament strain
Torticollis
Whiplash
Cervical spondylosis

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6
Q

What are the red-flag causes of back pain?

A

Spinal fracture
Cauda equina
Spinal stenosis
Ankylosing spondylitis
Spinal infection

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7
Q

What abdominal or thoracic conditions can cause back pain?

A

Pneumonia
Ruptured aortic aneurysms
Kidney stones
Pyelonephritis
Pancreatitis
Prostatitis
Pelvic inflammatory disease
Endometriosis

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8
Q

What are the spinal nerve routes of the sciatic nerve?

A

L4-S3

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9
Q

Where does the sciatic nerve emerge?

A

Exits through the greater sciatic foramen inferior to the piriformis

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10
Q

What symptoms do you get from sciatica?

A

Unilateral pain radiating down the back of the thigh to below the knee
Shooting pain

Paraesthesia

Numbness

Motor weakness

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11
Q

What are the main causes of sciatica?

A

Herniated disc
Spondylolisthesis
Spinal stenosis

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12
Q

What is the sciatic stretch test?

A

Used to diagnose sciatica

Patient lies on their back, leg is lifted and ankle is dorsiflexed until limit is reached

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13
Q

How do you remember which cancers metastasise to the bones?

A

PoRTaBLe
(only consonants=cancer)

Prostate
Renal
Thyroid
Breast
Lung

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14
Q

What investigations are used for lower back pain?

A

Patients with mechanical/ non-specific lower back pain are diagnosed clinically, does not require further investigation

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15
Q

What is imaging used to look for with back pain?

A

X-rays or CT used to diagnose spinal fractures

MRI for suspected cauda equina

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16
Q

What investigations are used for ankylosing spondylitis?

A

Inflammatory markers (CRP and ESR- erythrocyte sedimentation rate)

X-ray of spine and sacrum

MRI of spine

17
Q

What can X-ray and MRI show in ankylosing spondylitis?

A

X-ray
Bamboo spine

MRI
Bone marrow oedema early in disease

18
Q

What is STarT Back Screening Tool used for?

A

Stratify risk of a patient presenting with acute back pain developing into chronic back pain

19
Q

How is acute lower back pain managed?

A

Cauda equina-MRI

Ankylosing spondylitis-Inflammatory markers and rheumatology review

Spinal injury- Spinal immobilisation

20
Q

How are patients with low risk of chronic back pain managed?

A

Education
Reassurance
Analgesia
Staying active

21
Q

How are patients at medium or high risk of developing chronic back pain managed?

A

Physiotherapy
Cognitive behavioural therapy
Group exercise

22
Q

What analgesia is used for lower back pain?

A

NSAIDs (ibuprofen or naproxen)

Codeine (alternative)

Benzodiazepines (e.g. diazepam) for muscle spasm (short term only 5 days)

Do not use opioids

23
Q

What is radiofrequency denervation?

A

Targets and damages the medial branch nerves supplying the facet joints associated with back pain

24
Q

When is radiofrequency denervation used?

A

Chronic lower back pain originating in the facet joints

25
Q

What medications can be used for sciatica after following the acute back pain pathway?

A

Amitriptyline
Duloxetine

26
Q

How does amitriptyline and duloxetine work?

A

Blocks NorAd and Serotonin uptake at synapses

Duloxetine also increases dopamine in the prefrontal cortex

27
Q

What are the specialist management options of chronic sciatica?

A

Epidural corticosteroid injections

Local anaesthetic injections

Radiofrequency denervation

Spinal decompression

T&O Surgery (34 decks)

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