Lumbar spine

Question 1

what percentage of back pain is serious spinal pathology?

Answer 1

1%

Question 2

what percentage of back pain is nerve root pain / referred pain?

Answer 2

<5%

Question 3

what percentage of back pain is ‘simple’ lower back pain?

Answer 3

95%

Question 4

what is radiculopathy?

Answer 4

a neurological state in which conduction is blocked along the spinal nerve or its root

Question 5

what is the most common cause of radiculopathy?

Answer 5

disc herniation and inflammation of the affected nerve

Question 6

what are the features of somatic pain?

Answer 6

dull, aching pain, difficult to localise, inconsistent and non dermatomal pattern

Question 7

what causes somatic pain?

Answer 7

transmitted by nociceptive afferents that may converge onto shared spinal neurons, sometimes causing pain to be referred to distant areas like the lower limb

Question 8

what does radicular pain feel like?

Answer 8

lancinating, shocking, electric feeling in a thin band

Question 9

what causes radicular pain?

Answer 9

compression or inflammation, which triggers abnormal (ectopic) nerve signals from the dorsal root or dorsal root ganglion, leading to sharp, shooting pain along a specific nerve pathway (dermatome)

Question 10

L2 myotome

Answer 10

hip flexion

Question 11

L3 myotome

Answer 11

knee extension

Question 12

L4 myotome

Answer 12

dorsiflexion

Question 13

L5 myotome

Answer 13

hallux extension

Question 14

S1 myotome

Answer 14

ankle plantar flexion, eversion and hip extension

Question 15

S2 myotome

Answer 15

knee flexion

Question 16

what nerve root does knee jerk test for?

Answer 16

L3

Question 17

what nerve root does ankle jerk test for?

Answer 17

S1

Question 18

what are the timescales for acute vs sub acute vs chronic lower back pain?

Answer 18

acute - 0-6 weeks
sub acute - 6-12 weeks
chronic - 12 weeks +

Question 19

what percentage of lower back pain is non specific?

Answer 19

85-90%

Question 20

what happens in intervertebral disc degeneration?

Answer 20

decreased PGs
collagen changes from type II to type I
decreased elastic fibres

Question 21

what is discitis?

Answer 21

inflammation of the intervertebral space

Question 22

what is a disc herniation?

Answer 22

where the nucleus pulpous protrudes through annulus fibrosis

Question 23

what is the role of the facet joint?

Answer 23

load transmission
stabilise vertebra in flexion / extension
resist axial rotation and anterior translation

Question 24

what is spinal claudication?

Answer 24

leg pain caused by compression of spinal nerves, often due to lumbar spinal stenosis
relieved by flexion, aggracated in extension

Question 25

what are the two types of claudication?

Answer 25

spinal claudication - pain caused by nerve compression vascular claudication - pain caused by too little blood flow

Question 26

what is spondylolisthesis?

Answer 26

where one vertbera is anteriorly displaced compared to the vertebra below

Question 27

what is the most common vertebra for spondylolisthesis to happen?

Answer 27

L4/5

Question 28

what is spondyloloptosis?

Answer 28

where the vertebral body is completely displaced

Question 29

what is spondylolisthesis dysplastic?

Answer 29

congenital defect

Question 30

what is the phalen dickson sign for spondylolisthesis dysplastic?

Answer 30

tight hamstrings bent knees flexed hips waddling gait lordotic posture

Question 31

what causes spondylolisthesis isthmic?

Answer 31

repeated extension

Question 32

what are spondyloarthropathies?

Answer 32

a group of chronic inflammatory rheumatic conditions that share overlapping features

Question 33

what is sacroilitis?

Answer 33

inflammation of sacroiliac joints

Question 34

what is enthesitis?

Answer 34

inflammation of soft tissue attachments

Question 35

what is uveitis?

Answer 35

inflammation of eye

Question 36

what is the gene for increased risk of autoimmune diseases?

Answer 36

HLA B27

Question 37

what is ankylosing spondylitis?

Answer 37

inflammation and stiffening of vertebra which can lead to fusion of the joints

Question 38

when does inflammatory back pain damage often occur?

Answer 38

3rd decade of life

Question 39

what is the average time from onset to diagnosis of inflammatory back pain?

Answer 39

8 years

Question 40

is ankylosing spondylitis more common in males or females?

Answer 40

females

Question 41

what is the best way to image for AS?

Answer 41

MRI

Question 42

what are the blood tests that can be done for AS?

Answer 42

ESR/CRP - measures of inflammation HLA B27 - genetic susceptibility

Question 43

what are the 5 inflammatory back pain parameters and how many do you need to be diagnosed?

Answer 43

age at onset <40 insidious onset improvement with exercise no improvement with rest pain at night (with improvement on getting up) diagnosis if 4/5 present

Question 44

what is a mechanical presentation?

Answer 44

aggravated by certain postures and activities and eased by others

Question 45

which nerves are compressed in cauda equina syndrome?

Answer 45

below L1

Question 46

what is MSCC?

Answer 46

complication of cancer where metastatic tumours compress the spinal cord or cauda equina

Question 47

what is a upper motor neurone?

Answer 47

a motor neurone within the central nervous system (brain and spinal cord)

Question 48

what happens to tendon reflexes with an upper motor neurone lesion?

Answer 48

exaggerated tendon reflexes

Question 49

what are the tests for upper motor neurone lesion?

Answer 49

babinski, clonus, exaggerated reflexes

Question 50

what happens to tendon reflexes with a lower motor neurone lesion?

Answer 50

reduced

Question 51

what is a lower motor neurone?

Answer 51

a motor neurone from the peripheral nervous system

Question 52

what is a dermatome?

Answer 52

a sensory distribution (area of skin) supplied by a spinal nerve

Question 53

what is a myotome?

Answer 53

a group of muscle strength that is supplied by a spinal nerve

Question 54

what area does L3 dermatome supply?

Answer 54

mid thigh (lat to med)

Question 55

what area does L4 dermatome supply?

Answer 55

lateral thigh, knee, medial calf, big toe

Question 56

what area does L5 dermatome supply?

Answer 56

posterior/lateral thigh, lateral knee, anterior calf, middle 3 toes

Question 57

what area does S1 dermatome supply?

Answer 57

middle posterior thigh, knee, calf, little toe

Question 58

what area does S2 dermatome supply?

Answer 58

posterior medial thigh/knee/calf

Question 59

what are the 5 tests for SIJ pain and how many need to be positive for diagnosis?

Answer 59

distraction compression gaensiens thigh thrust sacral thrust 3 need to be positive

Question 60

what is spondylosis?

Answer 60

degenerative changes in intervertebral discs, vertebral bodies and facet joints of the spine

Question 61

what are the two types of facet joint pain?

Answer 61

intra articular, aggravated by compression of articular surfaces or degeneration changes periarticular, aggravated by stretching on capsule

Question 62

what is lumbar spine stenosis?

Answer 62

a degenerative condition, progression of OA/spondylosis causing crowding at the spinal column

Question 63

what are the signs of a lower motor neurone lesion?

Answer 63

reduced dermatomes reduced myotomes reduced reflexes

Question 64

what are some examples of diseases with upper motor neurone lesions?

Answer 64

spinal cord compression, stroke, MS, cervical myelopathy

Question 65

what are some examples of diseases with lower motor neurone lesions?

Answer 65

cauda equina syndrome, peripheral nerve injury / compression, motor neurone disease