2.2. Spine - Prolapsed Intervertebral Disk and Cauda Equina Syndrome Flashcards
What are the 2 types of Disk Protrusion which occur in the Lumbar Region, causing pain?
- Lateral Disk Protrusion
2. Central Disk Protrusion
What are the Features of the Intervertebral Disks?
- They are Secondary Cartilaginous Joints
- It is the largest Avascular Structure in the Body
- It contains 2 Layers:
- a) Annulus Fibrosus (Tough outer layer)
- b) Nucleus Pulposus (Gelatinous Core)
What happens during a Prolapsed Disk?
The Annulus Fibrosus (Tough outer layer) tears and the Nucleus Pulposus prolapses - causing cord / nerve root compression
What are the 2 types of Disk Protrusion which occur in the Lumbar Region, causing pain?
- Lateral Disk Protrusion (Compresses Nerve Roots)
2. Central Disk Protrusion (Compresses Roots within the Cauda Equina)
What does the Cartilaginous End-Plate of each Intervertebral Disk attach to?
The Bony End-Plate of the Vertebrae
What movements do the Intervertebral Disks resist?
Rotational Movement - The fibres of the Annulus Fibrosus run obliquely and alternately between layers
Note - Disks fail with twisting movements
What happens during the normal aging process?
- The water contents of the Disk Decreases
2. The Disk space narrows causing “Degenerative changes” on X-Rays and in the Facet Joints
What are common pathological process of the Intervertebral Disk Protrusion?
- Tearing of the Annulus Fibrosis and Protrusion of the Nucleus Pulposus
- Nerve Root Compression by Osteophytes
- Central Spinal Stenosis
- Abnormal Movement:
- a) Spondylolysis
- b) Spondylolisthesis
What are the features of Nerve Root Pain?
- Limb Pain is worse than Back Pain
- Pain in a Nerve Root Distribution (Radicular)
- Root Tension Signs
- Root Compression Signs
- Dermatomes and Myotomes affected
How is Nerve Root Pain managed?
- About 90% settle in 3 months
- Physiotherapy
- Stong Analgesia
- Referral after 12 weeks for MRI (imaging)
What are the 4 types of Disk Problems, which can cause Nerve Root Pain?
- Disk Bulge
- Disk Protrusion
- Disk Herniation
- Disk Sequestration
What is a Disk Bulge?
Generalized enlargement of the Disk
Note - this is common and the majority are asymptomatic
What is a Disk Protrusion?
The Annulus Fibrosus is weakened but still in tact
What is a Disk Herniation?
The Nucleus Fibrosus has run through the Annulus Fibrosus (it is no longer still in tact)
What is a Disk Sequestration?
Dessicated Disk Material is Free in the Canal
Where do Disk Problems most commonly occur, in the Thoracic Region?
Mid to Lower Levels (75% at T8-12), with Most occurring at T11/12
Note - This accounts for <1% of Intervertebral Disk Prolapses
Where do Disk Problems most commonly occur, in the Thoracic Region?
Mid to Lower Levels (75% at T8-12), with Most occurring at T11/12
Note - This accounts for <1% of Intervertebral Disk Prolapses
Where do Disk Problems most commonly occur, in the Lumbar Region?
- L4/5 (45%)
- L5/S1 (40%)
- L3/4 (10%)
What type of Herniation commonly occurs at the Lumbar Region?
Posterolateral
How does Central Disk Protrusion, from the Lumbar Region, present?
- Pain in both legs
2. Pain in the back only
What is the common name for a Central Disk Protrusion in the Lumbar Region?
Cauda Equina Syndrome
How serious is Cauda Equina Syndrome?
It is a Surgical Emergency
Other than a Central Lumbar Herniated Disk, what can cause Cauda Equina Syndrome?
- Tumours
- Trauma
- Spinal Stenosis
- Epidural Abscess
- Iatrogenic:
- a) Spinal Manipulation
- b) Spinal Epidural
- c) Surgery
What are the Clinical Features of Cauda Equina Syndrome?
- Injury / Precipitating Event
- Bilateral Buttock + Leg Pain
- Varying Dysaethesia + Weaknes
- Bowel / Bladder Dysfunction
- Saddle Anaesthesia - Loss of Anal Tone & Reflex
- High index of suspicion in Spinal Post-op patients
How is the severity of Cauda Equina Syndrome evaluated?
- MRI
2. Lumbar CT or Myelogram (if MRI is contraindicated)
What are the potential outcomes of Cauda Equina Syndrome?
- 30% undergoing discectomy did NOT regain normal Urinary Function
- 25% with motor deficits never regained full power
- 33% with sensory deficits never regained normal sensation
- 25% with perianal paraesthesia did not return to norma
- 26% had persistent Sexual Dysfunction
What are the potential outcomes of Cauda Equina Syndrome?
- 30% undergoing discectomy did NOT regain normal Urinary Function
- 25% with motor deficits never regained full power
- 33% with sensory deficits never regained normal sensation
- 25% with perianal paraesthesia did not return to norma
- 26% had persistend Sexual Dysfunction
