BASICS
Compression of lumbar and sacral nerve
ETIOLOGY
Most commonly from tumor or disc herniation
SIGNS AND SYMPTOMS
Back pain
Bowel or bladder dysfunction (urinary retention, overflow incontinence, loss of bowel or bladder control)
Saddle paresthesias
Leg weakness
DIAGNOSTICS
MRI
TREATMENT
Pain control
Urgent surgical decompression
BASICS
Condition that causes pressure on the spinal cord
Early recognition is key to improved outcomes
ETIOLOGY
Common complication of malignancy, usually from metastatic tumor
Also caused by arthritis, trauma, infection
Thoracic spine (60%), lumbar spine (30%), cervical spine (10%)
SIGNS AND SYMPTOMS
Back pain is first symptom
Motor weakness, followed by gait disorders, then paralysis
Sensory symptoms less common
Bowel and/or bladder dysfunction
DIAGNOSTICS
MRI of entire spine imaging of choice
CT plus myelogram for those with contraindication to MRI
TREATMENT
Pain control, steroids, surgical decompression, or radiation
Preserving or improving neurological function
BASICS
Abscess anywhere along spinal cord which can compress
ETIOLOGY
Most common pathogen Staphylococcus aureus
Risk factors include intravenous drug abuse (IVDA), vertebral osteomyelitis, bacteremia, recent spinal/epidural anesthesia or procedure/surgery, diabetes mellitus, HIV, trauma
SIGNS AND SYMPTOMS
Classic triad: fever, spinal pain, extremity weakness
DIAGNOSTICS
MRI test of choice for diagnosis followed by CT with IV contrast
Blood cultures
CT-guided aspiration for culture
TREATMENT
Surgery and long-term antibiotics
BASICS
Most commonly occurs at L4 to L5
Most common cause of chronic low back pain
SIGNS AND SYMPTOMS
Back pain, radiating down leg
Limited spine flexion
Decreased reflexes
DIAGNOSTICS
Straight leg raise
Outpatient MRI
TREATMENT
Conservative
• Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, physical therapy
Consider surgical referral
BASICS
Narrowing of spinal canal, nerve root canals, or intervertebral foramina
Causes nerve root entrapment
ETIOLOGY
Congenital, herniated discs, tumors, injury
SIGNS AND SYMPTOMS
Back pain, pain and tingling in legs, pain in calf/lower leg with ambulation and resolving with rest
Pain relieved with sitting/spine flexion
DIAGNOSTICS
Plain x-ray can show degeneration
MRI to assess nerve root entrapment and to rule out malignancy
TREATMENT
Conservative management with NSAIDs
Physical therapy, epidural steroid injections
Surgery can improve symptoms and functionality after conservative measures fail
Urgent treatment required where there are neuro deficits
INFLAMMATORY AND INFECTIOUS DISORDERS OF JOINTS AND BONES
See Table 9.1
BASICS
Painful inflammatory arthritis usually involving a single joint
ETIOLOGY
Uric acid forms crystals that build up in the joints
Risk factors: trauma, diet, dehydration, alcohol ingestion, medications, chronic kidney disease
SIGNS AND SYMPTOMS
Severe pain, redness, swelling, warmth over 24 hours
Podagra: inflammation of first metatarsophalangeal, most common
DIAGNOSTICS
Uric acid levels have no significant value
Joint aspiration reveals negatively birefringent crystals
TREATMENT
NSAIDs are first-line therapy (Indomethacin)
Colchicine often aborts flairs if taken as soon as symptoms begin, dose often limited by gastrointestinal side effects
Allopurinol used for chronic prevention
Steroids may be given intra-articularly or orally
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
