back pain NOT COMPLETE

Question 1

straight leg raise test

Answer 1

An assessment for nerve root impingement in the lumbosacral region that is often caused by disk herniation. With the patient in a supine position, the examiner lifts the leg 30º-70º with the knee in extension. The test is considered positive if the patient experiences pain radiating down the same leg, below the knee.

Question 2

red flags for cord compression

Answer 2

motor weakness
spasticity or hyperreflexia (upper motor neuron signs) distal to the site of compression
flaccid analysis and hyporeflexia (lower motor neuron signs) can occur distal to the site of compression in spinal shock
paraesthesias or anaesthesias including saddle anaesthesia
bladder, bowel or sexual dysfunction

Question 3

risk factors for compressive spinal emergency

Answer 3

Includes degenerative disk disease, intervertebral disk prolapse or protrusion, vertebral metastases, trauma, spondylolysis, spondylolisthesis, risk factors for epidural abscess, and risk factors for spinal epidermal hematoma.

Question 4

diagnostic findings in compressive spinal cord emergencies

Answer 4

urgent MRI without and with contrast
- edema of the spinal cord or cauda equina
- extrinsic compression
post void residual

Question 5

acute management of compressive spinal emergencies

Answer 5

urgent spinal decompression (neurosurgery consult)
treat the underlying cause e.g draining an abscess
high dose IV dexamethasone if suspected malignant cord compression
urinary catheter

Question 6

clinical presentation of vertebral fractures

Answer 6

trauma
localised pain and/or contusion
uneven alignment of the vertebral spinous processes
chronic corticosteroid use

Question 7

acute management of vertebral fracture

Answer 7

spinal precautions
urgent neurosurgery consult if unstable for surgical stabilisation and/or decompression

Question 8

risk factors for spinal infection

Answer 8

Includes recent bacterial infection, recent spinal surgery or instrumentation, immunocompromised state, intravascular devices, IV drug use, and chronic comorbidity (e.g., alcohol use disorder, diabetes mellitus, malignancy).

Question 9

clinical presentation of spinal infection

Answer 9

fever
tender point
limited spinal mobility
signs of spinal cord compression

Question 10

diagnosis of spinal infection

Answer 10

increased WBC and inflammatory markers
blood cultures
urgent MRI without and with contrast may find inflammation or abscess

Question 11

acute management of spinal infection

Answer 11

empiric antibiotic therapy
urgent neurosurgery evaluation
Most patients with spinal epidural abscess require either open or CT-guided drainage due to the high failure rates of nonoperative treatment.

Question 12

what kinds of infections do ‘spinal infections’ encompass

Answer 12

ncludes vertebral osteomyelitis, diskitis, spondylodiskitis, and spinal epidural abscess.

Question 13

clinical presentation of spinal epidural hepatoma causing cord compression

Answer 13

Possible history of:
Thrombocytopenia
Bleeding disorders
Use of anticoagulants
Vascular malformations
Localized trauma (e.g., following lumbar puncture, pulling of the epidural catheter)

Question 14

diagnosis for spinal epidural hematomas

Answer 14

MRI without and with contrast
blood in the epidural space with a smooth contour
there is a smooth contour because it is contained by the dura. bulging of the dura into the spinal canal may also be seen
loss of epidural fat signal

Question 15

acute management of spinal epidural hematoma

Answer 15

strict bed rest
anticoagulant reversal if indicated
urgent neurosurgery consult