Back pain, Scoliosis and Spinal Deformity Flashcards
(26 cards)
Back pain is a multifactorial problem, made up of what components?
Biological, social and psychological
What are the worrying red flag symptoms in back pain suggestive of serious pathologies?
Saddle anaestesia with/without bladder or bowel upset
Past history of cancer
What are the myotomes?
L1/2: Hip flexion
L3/4: Knee extension
L5: Foot dorsiflexion
S1/2: Ankle plantar flexion
What are the myotomes tested in the ankle jerk reflex?
L3/4
What are the nerve root irritation tests?
Straight leg raise and femoral stretch test
What are the key imaging modalities in back pain?
MRI, x-ray, diagnostic facet injection, contrast enhanced CT
What is the first line imaging modality in back pain?
MRI
What are the advantages and disadvantages of MRI in imaging back pain?
- Symptoms and signs need to match
- Very detailed, can show too much detail
- 76% false positives
- Requires expertise to be interpreted
Are x-rays useful in back pain investigation?
No, waste of time effectively
What is sciatica?
Buttox and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance
What happens during vertebral disc prolapse?
One of the vertebral discs is damaged and compresses one of the spinal nerves
How can you find out exactly where the disc prolapse is?
By the pattern of the myotomes and dermatomes due to the pattern of numbness and tingling
What are the presenting symptoms of disc prolapse?
Leg pain and neurology
Then leg pain becomes dormant and the back pain may disappear entirely
What is the treatment for disc prolapse?
70% will settle within 3 months and a further 90% in 18-24mnths therefore no long term benefit of surgery
What are the considerations given to back surgery?
Risk of permanent neurological damage therefore symptoms need to be bad enough to justify it
What is the best treatment for back pain?
Fast and active rehab, conservative treatment
What are the side effects of surgery?
- Up to 25% failure rate
- Mandatory extensive counselling
- Adjacent segment disease
What is meant by the term scoliosis?
”s” or “c” shaped spine instead of straight line
What are the classifications of scoliosis?
Congenital, early onset idiopathic, late onset idiopathic, secondary
What can secondary scoliosis be caused by?
Neuromuscular, cerebral palsy, spine bifida, tumours
What is the non operative management of scoliosis?
Corrective casts, bracing, corrective exercises
What is the surgical options for scoliosis?
Anterior surgery, one stage posterior surgery or combined surgery
What is kyphosis?
-Excessive anterior border of spine leading to “hunch back”
What is spondyolysis?
Failure of fusion, developmental defect
