4.9 Rheumatology Back Pain and Cauda Equina Syndrome – Flashcards
Unlock all answers in this set
Unlock answersquestion
What is the most common finding in caudal equine syndrome?
answer
Urinary retention (>100ml post void residual) has sensitivity of 90% and specificity of 95%.
question
List four non radiological investigations in work up for aetiology of cauda equina.
answer
FBE and film - lymphoma, leukaemia Calcium and ALP - bony metastatic disease PSA - prostate cancer SPEP and urinary Bence-Jones protein
question
What is the most common sensory deficit?
answer
Saddle anaesthesia Anal sphincter tone decreased in 60-80%
question
What is indicated by a positive Laseuge's sign?
answer
Aka straight leg raise, indicates nerve root irritation
question
In the absence of red flag features, list causes of acute lumbosacral back pain without radicular pain.
answer
Muscular and ligamentous sprain Facet joint sprain Internal disruption of annulus fibrosis of disk
question
What percentage of patient with acute lumbosacral back pain recover within 6 weeks?
answer
60-70%.
question
List clinical features of radiculopathy.
answer
Numbness, weakness and loss of deep tendon reflexes corresponding to a specific nerve root.
question
List causes of radiculopathy.
answer
Herniation of nucleus pulposis Facet joint hypertrophy and calcification
question
What percentage of patients with radicular pain get symptom resolution without specific treatment?
answer
90%
question
Does staying active alter outcomes in sciatica?
answer
No. This differs from acute lumbosacral pain without radiculopathy where activity improves recovery.
question
What is the most common symptoms caused by lumbar spinal canal stenosis?
answer
Neurogenic claudication - mechanical low back pain radiating to buttocks and thighs. Caudal equina is uncommon.
question
What exacerbates pain of lumbar spinal canal stenosis?
answer
Worse on walking and standing and eases with sitting, flexion of lumbar spine or lying.
question
How to differentiate vascular from neurogenic claudication?
answer
Pain doesn't resolve when patient stops walking.
question
List causes of spinal canal stenosis in the elderly.
answer
Disc degeneration Facet osteoarthritis Hypertrophy of ligamentum flavum Post laminectomy or fusion surgeries
question
List six differential diagnosis for acute back pain.
answer
Vertebral fracture Tumour Spinal infection Cauda equina syndrome AAA Inflammatory rheumatic disease
question
Mnemonic to remember differential diagnosis acute back pain?
answer
FIT CAR Fracture - history of trauma or prolonged steroid use? Infection - fever, IVDU, immunosuppressed, unwell? Tumour - weight loss, history of cancer Cauda equina - saddle anaesthesia, bladder and bowel dysfunction, bilateral sciatica AAAA - pulsatile abdominal mass, cardiovascular compromise Rhematic disease - structural deformity, systemically unwell, young
question
What is caudal equina syndrome and what nerve roots are contained in the cauda equina?
answer
Compression of nerve roots below the conus medullaris. Nerve roots from L1 to S5
question
List six causes of cauda equina syndrome and mnemonic.
answer
SETTD Spinal stenosis - OA, ank spond Epidural haematoma (post LP or spinal aneasthetic) or abscess Tumour Trauma Disc prolapse (central)
question
Mnemonic for cauda equina causes
answer
VIN HIT Vascular: spinal cord infarct from dissection or vasculitis, AVM Inflammatory: transverse myelitis or MS Neoplastic: metastatic (breast, kidney, prostate, bowel, lung) or primary Haematological: spontaneous or iatrogenic epidural haematoma Infective: epidural haematoma (haematogenous or local spread from discitis or OM) Trauma (most common): central disc herniation, vertebral body fractures
question
List management approach to suspected cauda equina.
answer
Time critical diagnosis as decompression improves outcome MRI organised at outset
question
List four investigations in suspected cauda equina.
answer
Radiological = MRI: definitive test to detect level of compression and likely cause, CXR (metastatic lung cancer) Laboratory = FBE: leukocytosis, cell counts (marrow infiltration), UEC: renal impairment secondary to obstructive uropathy, ALP and Calcium: bony metastesis
