how to avoid missing something serious in the spine
TRANSCRIPT
How do I avoid missing something serious in the spine?
Dr Angus Forbes Occupa;onal Physician
• Serious (but uncommon) condi;ons – Tumour – Infec;on – Fracture – Cauda Equina
Red flags • Age >50 • Fevers, chills, recent UTI / skin infec;on, penetra;ng wound near spine
• Significant trauma • Unrelen;ng night pain / pain at rest • Progressive motor or sensory deficit • Saddle anaesthesia, bilateral scia;ca, bilateral leg weakness, difficulty urina;ng, incon;nence
• Unexplained weight loss
Red flags
• History of cancer or strong suspicion • History of osteoporosis • Immunosuppression • Chronic oral steroid use • IV drug use • Failure to improve aTer 6 weeks
Red flags
• NHMRC – Evidence based management of acute musculoskeletal pain – 2003
– Now rescinded
Red flags
• Cochrane – Dubious in isola;on – Previous history of malignancy increased chance
Yellow flags
• Psychosocial and occupa;onal factors that may increase the risk of chronicity – Pain beliefs – Compensa;on – Family – Work – Compensa;on
• Waddell’s signs
Examina;on
• Gait / posture • ROM • SLR / crossed SLR • Strength • Reflexes • Sensa;on
Disc hernia;on
• Unlikely without leg pain below the knee • 4% of pa;ents with acute pain have hernia;on • 95% of pa;ents with hernia;on have scia;ca
Imaging
• Plain films • CT • MRI
MRI
• (MBS cervical radiculopathy) • Workcover? • Degenera;ve change is normal • Asymptoma;c adults – Herniated discs 9-‐76% – Bulging discs 20 – 81% – Annunlar tears 14 – 56%
Nexus
Canada