Presented by: Dr Angus Forbes – Occupational Physician Dr Paul Licina — Spine Surgeon Event: GP Education Day - 2015

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rescinded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