Spine - Head - Neck - Back

Question 1

5 Red Flags when screening for Vertebral Fractures

Answer 1

1. age >50
2. female
3. major trauma - esp with corticosteriod use
4. pain and tenderness
5. distracting, painful injury

Question 2

What is the primary goald of clinical examination of an individual with acute low back pain?

Answer 2

To identify patients who require immediate surgical evaluation and those whose symptoms suggest a more serious underlying condition

• diagnostic imaging is appropriate for progressive motor sensory deficit, saddle anesthesia, bilateral sciatica or leg weakness and difficulty urinating, ecal insentience are all justified for asking MD
• the more red flags the more justified you become

Question 3

Cauda Equina Signs and Symptoms

Answer 3

1. progressive neurologic deficits
2. bowel or bladder dysfunction
3. bilateral sciatica or weakness
4. numbness in saddle distribution
5. ALL REQUIRE MEDICAL REFERRAL

Question 4

Treatment Options for Low back

Answer 4

• NSAIDs = recommended for tx, strong evidence
• Opioids = little evidence, no sig advantage comapred to NSAIDs
• Muscle RElaxants = Strong evidence, helpful for non specific
• Corticosteriods = oral steriods are NOT supported
• Bed rest = strong evidence, activity is better
• Pt education = may speed recovery process, limited evidence
• Exercise therapy = specific back exercises are not helpful
• Massage = limited evidence, considered safe
• Acupuncture = limited evidence, mixed
• Heat/Ice = heat foudn to be helpful in reducing pain and increasing function
• Manipulation = some evidence supports short term
• Physical Therapy = McKenzie method is superior in short term pain relief, strong evidence that traction does NOT improve pts with sciatica long term

Question 5

Acute Back Pain - Major Red Flags

Answer 5

• gradual onset of back pain
• age <20 or >50
• thoracic back pain and isolated
• pain lasting >6wks
• h/o trauma
• fever/chills/sweats
• unintentional weight loss
• p! increases with recumbancy or at night
• unrelenting pain despite analgesics
• h/o malignancy
• h/o immunosuppression
• h/o IV drugs
• hypotension
• extreme HTN
• pale
• spinous process tenderness
• focal neurological signs
• acute urinary retention

Question 6

Red Flag Pain Signs with Back Pain

Answer 6

• Onset - gradual, <20 or >50
• location - thoracic (isolated) localized to midline
• Duration - persists longer than 6wks
• Context - p! after trauma, elderly, procedure
• Associated: neurologic, parasthesias, motor weakness, urinary or fecal incontinence,
• aggravating: laying down, p! at night
• alleviating: p! improves with sitting = stenosis,