The Spine Flashcards
is most back pain self-limiting?
yes
cardinal rules of back pain management
image early educate reassure avoid bedrest continue movement
red flags of back pain
age <20 and >55
non-mechanical, constant
history of cancer, steroids, HIV, immunocompromised
systemic symptoms e.g. malaise, fever, weight loss
structural deformity
saddle anaesthesia
severe pain for >6 weeks
yellow flags of back pain
low mood high level pain/disability belief that activity is harmful obesity secondary gain (compensation)
what is mechanical back pain?
back pain that is worse with movement and relieved by rest
causes of mechanical back pain
obesity
poor posture
poor lifting technique
lack of exercise
management of mechanical back pain
analgesia and reassure
physiotherapy
what is spondylosis
spinal osteoarthritis
why does spondylosis happen in the elderly?
intervertebral discs lose water content leading to wear and tear and overload at facet joints
what is a severe fracture that can happen in osteoporosis?
crush fractures of the vertebral body
presentation of spondylosis
pain worse with extension
cervical spine= stiffness and pain in neck which radiates to shoulder and occiput
diagnosis of spondylosis
MRI
management of spondylosis
facet joint injections
localised fusion if one or two segments affected
what is an acute disc tear?
acute tear in annulus fibrosis
where are acute disc tears most common?
L4/5
L5/S1
presentation of acute disc tears
pain, especially on coughing due to rich innervation of outer annulus
acute disc tear management
most settle by 3 months
physio
analgesia
what can spinal stenosis cause?
nerves to be compressed by osteophytes and hypertrophied ligaments (OA)
presentation of spinal stenosis
radiculopathy or burning leg pain on walking
pedal pulses are preserved (distinguish from vascular claudication)
what is neurogenic claudication?
radiculopathy/ burning leg pain on walking
when is there less neurogenic claudication in spinal stenosis?
when walking uphill as flexion creates more space
diagnosis of spinal stenosis
MRI
management of spinal stenosis
conservative= physio and weight loss
surgical decompression
what conditions can cervical spine instability occur in?
Down’s syndrome
RA
