PMC - Back pain and sciatica

Question 1

Name 3 causes of mechanical back pain

Answer 1

• Scoliosis
• Herniated disk
• Sacroiliac joint dysfunction
• Arthritic changes to joints
• Spondylolisthesis
• Muscle or ligament sprain
• Facet joint dysfunction

Question 2

Red flag causes of back pain (1)
Name 2 causes of back pain that is considered to be serious

Answer 2

• Cauda equina syndrome
• Ankylosing spondylitis
• Spinal stenosis
• Spinal fracture
• Spinal infection

Question 3

Red flag causes of back pain (2)
1) Which serious cause of back pain may present with intermittent, neurogenic claudication?
2) Which serious cause of back pain may present u40 with gradual onset with stiffness in the morning/night-time
3) Which serious cause of back pain may present with saddle anaesthesia, urinary incontinence, and bilateral neurological signs?

Answer 3

1) Cervical stenosis
2) Ankylosing spondylitis
3) Cauda equina syndrome

Question 4

Name 2 other causes of back pain that is not related to the spine

Answer 4

• Pneumonia
• Pyelonephritis
• Pancreatitis
• Endometriosis
• Pelvic inflammatory disease
• Metastases
• Kidney stones
• Prostatitis
• Ruptured aortic aneurysm

Question 5

Sciatica (1)
1) Which nerves form the sciatic nerve?
2) What 2 nerves does the sciatic nerve split to form at the knee?
3) What is the main symptoms that sciatica causes, and how may this be described?
4) Name another symptom it can present with

Answer 5

1) L4 and S3
2) Common peroneal and tibial
3) Unilateral pain that extends from the buttock down the back of the leg to the knee, and sometimes down to the foot. It may be described as an electric or shooting pain
4) Paraesthesia (pins and needles), numbness and motor weakness

Question 6

Sciatica (2)
1) The main causes of sciatica are lumbosacral nerve root compression - name a cause of this
2) Bilateral sciatica is a risk factor for what?

Answer 6

1) Herniated disk, spinal stenosis, spondylolisthesis
2) Cauda equina

Question 7

Name 4 of the main 5 cancers that metastasize to bone

Answer 7

• Prostate
• Lung
• Breast
• Renal
• Thyroid

Question 8

In patients with suspected cauda equina, what is the investigation done?

Answer 8

Emergency MRI

Question 9

The sciatic stretch test can be used to help diagnose sciatica - how does it work?

Answer 9

Patient lies flat. Examiner lifts 1 leg straight (80-90 degrees) and dorsiflexes ankle. Sciatic type pain in the buttock indicates sciatica, and the pain should go away when the knee is flexed

Question 10

1) Name an analgesic medication that can be used in back pain
2) Name an analgesic medication that shouldn’t be used in back pain

Answer 10

1) NSAIDs, codeine (alternative), benzodiazepines (for muscle spasms and short term only)
2) Opioids, TCAs, pregabalin, gabapentin, amitriptyline

Question 11

For the management of sciatica, neuropathic pain medications can be used apart from pregabalin and gabapentin - this leaves 2 options - name 1 of these

Answer 11

• Amitriptyline
• Duloxetine

Question 12

What happens in cauda equina syndrome?

Answer 12

Nerve roots of the cauda equina within the lumbar spine are compressed

Question 13

What is the commonest cause of cauda equina syndrome

Answer 13

Large central disc prolapse in the lower lumbar spine

Question 14

The diagnosis of cauda equina syndrome is clinical, but what is important to confirm the diagnosis?

Answer 14

MRI

Question 15

Name a consequence of cauda equina syndrome without urgent treatment

Answer 15

• Loss of bladder and bowel control
• Loss of sexual function
• Lower limb weakness

Question 16

How is cauda equina syndrome managed?

Answer 16

Emergency decompression