Lower back pain and sciatica Flashcards Preview

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Flashcards in Lower back pain and sciatica Deck (51)
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31

What modality of imagine should be used for spinal pathologies that have red flags or neurological si/sy?

MRI

32

What will radionucleotide scans show?

Increased bone turnover; #, osteomyelitis, paget's, ank spon
Mets
Tumours; osteoid osteoma

33

When should lab tests be utilised in LBP?

Malignancy; PSA, acid phosphate, monoclonal bands
Infection
Metabolic; alk phos, calcium, phosphate, HLA B-27

34

When should LBP be investigated?

No improvement after 4-6 weeks
Red flags

35

When should LBP be referred to secondary care?

Intractable pain
Serious pathology suspected or suggested initial imaging
Neurological deficit

36

What are risk factors for back pain?

Previous back pain
Heavy lifting/ frequent bending
Repetitive work with exposure to vibration

37

What is the most effective preventative measure for back pain?

Exercise

38

What are differential diagnosis for sciatica?

Root compression by other degenerative disease: bony spurs, canal stenosis, spondylolisthesis, facet hypertrophy
Root compression of sinister cause: tumour, fracture, TB
Root compression from outwith the spine: piriformis syndrome, endometriosis, pelvic disease, peroneal compression (painless foot drop)
No root compression: arachnoiditis, peripheral neuropathy

39

What commonly causes an increase in pain with a disc prolapse?

Coughing
Sneezing
Twisting

40

What are the examination signs of a L5/S1 disc prolapse?

Reduced forward flexion and extension (all disc prolapses)
Calf pain
Weak foot plantar flexion
Reduced pin prick over sole of foot and back of cald
Reduced ankle jerk

41

Examination findings in an L4/L5 disc prolapse

Hallux extension weak
Reduced sensation on outer dorsum of foot

42

What causes CES?

Central prolapse of lumbar disc

43

When is a discectomy indicated?

CES
Progressive muscular weakness
Continuing pain

44

What is spondylolisthesis?

Displacement of one lumbar vertebrae on another usually L5 on S1

45

What can cause spondylothesis?

Spondylosis (age related degeneration with osteophyte formation)
Congenital malformation
OA of facet joints

46

What causes lumbar spinal stenosis and lateral recess stenosis?

Generalised narrowing of lumbar spinal canal or its lateral recesses causing nerve ischaemia
Facet joint OA and osteophytes

47

What are the symptoms of spinal stenosis and lateral recess stenosis?

Pain worse on walking
Pain on extension
Negative SLR
Few CNS signs

48

Yellow flags for back pain

Belief that pian and subsequent activity are harmeful
Pain behaviour
Over-reliance on passive treatments
Depression, anxiety, personality disorders
Unsupportive home environment or over-protective family
Inappropriate expectations and failing to actively engage with tx

49

Typical causes of back pain in those 15-30yrs?

Prolapsed disc
Trauma
#
Ank spon
Spondylolisthesis
Pregnancy

50

Typical causes of back pain in those >30yrs?

Prolapsed disc
Malignancy (lung, breast, prostate, thyroid kidney)

51

Typical causes of back pain in those >50yrs?

Degenerative disc
Osteoporosis
Paget's
Malignant
Myeloma
Lumbar artery atheroma