Spinal conditions Flashcards by Laurence Forsyth

clinical features of mechanical back pain

comes on suddely in 60% of cases
-reported bending or lifting episode

v common- 80% of adults get it at some point

can be present with or without assoc leg pain

ALWAYS RULE OUT RED FLAG FEATURES

How well did you know this?

Not at all

Perfectly

differential diagnossi for mechanical back pain 10

mechanical back pain

OA of spine

prolpased intervertebral disc

spinal stenosis

spondlyolisthesis

discitis

inflammatory causes

malignancy

fracture

referred
-abdo
-hip pevlis SI joints

How well did you know this?

Not at all

Perfectly

red flag syx of lower back apin 5

age <20 or >50

history of previous malignancy

night pain

history of trauma

systemically unwell
-weight loss
-fever

How well did you know this?

Not at all

Perfectly

Ix for mechanical back pain 6

no Ix needed unless differential is suspected

patients with short history <6wks do not need routine investigations

prolonged syx or red flags:
-FBC with differential WCC
-ESR
-LFTs
-Bone profile
-Myeloma screen
-CRP

How well did you know this?

Not at all

Perfectly

management of mechanical back pain 4

promote patient education

early syx control w simple analgesia

early return to normal activities

self referral to physiotherapists

How well did you know this?

Not at all

Perfectly

what is nerve root impingement often a consequence of

degenerative disc disease

intervertebral disc herniation is most common in 3rd and 4th decades

How well did you know this?

Not at all

Perfectly

where do the majority of intervertebral disc herniations occur

over 95% occur at L4/5 or L5/S1

How well did you know this?

Not at all

Perfectly

basic pathophys of intervertebral disc heriniations leading to nerve root impingement

nucleus pulpous prolapses out via a defect in degenerative annulus fibrous

compresses the adjacent nerve root or the exiting nerve root, depending on location of disc herniation

How well did you know this?

Not at all

Perfectly

syx of nerve root impingement 2

radicular pain passes below the knee and follows the dermatome of the involved nerve root

leg pain caused by hernitated disc is commonly equal to or worse in severity to that of the back pain itself

How well did you know this?

Not at all

Perfectly

test for nerve root impingement 1
-diagnostic sign in this test

straight leg raising
-pain with SLR due to increased nerve root tension and lack of normal excursion of the root at the herniation site

Lasegue sign (this is the finding found in SLR)
-causes pain in ipsilateral leg distal to knee
-if contralateral leg pain this is a sign of disc herniation

How well did you know this?

Not at all

Perfectly

diagnosis of nerve root impingement 1

MRI

How well did you know this?

Not at all

Perfectly

what are indications for an MRI in a suspected nerve root impingement patient 3

patient present with radicular pain >6wks who have failed conservative measures

patients who develop neurologic deficits

bilateral lower limb deficits or peroneal syx
-NEED URGEN REFERRAL TO ORTHOPAEIDS AND EMERGENCY MRI TO RULE OUT CAUDA EQUINA

How well did you know this?

Not at all

Perfectly

define radicular pain

type of pain that radiates from your back and hip into your legs through the spine

How well did you know this?

Not at all

Perfectly

non-surgical management of nerve root impingement patient 4

majority non surgically:
-physiotherapy
-analgesic (simple analgesia and NSAIDs)
-muscle relaxants (limited short course initially)
-alternative therapies (acupuncture)

How well did you know this?

Not at all

Perfectly

when could surgery be considered for nerve root impingement patient

no earlier than 6 weeks from onset of syx
UNLESS:
-cauda equina syndrome
-progressive neurological deficits

How well did you know this?

Not at all

Perfectly

absoliute indcations for nerve root impingement surgery 2

cauda equina syndrome

progressive neurological deficit

How well did you know this?

Not at all

Perfectly

relative indications for nerve root impingement surgery 3

intractable radicular pain

neurological deficit not improving conservatively

recurrent sciatica following successful trial of conservative measures

How well did you know this?

Not at all

Perfectly

what are 5 serious spinal pathology

cauda equina syndrome

infection

tumour and spinal cord compression

spinal injuries

inflammatory conditions (Ank Spon)

How well did you know this?

Not at all

Perfectly

red flag spinal pathology features 10

<18 or >50 at onset of non-mechanical pain

bilateral radicular leg pain

limb weakness

bladder or bowel dysfunction

peri-anal numbness

Hx of cancer

constituaonal syx

trauma

thoracic pain

history of immuno-compromise or prolonged steroid use

How well did you know this?

Not at all

Perfectly

clinical features of cauda equina syndrome 2

bilateral syx of paresthia or mscule weakness

enquire about:
-saddle parestehia
-bladder and bowel dysfunction

How well did you know this?

Not at all

Perfectly

red flag cauda equina syndrome history compoentes 4

back pain w uni/bilateral sciatica

lower limb weakness

altered perianal sensation

faecal or urinary incontinence

How well did you know this?

Not at all

Perfectly

examination red flag features of cauda equina syndrome 5

limb weakness

other neuro deficits/ gait disturbance

hyper-reflexia, clonus, up-going plantars

urine retention

DRE- saddle anaetehisa, loss of anal tone

How well did you know this?

Not at all

Perfectly

investigations of cauda equina syndrome 3

full history and exam
-DO PR W SENSATION AND ANAL TONE

bladder scan pre and post void to assess for bladder emptying

if sus of CEs-> urgert MRI

managemetn of cauda equina syndrome 1

urgent surgical decompression

MRI findings in cauda equina syndrome 2

complete obliteration of spinal canal space compression of cauda equina

define discitis

infection of the disc space

define vertebral osteomyeltis

infection of vertebral body

assoications with discitis and vertebral osteomyelitis 3

IV drug use sepsis from another source post spinal surgery

organisms causing discitis and vertebral osteomyelitis 4

staph and strep most common strep and haemophilus in children tuberculosis -should be considered

clinical presenation of discitis and vertebral osteomyelitis 4

fever generally unwell back pain (unrelenting) late cases can have spinal deformity -kyphosis -scoliosis

investigations of discitis and vertebral osteomyelitis 5

blood -WCC -ESR -CRP imaging -X-ray- look for deformities -MRI- increased signal in intervertebral disc or bone/ collection/ assoc epidural abscess

management of discitis and vertebral osteomyelitis 3

biopsy via CT guided appropriate IV ANx- minimum 6 wks surgical treatment occasionally required -stabilisation -draining a large abscess

spinal tumour clinical presenation 2

in adults metastic tumours are most common spinal tumours present with: -pain -neurological *-always ask red flags

spinal tumour investigations 3

MRI whole spine -esp if ptx hx of cancer and new onset back pain bone scan serum calcium -check for hypercalcemia

overviwe of malignant spinal cord compression

occasionally patients with spine mets present with compression of spinal cord THIS IS A NEURO EMERGENCY emergency radiotehrapy or surgical decompression is usually indicated

what does spinal injuries include

includes fractures, subluxations and dislocations as a result of direct or indirect trauma

state the two classifications for spinal fractures 2

high energy injuries -RTAs, fall from height low energy -elderly patients with osteoporosis or metastatic disease *-note 10-20% of ptx w spinal fractures have a second fracture at another level

spinal fracture types based on anatomy 3

isolated anterior column fractures -wedge compression -tends to be stable column (burst fractures) or associated ligament injuries tend to be unstable

clinical assessment of spinal injuries in patients

high energy: -ATLS perspective -patients with facial or head injuries should be presumed to have a significant neck injury until proven otherwise -patients log rolled w C-spine control when spinal injury suspected

on examination what are sx of spinal injuries 4

bony midline tenderness clinical deformity or palpable step boggy swelling or brusing neurological compromise

features of spinal shock 2

bradycardia hypotension

diagnosis and imaging for spinal injuries 3

XR -C-spine -AP/lateral/ peg view T&L spine -AP & lateral CT -for high energy injruies -more than 1 column involvement MRI -if assessing ligament or spinal cord injuries

treatment of stable cervical spinal injuries 2

cervical -cervical collar -analgesia

treatment of stable thoracic and lumbar spinal injuries 2

thoracic and lumber -early mobilisation -bracing for symptomatic relief

treatment of unstable cervical spinal injuries 3

HALO jacket cerivcal collar (extended duration) ORIF

treatment of unstable thoracic & lumbar spinal injuries 3

ORIF bracing (extended duration) bed rest in medically unfit patients

first steps in spinal cord injuries 2

surgical decompression stabilisation

define scoliosis

lateral deviation or rotational deformity of the spine

causes of scoliosis 4

idiopathic -most common neuromuscular congenital secondary

clinical features of scoliosis 4

pain uncommon -if present should prompt further investigation rib hump asymmetrical shoulder height limb length inequality chest expansion may be affected in severe deformites

treatment of mild curve scoliosis 2

majority of idiopathic curves -conservative treatment occasionally bracing if risk of progression of curve identified

treatment of moderate/severe curve scoliosis

more commonly assoc w neuromusclar condtions or congenital curves -surgical correction to prevent progression -or to prevent deformity compromising cardio/respiratory function

neuromusulcar conditions causing scoliosis

ncluding central nervous system disorders such as cerebral palsy and spinal cord injury; motor neuron disorders, for example, spinal muscular atrophy; muscle fiber disorders, for example, Duchenne muscular dystrophy; multifactorial disorders, for example, ...

define kyphosis

exageratted forward rounding of the upper back

cause of kyphosis

poor posture in childhood or scheuermanns kyphosis -vertebrae dont develop properly

treatment of kyphosis

reduce weight bearing and strenusous activites rarely- brace or surgery

define fixed and flexible kyphosis

fixed- cant straighten spine when standing straight -due to abnormal vertebrae (scheuermanns kyphosis) felxible- can straighten spine