Back Pain

Question 0

Lumbar disc herniation – pain must be exacerbated by these activities to be a herniated disc?

Answer 0

Coughing, sneezing, defecating

Question 1

Lumbar disc herniation – spinal level? Description of pain?

Answer 1

L4-L5 or L5-S1

1. They taking pain produced by pressure on anterior spinal ligament
2. Later, sudden onset of neurogenic pain (Like electrical shock shooting down leg) precipitated by forced movement

Question 2

Lumbar disc herniation – physical exam findings? Confirm diagnosis with? Management? When surgery?

Answer 2

Positive straight leg raising test

MRI

1. Three weeks of bedrest
2. Nerve blocks for pain
3. Surgery if neurological deficits are progressing or cauda equina syndrome

Question 3

Signs if Cauda equina syndrome? Surgery when?

Answer 3

Distended bladder, flaccid rectal sphincter, perineal saddle anesthesia

Immediate surgery

Question 4

Ankylosing spondylitis – demographic? Pain worse when?

Answer 4

30-40 year old men

Pain worse at rest, improved with activity

Question 5

Elderly patient with progressive back pain that is worse at night and unrelieved by rest or positional changes – Suspected diagnosis? Diagnostic tests?

Answer 5

Metastatic malignancy; x-ray or MRI