OnlineMedEd: Neurology - Back Pain

Question 1

What are some symptoms that suggest cord compression in patients with lower back pain?

Answer 1

Focal neurologic deficits:
•Saddle anesthesia
•Bowel or bladder incontinence

Question 2

If you suspect cord compression in lower back pain, then you need to _____________.

Answer 2

order an MRI to evaluate for the cause (e.g., hematoma, abscess, fracture)

Question 3

What are the guidelines for treating musculoskeletal lower back pain?

Answer 3

Rest and NSAIDs for four weeks and then reevaluate if the pain is still present

Question 4

Musculoskeletal lower back pain is often described as _______________.

Answer 4

belt-like

Question 5

Describe how herniation presents.

Answer 5

• Usually a person age 30 - 50
• Pain after heavy lifting
• Positive straight leg raise
• Sciatic pain

Question 6

How should herniation be managed?

Answer 6

• At six months, surgery is better than conservative management
• At one year, conservative management is equivalent to surgery

Question 7

______________ can be easily confused with herniation.

Answer 7

Osteophytes

Question 8

Both osteophytes and herniation present with a positive straight leg raise and asymmetric symptoms. How are they different?

Answer 8

• Osteophytes come on gradually, without a history of heavy lifting.
• Osteophytes are more common in men older than 50, while herniation is more common in men younger than 50.

Question 9

Herniation and osteophytes are both best detected on _____________.

Answer 9

MRI

Question 10

Compression fractures usually present with _____________.

Answer 10

• Vertebral step offs
• New-onset point tenderness over the spine
• More common in older females

Question 11

The classic symptom of spinal stenosis that helps to distinguish it from peripheral vascular disease is ________________.

Answer 11

claudication when the back is extended (such as walking downhill) but not when walking uphill (because the back is hunched)

Note: peripheral vascular disease will have worse claudication when walking uphill.

Question 12

Treatment for spinal stenosis is ________________.

Answer 12

laminectomy (though, of course, conservative measures can also help)