The Spine and Back Pain

Question 1

how many vertebrae are there

Answer 1

33

Question 2

how many cervical, thoracic, lumbar, sacral and fused coccygeal vertebrae are these

Answer 2

7, 12, 5, 5, 4

Question 3

describe the curvatures of the spine

Answer 3

cervical lordosis
thoracic kyphosis
lumbar lordosis
coccygeal kyphosis

Question 4

what are the parts of the body of a vertebra

Answer 4

outer annulus fibrosis, inner nucleolus pulposus

Question 5

what are the atypical vertebrae

Answer 5

c1, c2, c7

Question 6

what is atypical about c1

Answer 6

“atlas” no vertebral body for head rotation

Question 7

what is atypical about c2

Answer 7

“axis” has a dens

Question 8

what is atypical about c7

Answer 8

“vertebrae prominens” small foramina transveraria, non-bifid for vertebral artery passage

Question 9

what is the cauda equina and what vertebral level is it

Answer 9

L1 spinal cord ends

Question 10

where do sensory neurons originate

Answer 10

dorsally

Question 11

where do motor neurons originate

Answer 11

anteriorly from dorsal horn

Question 12

what are mixed spinal nerves formed of

Answer 12

anterior & posterior roots

Question 13

what is spondylosis

Answer 13

group term for degeneration of the spine

Question 14

what is spondylolysis

Answer 14

stress #/defect in pars interarticularis of vertebrae at L5

Question 15

what is spondylolisthesis

Answer 15

1 vertebra slips forward on another

Question 16

what vertebrae are affected by spondylolithesis

Answer 16

L4/5 or L5/S1

Question 17

what plane is a gibbus viewed in

Answer 17

saggital

Question 18

what are the red flags of back pain

Answer 18

PH carcinoma
cauda equina synd
morning stiff
immunocompromised
non-mechanical
6 wk

Question 19

what ages are is back pain more worrying

Answer 19

acute <20/>55

Question 20

what area of the spine is back pain more worrying in

Answer 20

thoracic

Question 21

what is the commonest cause of back pain

Answer 21

mechanical

Question 22

what is the management of mechanical back pain

Answer 22

NSAID/PT/chiro

Question 23

how long does mechanical back pain usually take to heal

Answer 23

6wk

Question 24

what type of back pain is OA

Answer 24

mechanical

Question 25

how to differentiate mechanical back pain

Answer 25

worse on activity, relief on rest

Question 26

which vertebrae are affected by osteoporosis/spondylosis

Answer 26

L4/5/S1

Question 27

how to distinguish back OP

Answer 27

pain relief on extension

Question 28

what test can be done to diagnose/treat back OP

Answer 28

facet joint injection under fluoroscopy

Question 29

what is the presentation of a lumbar disc prolapse

Answer 29

episodic back pain, then dominating dermatomal leg pain

Question 30

what ages are affected by lumbar disc prolapses

Answer 30

30s-50s

Question 31

what is the presentation of sciatica

Answer 31

dermatomal tingling/burning pain in lower leg +- bum

Question 32

what is the pathology of sciatica

Answer 32

nucleus pulposus herniates to spinal canal; compresses L4/L5/S1, radiates on sciatic nerve

Question 33

what is the initial management of sciatca

Answer 33

PT/analgesia/NSAID +- muscle relaxant diazepam

Question 34

when to refer sciatica

Answer 34

if >3 months

Question 35

what is done for sciatica after referral

Answer 35

MRI to decide if surgery is appropriate

Question 36

what surgeries can be done for sciatica

Answer 36

discectomy or decompression

Question 37

what is the pathology of spinal stenosis

Answer 37

osteophytes, hypertrophied ligamentum flavum & bulging discs < cauda equina space; compress nerve

Question 38

what are risk factors for spinal stenosis

Answer 38

(>50 obese male

Question 39

what is the presentation of spinal stenosis

Answer 39

neurogenic claudication, burning leg pain walking downhill, relief up hill/ flexing/ cycling

Question 40

what is the management of spinal stenosis

Answer 40

sometimes decompression is appropriate

Question 41

when to MRI back pain from primary care

Answer 41

sciatica >3mth, spinal claudication

Question 42

problem with MRIs for back pain

Answer 42

many false +ves

Question 43

how long does spinal shock last

Answer 43

24hr

Question 44

presentation of neurogenic shock

Answer 44

temporary paralysis, hypotension, bradycardia

Question 45

cause of a vertebral crush/wedge fracture

Answer 45

OP

Question 46

management of a vertebral crush/wedge fracture

Answer 46

conservative or balloon vertebroplasty

Question 47

describe discogenic pain

Answer 47

deep central lower back, worse end of day/flex/activity

Question 48

gold standard investigation of back pain

Answer 48

MRI

Question 49

investigation of spinal fracture

Answer 49

CT