Spine Problems

Question 1

What re the 6 RED FLAG symptoms in spinal injuries?

Answer 1

Under 20 or Over 55
Associated with systemic/neurological symptoms 
Persistant and serious suspected
Nocturnal pain or worse in the morning 
Malignancy/HIV/Infection 
Acute onset in the elderly

Question 2

What are the 3 areas of back pain?

Answer 2

Mechanical
Nerve root entrapment
Serious underling pathology

Question 3

What are the 2 types of prolapsed IV disc?

Answer 3

Lateral = compression of the nerve root

Posterior central = entrapment of the spinal cord causing caudal eqina syndrome

Question 4

What are the 4 most commonly affected areas?

Answer 4

C5/6 T11/12 L4/5

L5/S1

Question 5

What are the symptoms of a nerve root entrapment?

Answer 5

Sciatica = pain in the buttock radiating down the leg
Loss of ankle reflex
Pain and muscle spasms
Sensory and or motor weakness

Question 6

What is the treatment of a mild prolapsed IV disc?

Answer 6

Physiotherpay
Bed rest for 3 days
Strong analgesia
Most resolve

Question 7

Apart from IV disc prolapse what can be the cause of caudal equina?

Answer 7

Tumour
Trauma
Spinal stenosis

Question 8

What are the symptoms of CA syndrome?

Answer 8

Loss of sacral sensation 
Overflow incontinence
Urinary retention 
Bowel dysfunction 
Loss of tone of sphinters
Pain that radiates down the legs

Question 9

What is the management of CA syndrome?

Answer 9

Surgery within 48hrs - removal of the disc

Urgent MRI/CT?lumbar myelogram

Question 10

Where can a metastatic spinal tumour come from?

Answer 10

CNS tumour 
Breast
Bone 
Prostate
Lung
Renal 
Primary sarcoma

Question 11

What re the symptoms of a metastatic spinal tumour?

Answer 11

Parasthesia
Loss of anal tone
Pain
Sensory Changes

Question 12

How can you diagnose a metastatic bone tumour?

Answer 12

X-ray

Can do CT/ MRI

Question 13

What is the management of a metastatic bone tumour?

Answer 13

Immediate surgical resection
Chemo/radio
Find the primary

Question 14

What is the definition of
Spondylolysis
Spondylolisthesis?

Answer 14

1. This is a stress fracture in one of facet joins AKA Par Interarticularis
2. Fracture leading to the asteroid slippage of a vertebrae leading to pain and injury

Question 15

What are the common presenting symptoms of the 2 S’s?

Answer 15

Lower back pain 
Gradual onset
Resticts daily living 
unilateral tenderness
Sensory/ nerve damage

Question 16

What are the managements of the S’s?

Answer 16

Rest, NSAID’s, brace and physio

Can do a fusion Sx

Question 17

What is scoliosis?

Answer 17

This is the abnormal curate of the spine

Question 18

What are the clinical findings in scoliosis?

Answer 18

They have asymmetry standing and the waist and shoulder are out of lone

Question 19

What is the treatment of scoliosis?

Answer 19

Surgical correction

Question 20

What is spinal stenosis

Answer 20

Abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots.

Question 21

What are the 2 most common causes of a Spinal cord Injury?

Answer 21

Fall or RTA

Question 22

What are the 3 effects of SCI?

Answer 22

Quadraplegia = all 4 limbs
Paraplegia = 2 lower limbs
Hemiplegia = down one side

Question 23

What are the features of Brown Sequard Syndrome?

Answer 23

Paralysis on the affected side and loss of proprioception on he alternative side

Question 24

What is a central cord syndrome?

Answer 24

Caused by a hyperextension injury, greater weakness of the arms than the legs

Question 25

What is a anterior cord syndrome?

Answer 25

Hyperflexion injury causing profound weakness but the proprioception is preserved

Question 26

What is a posterior cord syndrome?

Answer 26

RARE! Loss of proprioception but pain and temperature is preserved

Question 27

What is the management of a spinal cord injury?

Answer 27

``` A - Secure the spine B -Ventilation and oxygenation C - IV fluids and consider neurogenic shock (hypotensive and bradycardia) D -assess the neurological function Spinal surgery, OT, physio ```

Question 28

``` What do the following levels correspond to in terms of movements and movements and muscles: C5 C6 C7 C8 T1 ```

Answer 28

``` Abduction = deltoid Elbow flexion = biceps Elbow extension = triceps Finger flexion = FDS FDP Finger abduction = interossei ```

Question 29

``` What do the following levels correspond to in terms of movements and movements and muscles: L2 L3/4 L4 L5 S1 ```

Answer 29

``` L2 = Hip flexion = Iliopsoas Knee extension = quads Ankle dorsiflexion = tibialis anterior Big toe extension = EHL Ankle plantar flexion = gastrocnemius ```