Back conditions Flashcards by Jay Slater

which imaging technique is used to show spinal cord damage, intervertebral discs, nerves etc

GOLD standard for back pain

MRI

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what do xrays show

bone only

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scoliosis definition

lateral curvature of the spine

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aetiology of scoliosis (6)

congenital
idiopathic
secondary to; neuromuscular disease, tumours, infection, spina bifida

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is scoliosis painful

sometimes

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investigations for scoliosis

why

MRI - for tumour

blood tests - for infection

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scoliosis treatment if causing no pain and not deteriorating (3)

physio
casts/brace
wheelchair

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scoliosis treatment if painful and deteriorating

anterior surgery

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risk of surgery of any back surgery (eg for scoliosis)

spinal cord injury

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presentation of scoliosis

resp distress

posture to one side (L or R)

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where is your centre of gravity in kyphosis

anterior to spine

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what does chance fractures increased your risk of

kyphosis

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treatment of kyphosis (4)

same as scoliosis;
physio
brace
surgery

pain management

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forward slippage of one vertebrae onto another

spondylolisthesis

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aetiology of spondylolisthesis (3)

arthritis
trauma
stress fracture

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where does spondylolisthesis occur (vertebral levels (2))

L4/5

L5/S1

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where is the pain in spondylolisthesis

lower back

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risk factors for spondylolisthesis (3)

often young
sport (bending over)
jobs with heavy weights

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treatment for spondylolisthesis

rest
pain relief
physio

surgery (rarely - if >50% slip)

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mechanical back pain treatment (4)

generally nothing
increase exercise (NOT bed rest)
pain relief
acupuncture, physio

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back pain with no neuro symptoms, no red flags

mechanical back pain

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what is the problem in mechanical back pain

muscles

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aetiology of mechanical back pain

poor posture
obesity
facet joint OA

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when is the pain worst in mechanical back pain

movement

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when is pain relieved in mechanical back pain

rest

are slipped discs and spondylolisthesis different things

yes, different aetiology, there is no slipped disc in spondylolisthesis (just the vertebrae)

what is the most common cause of back pain in primary care

mechanical back pain

common name of prolapsed intervertebral disc

slipped disc

risk factors for slipped disc (2)

heavy lifting | old age

pathophysiology of slipped disc

outer fibrous ring allows central part of disc (annulus) to bulge out

what are the common conditions at L4/5 and L5/S1 (2)

slipped disc | spondylolisthesis

where does slipped discs usually occur

L4/5 and L5/S1

why is a slipped disc painful

annulus is highly innervated

what feature of intervertebral discs makes them more likely to prolapse (slipped disc)

if they are dehydrated

presentation of PAIN in slipped disc when is the pain worse

episodic back pain then onset of leg pain worse walking uphill

what imagining technique shows disc dehydration for increased risk of slipped discs

MRI

treatment of slipped disc (4)

self limiting pain relief - NSAID, gabapentin if leg pain increased activity (not bed rest) physio

slipped discs are self limiting, what % are fine after; 3 months 2 years

70% 90%

what is usually the cause of sciatica

slipped disc at L4-S3 = compression of sciatic nerve

buttock/leg pain not caused by hip, knee or ankle

sciatica

is sciatica usually unilateral or bilateral

unilateral

what pattern is the leg pain in sciatica in

dermatomal

pain worse walking downhill

spinal stenosis

what is spinal stenosis

narrowing of spaces in your spine = pressure on spinal cord = pain

aetiology of spinal stenosis (2)

bulging discs | osteophytosis (bony spurs)

spinal stenosis risk factors (4)

male >50 years old manual worker obesity

when is pain worst in spinal stenosis

walking downhill

why does walking downhill cause pain in spinal stenosis

need to extend back to stay upright = compresses spinal cord

when is pain relived in spinal stenosis example

bending forward eg cycling

apart from the back, where else might you get pain in spinal stenosis when walking downhill

legs

investigation for spinal stenosis

MRI

what causes discogenic pain (2)

acute disc tear | degenerative disc

how is discogenic back pain different from other types of back pain (how does the pain present)

severe sudden exacerbations of pain worse as day goes on, worse with activity deep seated central back pain

discogenic back pain treatment (2)

physio | analgesia

spinal stenosis treatment (3 think of risk factor)

physio weight loss surgery (spinal decompression)

degenerative disease of facet joints (cartilage between them)

facet joint arthritis (facet arthropathy)

why is there pain in facet joint arthritis (facet arthropathy)

nerves travel close to facet joints

when is pain worst in facet arthropathy

morning | rest (no movement)

when is pain relieved in facet arthropathy

exercise

which back problem presents with morning stiffness

facet arthropathy

treatment of facet arthropathy (3)

exercise pain relief facet joint injections

aetiology of cauda equina syndrome

disc prolapse at S3/4 level

where is the cauda equina in relation to the spinal cord

below it, but still in the vertebrae

presentation of cauda equina (3)

lower back pain loss of bladder/bowel control saddle anaesthesia - bilateral loss of sensation to buttocks/perineum/inner thigh

investigations for cauda equina syndrome (2)

MRI | PR exam

findings on PR exam in cauda equina syndrome

loss of anal tone

treatment of cauda equina syndrome

emergency surgery within 24 hours

complication of untreated cauda equina syndrome

paralysis

complication of treated cauda equina syndrome

permanent bladder/bowel dysfunction

spinal fracture with complete cord lesion results in...

complete paralysis

spinal fracture with incomplete cord lesion results in...

some sensory/motor loss function below the point of injury

what is the complete loss of sensation and motor function below the level of spinal cord injury that resolves in 24 hours called

spinal shock

what conditions that affect the rest of the spine can also affect the cervical spine (4)

ankylosing spondylosis (degeneration) disc prolapse instability fractures

which 2 conditions are associated with cervical spine instability

downs syndrome | rheumatoid arthritis

where does cervical instability typically happen (spinal level)

between C1 and C2 (atlanto-axial subluxation)

acute pain and stiffness in cervical spine bilateral foot pain difficulty breathing 50 year old

ankylosing spondylitis

Back conditions Flashcards

(76 cards)