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Hi, everyone. Thank you for waiting. Um, so my name is George and thank you for joining us today. I'm one of the board members at sa uh this week we're focusing on neurosurgery. Er, and we're very excited to have you all join us today. So today I'm joined by Zack who's going to guide you through back pain. Um, Zack is a second year medical student from the University of Edinburgh. So to make these sessions as engaging as possible, we're gonna be releasing polls throughout these are completely anonymous. So we encourage you to participate with them. Um If you have any questions during the session, please pop them in the chat and we'll do our best to address them at the end of the session. We'll share the feedback form with you. If you complete this, then you'll get a certificate of attendance and exclusive discount codes for teaching me surgery. And past the MRC S additionally, this session is being recorded and the recording and the slides will be shared to our me page a couple of hours after the session. So be sure to keep an eye out for that. We're also excited to share that we have an exclusive question bank and other resources that you'll be able to use on our learning portal. So please check out our website which is S PA um UK to access them. Er, if you create a free membership account with us, you'll automatically receive a discount code for 10% off the geeky medics, anatomy flash cards, surgery flash cards and the knowledge bundle. We also have an exciting opportunity for all our attendees. So two lucky people will win access to the geeky medics, surgical flash cards and the geeky medics oy stations. Uh that'll be for free. So to enter, please simply complete the Google form at the end of the session. Enter the unique code that we provide. The more sessions you attend, the higher your chances are of winning. So please be sure to stay till the end of today's session and attend as many of our other sessions as you can as well. Um We'd also just like to thank our partners, uh the Royal College of Surgeons of England, geeky medics, the MDU more than skin deep med, all teach me surgery and past the MRC S um and a final couple of shout outs. Er, so please watch our social media pages. We're going to be releasing our conference very soon. Um This will be open to um everyone but it specifically aimed at medical students and will be a national conference which we hope that people will be able to present at um and we will be opening abstract submissions soon for that as well. So please do watch out for that. Um And also we do have the er preparation for life as an F one series which will also be coming out soon. Um So again, please watch our socials for that. Er, and without further ado I will hand over to Zack. Thank you. Thank you for that kind introduction. Um Just checking. Can you hear me and see my slides? Yes, we can. Ok, cool. Ok, so welcome everyone. Today, we're going to explore one of the most common complaints. We'll see a medicine, uh back pain. We try and do a whistle stop tour of the different types of anatomy, pathology and some red flags that might indicate a more serious underlying condition. So uh as my colleague said, thank you to our partners for making this possible so that there's a lot of good prizes up for grabs. Yeah, just some of the learning objectives. II won't list them, but you can see kind of the main things that we're going to cover here and here. Well, I'll just try and keep it a a brief wi stop of a different anatomy and pathology. So let's start out the basics of the vertebral column. The structure is central to human posture, movement and protection of the spinal cord. It usually will consist of 33 vertebrae, but this does vary depending on the individual as I, I'll go on to talk about in a bit, the seventh ever called T 12 thoracic five lumbar uh five sacrum. Uh What's interesting about the sacrum is in the, during development, the bones actually develop individually, but then later on, during the development process, they become fused and it's similar with the coccyx. But there's actually some variation in the number of bones in the coccyx particularly, which is why that number can change depending on the individual. So those are just the main uh function, support movement section. As you mentioned before, the vertebrae, they also vary in shape and function across the different regions as we'll get into. So it's, it's the specialized ree the first two cervical vertebrae, they are uniquely adapted for head movement. The first one, c one of the Atlas, it supports the skull and has no vertebral body. A good way to remember that it is the Atlas is uh Atlas is like somebody who's hoarding up the earth. And the Atlas in anatomy terms is the bone that is holding up your head. Then there's C two, the access, it's distinguished by the dens or don process, they're both the same thing. But depending on the where you read it, it will might use different names and it serves as a pivot. There are major joints formed here, the Atlanto occipital joint which allows for the nodding, yes movement. And the atlantoaxial joint which allows for rotational movement, the no movement, understanding this anatomy is crucial especially in trauma scenarios where C one and C two fractures can have catastrophic consequences. So, in terms of the actual different vertebrae themselves, in general, the vertebrae, they vary in shape and function across the different regions. The cervical vertebrae, they allow for greater flexibility and support of the head. The thoracic region anchors the ribs and limits movement to protect thoracic organs. While the lumbar region bears the body's weight. Clinically, understanding the uh location and nature of back pain can often be linked with these specific vertebral regions. That's why it's so important to understand the fundamentals in terms of the movements. One of the the key functions we talked about there. What was the movement? Uh this movement. It depends on several anatomical factors. As we can see in these diagrams, there's loads of different ways that you can move your re or column. Some things that will affect this are the disc shape. So invertable discs, they act as shock absorbers and allows a slight movement, the facet joint orientation, these determine the type of movement. So for example, the cervical facets allow for more rotation and also the ligaments and muscles which provide some stability and can help guide movement overall. Uh the cervical region allows for the most motion, especially rotation. As you can see in those diagrams there, the spine is more rigid due to those rib attachments that we were talking about and the lumbar region allows flexion and extension but limited rotation. So just to summarize briefly, there's thirsty fever at Tobra consisting of those different groups. C one and C two enable head movement, uh facet joint orientation, uh the discs and the muscles, they can influence movements and knowing this is very important in helping to localize uh back pain and pathology. So here's one of the questions I believe this will be one of the ones in the poll. So you can either message in the fall or type in the the chat, which of the following structures is responsible for the primary rotational movement of the head. Um ABC or D I'll just give you a minute to. Mhm OK. It, it's B OK. So now that we've talked about the anatomy, it's time to talk about some of the pathology. So shifting into pathology, the back back pain has a wide range of different causes as you talked about before. It's probably one of the most common presentations that you will see. So there are things like mechanical issues like strain of the muscles, degeneration of discs or facet joint arthritis. There's nerve compression syndromes like sciatica, for example, inflammatory conditions like ankylosing spondylitis. And they can also be quite serious conditions like malignancy infection or cada equina syndrome. So we'll be starting with a S or ankylosing spondylitis. A is a chronic inflammatory disease of the spine and sacroiliac joints. Some of the key points are highlighted in this uh nice infographic. And I think this is quite good for revision of this infographic. It summarizes it quite well. The onset of A S is usually in teens to uh V and it's more common in men. It's a social.