How to avoid missing something serious in the spine
- 1. How do I avoid missing something serious in the spine? Dr Angus Forbes Occupa;onal Physician
- 3. • Serious (but uncommon) condi;ons – Tumour – Infec;on – Fracture – Cauda Equina
- 4. 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
- 5. 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
- 6. Red flags • NHMRC – Evidence based management of acute musculoskeletal pain – 2003 – Now rescinded
- 7. Red flags • Cochrane – Dubious in isola;on – Previous history of malignancy increased chance
- 8. 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
- 10. Examina;on • Gait / posture • ROM • SLR / crossed SLR • Strength • Reflexes • Sensa;on
- 11. 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
- 12. Imaging • Plain films • CT • MRI
- 13. 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%
- 14. Nexus
- 15. Canada