W7 - MSK spinal Cord

Question 1

Classify spinal pain into red flags, specific & non-specific

Answer 1

Red flags (1-2%) =0.98 medical investigation with scans
Specific (5-10%) =4.5 wither physio or surgery & potential scans
Non-specific (90%) =0.9 physio & scans are unlikely

Question 2

What are the 8 spinal red flags

Answer 2

Myelopathy (central/spinal cord compression)
Cervical arterial dysfunction (CAD)
Malignancy
Systemic inflammatory disorders
Infections
Fractures
Cauda equina syndrome
Osteoporosis

Question 3

Name the 8 specific lower back pain conditions

Answer 3

Ankylosing spondylitis
Spinal stenosis (central & foraminal)
Spondylitis
Spondylolisis
Spondylolisthesis
Scoliosis
Whiplash
Radiculopathy

Question 4

What is ankylosing spondylitis

Answer 4

Inflammatory arthritis with symptoms being back pain at the SIJ

Question 5

What areas does ankylosing spondylitis mainly effect

Answer 5

Entheses where ligaments, tendons & capsules are attached to the bone

Question 6

What scans might be used for ankylosing spondylitis

Answer 6

X-rays (oesteophytes & possible fusions)
MRI scans (inflammation)

Question 7

Risk factors of an ankylosing spondylitis

Answer 7

Genetics (family history & HLA-B gene), men, age (late adolescence)

Question 8

Typrical presentation of ankylosing spondylitis

Answer 8

Slow or gradual onset of back pain with stiffness over weeks/months
Early morning stiffness & pain which wears off during the day & with exercise
Persistent for 3 months
Feeling better after exercise & worse after rest
Weight loss in early stages
Fatigue & tiredness
Feeling feverish & night wpsweats
Can affect other tendons, eyes, lungs & bowels

Question 9

What is a spinal stenosis

Answer 9

Narrowing of the spinal canal

Question 10

Name the 2 types of spinal stenosis

Answer 10

Central spinal stenosis = narrowing of the vertebral foramen
Foramina soinal stenosis = narrowing of the intervertebral foramen

Question 11

Causes of a spinal stenosis

Answer 11

Osteophystes
Disc herniating
Thickening of ligaments
Tumours
Age related changes

Question 12

Symptoms of a spinal stenosis

Answer 12

Not alsways causes symptoms
Neck or lower back spinal pain
Nerve symptoms

Question 13

What can happen if there is a central cord compression in the cervical spine

Answer 13

Cause a myelopathy

Question 14

What can happen if there is a central cord compression at the bottom of the lumbar/sacral spine

Answer 14

Cause cauda equina syndrome

Question 15

Why do symptoms of a spinal stenosis improve with flexion activities & worsen with extension

Answer 15

Canals are narrower in extension and open in flexion so less pressure on the soinal cord in flexion

Question 16

Spinal stenosis management

Answer 16

Sometimes surgery
Physio management: advice & education, pain management strategies, exercises & life style changes

Question 17

What is spondylosis

Answer 17

Umbrella term for osteoarthritis changes in the spine

Question 18

What areas can a spondylosis affect

Answer 18

Vertebra, intervertebral discs, facet joints, joints of luschka, ligamentum flavum & laminae

Question 19

What can a spondylosis cause

Answer 19

Stenosis

Question 20

Risk factors of a spondylosis

Answer 20

Age related changes

Question 21

Spondylosis management

Answer 21

Physio management:
Address individuals beliefs & goals, reassurance, encourage normal movement & function, increase ROM, increase strength & gradedexposure

Question 22

What is a spondylolisthesis

Answer 22

Anterior translation of the superior vertebra relative to the inferior vertebra

Question 23

Where is a spondylolisthesis most common

Answer 23

L5/S1 and L4/5

Question 24

What are the grades of a spondylolisthesis

Answer 24

Grade 1 = 0-25%
Grade 2 = 26-50%
Grade 3 = 51-75%
Grade 4 = 76-100%
Grade 5 = above 100% (spondyloptosis)

Question 25

Risk factors of a spondylolisthesis

Answer 25

Genetics Trauma Degeneration Spondylolisis PARSfracture Pathological spondylolisthesis = can be systemic causes such as bone or connective tissue disorder, infection & neoplasm

Question 26

Spondylolisthesis management

Answer 26

Surgery for high grades & severe nerve compression Physio

Question 27

What is scoliosis

Answer 27

S shaped curve in the spine which may or may not cause pain 80% are idiopathic Congenital Can be caused by neuromuscular conductions such as cerebral palsy, ,usc,usar dystrophy & soina bífida

Question 28

Fisk factors of scoliosis

Answer 28

Cannot be prevented Not linked to bad posture, exercise or diet Cause my genetics

Question 29

When is surgery needed for a patient with scoliosis

Answer 29

Spinal fusion surgery is needed if the COBB angle is greater then 40-50 degrees

Question 30

Scoliosis management

Answer 30

Physio: maintain ROM & manage symptoms

Question 31

What is whiplash

Answer 31

Generic term for neck pain following sudden force (acceleration or deceleration) normally from RTA Yellow flags (insurance claims)

Question 32

Symptoms of whiplash

Answer 32

Neck pain Hearing loss Headaches Numbness/weakness Double vision Tinnitus Numbness of head or face Vision loss Eye pain Nausea

Question 33

Management for whiplash

Answer 33

Education/reassurance Physio: ROM, exercise, stretching, oain management techniques & manual therapy

Question 34

Causes of non-specific back pain

Answer 34

Issues around the: Soft tissue Muscles Ligaments Tendons Joints Discs

Question 35

Non-specific pain management

Answer 35

Self management = advice & info Exercises Orthotics (not needed)