Spine Conditions

Question 1

What is mechanical back pain?

Answer 1

back pain with no neurological symptoms that is worse when moving and relieved by rest

Question 2

What is spondylosis?

Answer 2

osteoarthritis in the spine

Question 3

How does spondylosis develop?

Answer 3

Intervertebral discs lose water with age which puts extra load on the facet joints -> this leads to OA in these joints

Question 4

Will it be more painful to lean forwards or backwards in spondylosis and why?

Answer 4

more painful to lean backwards bc putting even more load onto the facet joints

Question 5

What is spinal stenosis?

Answer 5

Compression of nerve roots leaving the spinal cord due to Osteoarthritis

Question 6

What causes spinal stenosis?

Answer 6

osteophytes and thickened ligaments in the vertebrae due to osteoarthritis (spondylosis)

Question 7

How does spinal stenosis present?

Answer 7

Neurogenic claudication -> burning pain in legs when exercising

Question 8

What makes neurogenic claudication in spinal stenosis better/worse?

Answer 8

better = walking uphill
worse = walking downhill

Question 9

What happens in an intervertebral disc prolapse?

Answer 9

the nucleus pulposus pops out of the annulus fibrosis and compresses nerve roots

Question 10

Which regions in the back are lumbar intervertebral disc prolapses most likely to occur in?

Answer 10

L4/5

L5/S1

Question 11

Back pain that is worse when coughing is a sign of what?

Answer 11

Intervertebral disc prolapse

Question 12

How long does it take most disc prolapses to get better by?

Answer 12

3 months

Question 13

Which nerve root would be affected in:
Lateral L4/5 disc prolapse
Posterior L4/5 disc prolapse

Answer 13

Lateral = exiting L4 nerve root 
Posterior = transverse L5 nerve root

Question 14

What is altered bladder and bowel function a red flag for?

Answer 14

Cauda equina syndrome

Question 15

What investigation should always be done if cauda equina syndrome is suspected? What would be found?

Answer 15

PR exam - loss of anal tone

Question 16

What is cauda equina syndrome?

Answer 16

compression of all sacrolumbar nerve roots due to a prolapsed disc

Question 17

Management of cauda equina syndrome?

Answer 17

Urgent surgical decompression

Question 18

What is scoliosis?

Answer 18

lateral spinal curvature with secondary vertebral rotation, Cobbs angle >10

Question 19

Give 3 causes of scoliosis?

Answer 19

idiopathic (most common)
congenital (wedges of vertebra don’t develop properly)
neuromuscular (muscles dont work so spine is pulled to the side)

Question 20

What is Cobbs angle?

Answer 20

Measurement of curvature of the spine in degrees

Question 21

Does growth make scoliosis better or worse?

Answer 21

Worse - it will accentuate the curve

Question 22

How can mild scoliosis be made more obvious on examination?

Answer 22

asking the patient to lean forward

Question 23

Management of scoliosis?

Answer 23

conservative: physio, bracing, corrective exercises
surgery: for cosmetics and breathing difficulties

Question 24

What is kyphosis?

Answer 24

excessive curvature in the saggital plane of the spine (>40 degrees) - hunchback

Question 25

Give 3 things that can cause kyphosis?

Answer 25

``` Spinal TB (developing world v common) Congenital deformity Severe osteoporosis ```

Question 26

When is kyphosis operated on and why?

Answer 26

when the curve gets to 70 degrees or worse - surgery is v risky and has lots of complications so want to avoid if possible

Question 27

What is spondylolysis?

Answer 27

Stress fracture of the isthmus of the vertebral arch

Question 28

What can spondylolysis progress to?

Answer 28

Spondylolisthesis

Question 29

what is spondylolisthesis?

Answer 29

anterior displacement of one lumbar vertebrae on the one below - basically a slipped vertebrae

Question 30

At what level do spondylolisthesis usually occur?

Answer 30

L5/S1

Question 31

A patient presents with sudden onset lower back pain, sciatica and a waddling gait. Their lumbar spine looks flat. Most likely diagnosis?

Answer 31

Spondylolisthesis

Question 32

Why do people present with a waddling gait in spondylolisthesis?

Answer 32

their hamstrings are tight due to supporting the lower back and compensating for the slipped vertebrae

Question 33

Management of spondylolisthesis?

Answer 33

conservative management first | if unsuccessful then spinal fusion (happens in 50%)

Question 34

What is cervical spondylosis?

Answer 34

OA in facet joints of the cervical spine

Question 35

Typical presentation of cervical spondylosis?

Answer 35

slow onset stiffness and pain in the neck | pain can radiate to shoulders

Question 36

What can cause upper limb nerve problems in patients with cervical spondylosis?

Answer 36

nerve impingement due to osteophytes

Question 37

What 2 conditions can atraumatic cervical spine instability occur in and which joint does it occur in?

Answer 37

Down syndrome rheumatoid arthritis Atlanta/axial joint (C1/C2)

Question 38

Management of cervical spine instability?

Answer 38

``` mild = collar severe = spinal fusion ```