Back & Spine

Question 1

A strain of the back involves the _______ (muscles/ligaments) and a sprain involves the ________ (muscles/ligaments)

Answer 1

Muscles

Ligaments

Question 2

Up to ___ of the population will experience lower back pain

Answer 2

70%

Question 3

Lower back pain is considered acute if the onset is less than __ weeks

Answer 3

6 weeks

Question 4

Why is radiation of pain an important history question when evaluating lower back pain?

Answer 4

Sciatica

Question 5

What systemic (constitutional) symptoms would be ‘red flags’ in the setting of lower back pain?

Answer 5

Fever
Chills
Weight Loss

Question 6

Other than constitutional symptoms….

What are “red flags” associated with lower back pain?

Answer 6

Urinary Incontinence
Fecal Incontinence
Neurological Deficits
Unrelenting Pain

Question 7

Is imaging warranted for diagnosing acute (<6 weeks) lower back pain?

Answer 7

No

Question 8

What are the mainstays of LBP treatment?

Answer 8

Rest and modified activity
Physical Therapy (Core strengthening)
NSAIDs (NO Opioids)

Question 9

_______ is defined as lateral curvature of the spine.

Answer 9

Scoliosis

Question 10

Are teenage females or males more likely to develop scoliosis?

Answer 10

Females

Question 11

What physical Examination findings may alter you to the potential of scoliosis?

Answer 11

Off-center head
One hip/shoulder may appear higher
Obvious curvature of the rib cage

Question 12

What ‘angle’ is measured on an XR with lateral spine curvature?

Between what degrees should a patient be monitored every 4 - 6 months?

Answer 12

Cobb’s Angle

Monitor between 10 - 25 degrees

Question 13

What brace is commonly used in treating scoliosis?

Answer 13

Boston Brace

Question 14

How could scoliosis be managed surgically?

Answer 14

Spinal Fusions

Question 15

What is a medical term for a “slipped disc”?

Answer 15

Herniated Nucleus Pulposis (HNP)

Question 16

What physical examination finding may be present on a patient with HNP?

If this is positive, what nerve roots are likely effected?

Answer 16

Straight Leg Raise

L4, L5, S1

Question 17

What is the diagnostic imaging study of choice when working up HNP?

Answer 17

MRI

Question 18

How can HNP be treated?

Answer 18

Bed Rest
NSAIDs or Prednisone
Muscle Relaxants (Flexeril) 
Narcotics
PT

Question 19

Steroids can be given by what route to treat HNP?

Answer 19

Epidural

Question 20

When would surgical intervention be warranted in treating HNP?

Answer 20

Conservative management fails
Severe pain
Neurological deficits

Question 21

______ ______ results from thickening of ligaments and bones in the spine which impinges on nerves and the spinal cord resulting in back pain and numbness.

Answer 21

Spinal Stenosis

Question 22

What are THREE examples of spinal stenosis?

Answer 22

Central Stenosis
Foraminal Stenosis
Extra-Foraminal Stenosis

Question 23

How would lumbar spinal stenosis present?

Answer 23

Dull aching back pain
Numbness (“pins and needles”) in legs, calves, buttocks
Weakness/Loss of balance

Question 24

________ (standing/sitting) exacerbates symptoms in spinal stenosis while ________ (standing/sitting) would relieve the symptoms

Answer 24

Standing

Sitting

Question 25

What is the most diagnostic imaging study for working up spinal stenosis?

Answer 25

MRI

Question 26

How is mild spinal stenosis manged compared to severe?

Answer 26

Mild: Epidural Injection PT NSAIDs Weight Loss and lifestyle changes Severe: Laminectomy +/- Fusion

Question 27

What condition of the lower back is considered a surgical emergency?

Answer 27

Cauda Equina Syndrome

Question 28

Where is the most common site of disc herniation that results in Cauda Equina Syndrome?

Answer 28

L4-L5

Question 29

A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an "electric shock" radiate down both his posterior legs. At this point, the presence of what THREE symptoms would arise concern for cauda equina syndrome?

Answer 29

Urinary Retention (followed by incontinence) Fecal Incontinence Saddle Anesthesia

Question 30

A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an "electric shock" radiate down both his posterior legs. Interestingly, he admits to urinary incontinence on the ride over. On examination, he note decreased rectal sensation and weakness in his lower extremities. What is the most immediate next step in management of this patient?

Answer 30

MRI

Question 31

A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an "electric shock" radiate down both his posterior legs. Interestingly, he admits to urinary incontinence on the ride over. On examination, he note decreased rectal sensation and weakness in his lower extremities. MRI confirms cauda equina syndrome? How does this patient need to be managed?

Answer 31

Surgically! (Laminectomy) Immediately within 24 hours

Question 32

If surgical intervention does not occur in cauda equina syndrome, what permanent deficit may the patient have?

Answer 32

Bladder and Bowel Incontinence

Question 33

Where is the most common site of spondylolysis? Where is the most symptomatic site of spondylolysis?

Answer 33

Common: L5 Symptomatic: L4

Question 34

What is the most common cause of spondylolysis?

Answer 34

Overuse (Hyperextension)

Question 35

On XR, how is spondylolysis described?

Answer 35

"Scottie Dog with a collar"

Question 36

Other than XR, how is spondylolysis diagnosed?

Answer 36

SPECT Scans

Question 37

What imaging modality can be used to classify spondylolysis?

Answer 37

CT

Question 38

Focal bone absorption with a hairline deficit would be considered _______ spondylolysis

Answer 38

Early

Question 39

Wide defect with small fragments present would be considered _______ spondylolysis

Answer 39

Progressive

Question 40

The presence of sclerotic changes would be considered _______ spondylolysis

Answer 40

Terminal

Question 41

___________ is the anterior or posterior translation of one vertebral body over another

Answer 41

Spondylolisthesis

Question 42

What imaging modality is used to diagnosis Spondylolisthesis?

Answer 42

XR

Question 43

T/F: 90% of Ankylosing Spondylitis patients will express the HLA-B27 gene

Answer 43

True

Question 44

Which NSAID is the "drug of choice" for treating ankylosing Spondylitis?

Answer 44

Indomethacin

Question 45

Which DMARD can be used in ankylosing spondylitis?

Answer 45

Sulfasalazine

Question 46

Hyperkyphosis may also be referred to as what?

Answer 46

"Dowager's Hump"

Question 47

Are vertebral fractures common in kyphotic patients?

Answer 47

Yes