Term
| What does acute low back pain without radiation into the leg suggest? |
|
Definition
| Simple mechanical low back pain |
|
|
Term
| How is the location of the pain from simple mechanical low back pain classically described? |
|
Definition
| As a band across the back. |
|
|
Term
| What do weight loss, anaemia and general ill health on initial inspection suggest? |
|
Definition
|
|
Term
| A stooped posture with flexion of the knee suggests what? |
|
Definition
|
|
Term
| What is your first thought as to the diagnosis when a frail old lady with a stooped posture presents? |
|
Definition
|
|
Term
| What two conditions are likely with a very stiff spine? |
|
Definition
| Simple low back pain or AS. |
|
|
Term
| Where is pathology likely to exist in a patient with an antalgic or trendelenburg gait? |
|
Definition
|
|
Term
| Where will often be tender in simple low back pain? |
|
Definition
| Around the posterior superior iliac spine and sacroiliac joint. |
|
|
Term
| When should blood tests be carried out in a case of back pain and why? |
|
Definition
| In patients over 55 to exclude sinister sources, or as guided by clinical suspicions. |
|
|
Term
| An___ia can be found in Ma_____cy |
|
Definition
| Anemia can be found in malignancy. |
|
|
Term
| What two reasons might blood biochemistry be necessary? |
|
Definition
| To help confirm malignancy or to exclude abdominal causes. |
|
|
Term
| Why would you check immunoglobulins and bence jones protein in back pain? |
|
Definition
|
|
Term
| In what instance should plain x-rays of the spine be taken routinely? |
|
Definition
|
|
Term
| When will an x-ray appear normal, even if low back pain, prolapsed disc, malignancy or infection are present? |
|
Definition
| Early in the disease process. |
|
|
Term
| In low back pain, name 5 things to look for in an x-ray of the spine |
|
Definition
OA changes
Spondylolisthesis
Destruction of the vertebral body, classically the pedicle (winking owl sign)
Fracture
Erosion of the vertebral body around the disc due to infection. |
|
|
Term
| Give three known risk factors for back pain. |
|
Definition
Smoking
Having a medicolegal case pending
Age > 30 |
|
|
Term
| Do patients with a short history (less than 6 weeks) of mechanical back pain symptoms normally require further investigations? |
|
Definition
|
|
Term
| Do patients with a long history (more than 6 weeks) of mechanical back pain symptoms normally require further investigations? WHy? |
|
Definition
| Yes. In order to exclude sinister causes |
|
|
Term
| Should any blood tests be abnormal in mechanical back pain? If so, what? |
|
Definition
|
|
Term
| Are MRI or CT normally heloful in investigating mechanical back pain? |
|
Definition
|
|
Term
| What treatment should be avoided in acute low back pain? |
|
Definition
|
|
Term
| Give three conservative treatment options for acute low back pain. |
|
Definition
Analgesia
NSAIDs
Physiotherapy |
|
|
Term
| What is the rare occasion where surgery may be an option to cure acute low back pain? |
|
Definition
| Degenerative disk disease. |
|
|
Term
| When does acute low back pain become extremely difficult to treat? |
|
Definition
|
|
Term
| What kind of approach does acute low back pain that has become chronic require? |
|
Definition
|
|
Term
| What happens in an intervertebral disk prolapse? |
|
Definition
| Part of the nucleus pulposus herniates through the annulus fibrosus and presses on a spinal nerve root. |
|
|
Term
| What is the usual age range for presentation with a prolapsed intervertebral disk? |
|
Definition
|
|
Term
| Give two risk factors for a disc prolapse. |
|
Definition
Manual work involving heavy lifting
Regular car use. |
|
|
Term
| Where on the disk does herniation tend to occur, and why? |
|
Definition
| Posterolaterally, because the annulus is thinner here. |
|
|
Term
| If a patient has a disc prolapse with back pain but no sciatica or cauda equina or any other neural involvement, what does that tell you? |
|
Definition
| That there is no spinal root involvement. |
|
|
Term
| Give two levels that a disc prolapse is commonly found at. |
|
Definition
|
|
Term
| Which nerve root does an L4-L5 disc prolapse press on? |
|
Definition
|
|
Term
| What is the main symptom of lower lumbar or sacral nerve root irritation? |
|
Definition
|
|
Term
| Describe the symptoms of sciatica |
|
Definition
| There is severe pain radiating down the leg as far as the toes. There may be numbness or tingling or weakness of the foot. Patients find it very uncomfortable to sit, and either stand or lie down. Coughing and sneezing worsens the pain. |
|
|
Term
| Describe the symptoms of cauda equina syndrome. |
|
Definition
| Bladder and bowel dysfunction with possible urinary retention and saddle anaesthesia. |
|
|
Term
| What are bilateral leg symptoms combined with those of a prolapsed intervertebral disc suggestive of? |
|
Definition
|
|
Term
| Give a test that will be positive in sciatica. |
|
Definition
|
|
Term
| Give a sign that may be positive in sciatica |
|
Definition
|
|
Term
| Upon digital rectal examination, what will you find in cauda equine. |
|
Definition
| Loss of anal tone and reduced perianal sensation. |
|
|
Term
| Why would an x-ray be carried out in suspected disc prolapse. |
|
Definition
| TO exclude dony pathology such as spondylolisthesis |
|
|
Term
| What is the scan of choice for patients with persistent symptoms of disc prolapse? |
|
Definition
|
|
Term
| Describe the conservative treatment of a prolapsed disc. |
|
Definition
| A short period of bed rest followed by gentle physiotherapy with appropriate analgesia. |
|
|
Term
| Give the two only indications for urgent surgical discectomy. |
|
Definition
| Cauda equina syndrome and progressively worsening neurological deficit. |
|
|
Term
| When might non-urgent surgery be considered in the case of a prolapsed disc? |
|
Definition
| In the cause of prolonged irretractable back pain longer than 9 months. |
|
|
Term
| What percentage of acute disc prolapses resolve spontaneously? |
|
Definition
|
|
Term
|
Definition
| The slipping of one vertebral body on another. |
|
|
Term
| What percentage of the population have a spondylolisthesis? |
|
Definition
|
|
Term
| Give two sports that predispose someone to spondylolisthesis. |
|
Definition
Gymnastics
Cricket (fast bowlers) |
|
|
Term
| Can spondylolysis cause spondylolisthesis? |
|
Definition
|
|
Term
| What is the most common cause of persistent back pain in children? |
|
Definition
|
|
Term
| Where does a spondylolisthesis normally occur? |
|
Definition
|
|
Term
| What two deformities of the spine can be associated with spondylolisthesis? |
|
Definition
|
|
Term
| Is the slip in spoldylolisthesis becomes severe, wha tcan occur and what does this cause? |
|
Definition
| Nerve root irritation can occur, causing sciatica. |
|
|
Term
| What movement of the spine is classically painful in spondylolisthesis? |
|
Definition
|
|
Term
| In a spondylolisthesis, what may be shown on an oblique x-ray? |
|
Definition
| Collar on scottie dog sign. |
|
|
Term
| In a spondylolisthesis, what will be shown on a lateral x-ray? |
|
Definition
| The degree and angle of slippage. |
|
|
Term
| In spondylolisthesis, when should and MRI be performed? |
|
Definition
| In suspected nerve root irritation. |
|
|
Term
| Describe the conservative treatment of a spondylolisthesis that hasn't slipped. |
|
Definition
| Initial rest and restriction of activities to prevent a slip, followed by physiotherapy, analgesia and activity modification. |
|
|
Term
| Give three indications in spondylolisthesis for surgery. |
|
Definition
Persistent pain
Radiculopathy
Significant deformity. |
|
|
Term
|
Definition
| Degenerative changes of the spine, narrowing the spinal canal and causing compression of the nerve roots. |
|
|
Term
| Which group of people does spinal stenosis most commonly affect?` |
|
Definition
|
|
Term
| What kind of occupation has an increased risk of spinal stenosis? |
|
Definition
|
|
Term
| What is spinal stenosis normally secondary to? |
|
Definition
| Degenerative changes of the spine. |
|
|
Term
| What exacerbates the pain in spinal stenosis? |
|
Definition
|
|
Term
| What relieves the pain of spinal stenosis. |
|
Definition
| Rest and flexion of the spine. |
|
|
Term
| Where is pain commonly referred to in spinal stenosis? |
|
Definition
| The buttock, calves and feet. |
|
|
Term
| What daily activity typically causes discomfort in spinal stenosis? |
|
Definition
|
|
Term
| What will the sciatic stretch test in spinal stenosis be? |
|
Definition
|
|
Term
| What will examination of a patient with spinal stenosis reveal? |
|
Definition
|
|
Term
| What other system is important to examine in patients with spinal stenosis and why> |
|
Definition
| The peripheral vascular system as vascular claudication presents in much the same way. |
|
|
Term
| What will an x-ray typically show in spinal stenosis? |
|
Definition
| Degenerative changes to the spine. |
|
|
Term
| What will and MRI show in spinal stenosis? |
|
Definition
| The degree of stenosis and nerve root involvement. |
|
|
Term
| What kind of imaging would you use to exclude peripheral vascular insufficiency? |
|
Definition
|
|
Term
| Give four conservative treatments for spinal stenosis. |
|
Definition
Weight loss
NSAIDS
Activity modification
Physiotherapy. |
|
|
Term
| What is the prognosis of spinal stenosis? |
|
Definition
| It tends to be progressive. |
|
|
Term
|
Definition
| Infection of the disc space. |
|
|
Term
| What is vertebral osteomyelitis? |
|
Definition
| Infection of the vertebral body. |
|
|
Term
| What age can vertebral osteomyelitis and discitis present? |
|
Definition
|
|
Term
| In adults, what are the common infecting organisms in vertebral osteomyelitis and discitis? |
|
Definition
| Staphylococci and steptococci. |
|
|
Term
| In children, what are the common infecting organisms in vertebral osteomyelitis and discitis? |
|
Definition
| Staphylococci and haemophilus. |
|
|
Term
| As well as Staphylococci and steptococci as infecting organisms in vertebral osteomyelitis and discitis in adults, what other infecting organism should be considered? |
|
Definition
|
|
Term
| What kind of conditions predispose someone to vertebral osteomyelitis and discitis? |
|
Definition
| Those associated with other bone or joint infections. |
|
|
Term
| What should you be thinking when a patient that is unwell with pyrexia presents with severe, unrelenting back pain? |
|
Definition
| Vertebral osteomyelitis or discitis. |
|
|
Term
| What may be revealed on examination of someone with vertebral osteomyelitis ordiscitis? |
|
Definition
A swelling, and in severe cases, an angular scoliosis or kyphosis.
Pain on palpation, reduced movement and possible abnormal neurology. |
|
|
Term
| Describe the WCC, ESR and CRP of someone with vertebral osteomyelitis or discitis. |
|
Definition
|
|
Term
| What may show on an x-ray of someone with vertebral osteomyelitis? |
|
Definition
|
|
Term
| What may show on an x-ray of someone with discitis? |
|
Definition
|
|
Term
| What will be shown on a bone isotope scan of someone with vertebral osteomyelitis or discitis? |
|
Definition
| Hot spots in the affected area. |
|
|
Term
| Why should you perform an MRI in the case of vertebral osteomyelitis or discitis? |
|
Definition
| To check for any epidural abscess. |
|
|
Term
| What should be obtained for culture and sensitivity in vertebral osteomyelitis or discitis? |
|
Definition
|
|
Term
| What is the conservative treatment for vertebral osteomyelitis or discitis? |
|
Definition
| A 6-week course of IV antibiotics, with a prolonged course of oral antibiotics if required. |
|
|
Term
| What is the surgical treatment for vertebral osteomyelitis or discitis? |
|
Definition
| Any abscess should be drained, and an unstable spin with significant deformity needs stabilisation. |
|
|
Term
| What needs to happen to any abscess occuring in vertebral osteomyelitis or discitis? |
|
Definition
|
|
Term
| What is the prognosis of vertebral osteomyelitis or discitis in children? |
|
Definition
| good, children respond well and should return to normality. |
|
|
Term
| What is the prognosis of vertebral osteomyelitis or discitis in adults with severe infection? |
|
Definition
| Poor, can be life-threatening, with surgery carrying significant risk. |
|
|
Term
|
Definition
| Lateral deviation and rotational abnormality of the spine. |
|
|
Term
| What is the incidence of idiopathic scoliosis? |
|
Definition
|
|
Term
| What are the four types of causes of scoliosis? |
|
Definition
Congenital
Idiopathic
Neuromuscular
Secondary |
|
|
Term
| What is the pathology of a congenital scoliosis? |
|
Definition
| Abnormal development of the spine. |
|
|
Term
| What is the pathology of a neuromuscular scoliosis? |
|
Definition
| Abnormal muscle forces on the spine. |
|
|
Term
| What is the pathology of a secondary scoliosis? |
|
Definition
| The curve develops secondary to another process. |
|
|
Term
| What type of scoliosis is that caused by hemivertebra? |
|
Definition
|
|
Term
| What type of scoliosis is that caused by cerebral palsy? |
|
Definition
|
|
Term
| What type of scoliosis is that caused by leg length discrepancy? |
|
Definition
|
|
Term
| Is pain normally a feature of scoliosis? |
|
Definition
|
|
Term
| On clinical examination, when is the rib hump from scoliosis more prominent? |
|
Definition
|
|
Term
| What life-threatening consequence can severe scoliosis have? |
|
Definition
| It can limit chest expansion. |
|
|
Term
| What is often an indication for surgical stabilisation in scoliosis? |
|
Definition
| A significant increase in the severity of the curve. |
|
|
Term
| Why are MRI scans performed in scoliosis? |
|
Definition
| To exclude any associated spinal cord abnormality. |
|
|
Term
| For mild to moderate curves, what is the initial conservative treatment for scoliosis? |
|
Definition
|
|
Term
| What will all congenital, some neuromuscular and severe or progressive idiopathic scoliosis require? |
|
Definition
| Surgical stabilisation, fusion and correction. |
|
|
Term
| How can severe curves in neuromuscular scoliosis cause death? |
|
Definition
| Cardiorespiratory compromise. |
|
|
