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This is the spine teaching that I always wish I’d had! Spine for non-spine specialists.
We’ve all had a spot of back pain once or twice in the past, and no mistake. Whether it’s putting down a patio, frolics in the bedroom or just sleeping awkwardly, a bad back is a common thing indeed. But we also know what happens if you try to admit a patient to hospital with terrible back pain – you get roasted by the boss in the morning meeting! Yet now and then, just occasionally, that back pain turns into cauda equina (CES) and suddenly you’ve got an emergency on your hands. CES is a huge source of litigation vs medics and the NHS and missing a case is a deep-seated fear for all of us.
So who needs admitting? What is a ‘red flag’ and are some more red than others? Does everyone get an MRI? Who needs an injection and who needs to toughen up? Can we really just refer people for yoga lessons? What about sciatica, sit tight or intervene? Who goes to the pain service?
Plus we’re covering basic trauma spine too – what gets fixed and what gets a brace. Who gets an MRI and who needs logrolling? Do we have to refer all fractures, even the low-energy ones?
All these Qs, and tons of others, confronted and answered by our totally awesome faculty.
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A good talk about a topic that perplexes many trainees.
Awesome, glad you found it helpful. Mike B
Excellent talks on important topics. Good delivery and discussion points. Thank you.
Thanks for the great feedback. Mike b
Glad you enjoyed them. Mike B
Great informative content and enjoyable too. Thank you very much.
Great, thanks for joining us. Mike B
One question please:
I found in the literature this paper: https://pubmed.ncbi.nlm.nih.gov/31479434/
Bladder Scans and Postvoid Residual Volume Measurement Improve Diagnostic Accuracy of Cauda Equina Syndrome
Should we routinely perform a bladder scan in suspicion of CES before we order an urgent MRI? Is this part of the newest guidelines?
Bladder scan is a valuable investigation. If the post micturation volume is >200mls then this is abnormal. This is a useful, easily accessible investigation that will not delay getting a scan. It does not mean there is or is not compression of the CE or cord, but it if >200mls then this suggests there is possibly something going on and to tread carefully.
We will pass this on to the panel and get some comments too.
Mike B