35: Spinal Symposium - Spine Degeneration, Low Back Pain, Disc Prolapse, Spinal Stenosis

Question 1

what type of joint are the intervertebral discs?

Answer 1

secondary cartilaginous joint

Question 2

what is the largest avascular structure in the body?

Answer 2

intervertebral discs

Question 3

describe the components of the intervertebral discs

Answer 3

• annuluis fibrosus is tough outer layer
• nucleus pulposus is gelatinous core

Question 4

which ligaments connect the intervertebral discs with vertebral bodies?

Answer 4

• anterior longitudinal ligament
• posterior longitudinal ligament

Question 5

what normally happens to the intervertebral discs as we age?

Answer 5

• decreased water content of discs
• disc space narrowing
• ‘degnerative’ changes on x-ray
• degenerative changes in the facet joints
• aggravated by smoking etc.

Question 6

Describe the pathology of intervertebral disc herniation.

Answer 6

• tearing of annulus fibrosus and protrusion of the nucleus
• nerve root compression by osteophytes
• central spinal stenosis
• abnormal movement: spondylolysis, spondylolisthesis

Question 7

nerve root pain management

Answer 7

• most will settle, about 90% in three months
• physio
• strong analgesia
• referral after 12 weeks
• imaging: MRI

Question 8

list the different types of disc problems

Answer 8

• bulge (generalised), common, majority asymptomatic
• protrusion (annulus weakened but still intact)
• extrusion (through annulus but in continuity)
• sequestration (dessicated disc material free in canal)

Question 9

cauda equina syndrome aetiology

Answer 9

• central lumbar disc prolapse (commonest)
• tumours
• trauma or spinal stenosis
• infection (epidural abscess)
• iatrogenic (spinal surgery or manipulation, spinal epidural injection)

Question 10

cauda equina syndrome clinical features

Answer 10

• injury or precipitating event
• location of symptoms (bilateral buttock & leg pain + varying dysaethesia + weakness)
• bowel or bladder dysfunction (urinary retention +/- incontinence overlfow)
• PR exam - saddle anaestheisa (perianal loss of sensation), loss of anal tone & anal reflex)
• high index of suspicion in spinal post-op patients with increasing leg pain in presence of urinary retention

Question 11

cauda equina management

Answer 11

MEDICAL EMERGENCY!!!
- MRI, if contraindicated then lumbar CT myelogram
- treatment is operative, within 48hrs

Question 12

spinal claudication clinical presentation

Answer 12

• usually bilateral
• sensory dysaesthesia
• poss weakness (drop foot - tripping)
• takes several minutes to ease after stopping walking
• worse when walking down hills