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20 Cards in this Set
- Front
- Back
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What signs/symptoms associated with low back pain are considered "red flags"?
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Incontinence of bowel/bladder
Pain radiating down leg Bilateral pain Weakness of muscles |
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When do you order X-rays to investigate low back pain?
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Only in pain persists past 6 weeks or if there are red flags.
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What clinical exam findings suggest a herniated disc?
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Lower motor neuron findings
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• Give a differential diagnosis for low back pain.
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o Degenerative low back pain (>90% of cases)
o Mechanical back pain (idiopathic, but is this different than degenerative back pain?) o Herniated disc o Facet joint pathology (spondylolysis, spondylolysthesis) o Spinal stenosis o Cauda equina syndrome o Neoplastic (primary or metastatic) o Infectious (osteomyelitis, TB) o Inflammatory (spondyloarthritis, e.g. ank. spon.) o Traumatic (fracture with spinal cord injury) |
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• What is degenerative low back pain?
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o Essentially osteoarthritis of the back, with loss of vertebral disc height
o Degeneration results in bulging and tears of anullus fibrosus, change in alignment of facet joints, osteophyte formation |
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• Name 5 conditions that you must consider and rule out in a patient presenting with low back pain.
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o Neoplasm (can be primary or metastatic)
o Infection (osteomyelitis of vertebrae, tuberculosis) o Inflammatory (spondyloarthritis, e.g. ankylosing spondylitis) o Cauda equina syndrome (compression of cauda equina) o Fracture with associated spinal cord damage |
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• What is spinal stenosis?
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o Narrowing of the spinal canal to <10mm
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• What is a complication of spinal stenosis?
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o Neurogenic claudication
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• How does neurogenic claudication present clinically?
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o Pain or cramping in the legs
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• What are the two types of claudication?
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o Neurogenic and vascular
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• How can you differentiate neurogenic from vascular claudication?
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o Character, timing, aggravating factors, alleviating factors
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• What is the quality of neurogenic claudication? Vascular claudication?
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o Neurogenic: may be neurologic dysfunction
o Vascular: muscle cramping |
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• What precipitates/aggravates neurogenic claudication? Vascular claudication?
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o Neurogenic: standing/exercise, walking a variable distance
o Vascular: walking a set distance |
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• What alleviates neurogenic claudication? Vascular claudication?
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o Neurogenic: change in position
o Vascular: cessation of walking |
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• How long does it take neurogenic claudication to settle down? Vascular claudication?
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o Neurogenic: >10 mins
o Vascular: <2 mins |
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• What is the usual cause of cauda equina syndrome?
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o Large central disc herniation
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• What else can cause cauda equina syndrome?
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o Other space occupying lesions: tumour, abscess, hematoma
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• What symptoms are classically associated with compression of the cauda equina?
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o Urinary/fecal incontinence
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• What imaging studies are ordered to investigate cauda equina syndrome?
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CT myelogram or MRI
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• What is the treatment of cauda equina syndrome?
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o Emergency surgical decompression
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