3rd part OF PTS Flashcards
What is intervertebral disc disease?
common condition characterised by the breakdown (degeneration) of one or more of the discs that separate the bones of the spine (vertebrae), causing pain in the back or neck and frequently in the legs and arms.
Which discs are most commonly affected
Discs in the lower lumbar spine
What is acute disc diseae
Progressive intervertebral disc breakdown leading to prolapse of the intervertebral disc resulting in acute back pain (lumbago)
Epidemiology of Acute disc disease
- Disease of younger people (20-40 yrs) - the disc degenerates with age
and in the elderly it is no longer able to prolapse- In older patients, sciatica is more likely to result (as opposed to prolapse) - due to compression of the nerve root by osteophytes in the lateral recess of
the spinal canal
- In older patients, sciatica is more likely to result (as opposed to prolapse) - due to compression of the nerve root by osteophytes in the lateral recess of
Aetiology of Acute disc disease
- Accumulation of natural stress, minor injury throughout life
- Genetic predisposition
RF for acute disc disease
- Genetic predisposition
- Advanced age
- Menopause
- Repeated spinal trauma
Pathophysiology of acute disc disease
Intervertebral disc’s nucleus pulposus (mostly water) dehydration → decreased proteoglycan and collagen → decreased padding between vertebrae → decreased shock absorption → disc collapse → herniation of disc contents into spinal canal → nerve impingement → pain
Clinical manifestations acute disc injury
- Sudden onset of severe back pain - often following a strenuous activity
- Decreased range of motion
- Tingling, paresthesia and numbness
- Muscle weakness and atrophy
- Muscle spasm leads to a sideways tilt when standing
- Decreased tendon reflexes
- The radiation of the pain and the clinical findings depend on the disc
affected - the lower three disks are more commonly affected
Investigation of acute disc
- X-rays are often normal - can detect fracture
- MRI
- Evaluates spinal canal
- Detects annular tears
- Increased signal may indicate disc dehydration
- If surgery is being considered
Management for acute disc disease
- Bed rest on firm mattress
- Analgesics - NSAIDs
- Surgery only for severe or increasing neurological impairment
- Nerve root injection
- Corpectomy
Complications of Acute Disc disease
- Spine collapse
- Disc herniation
- Compression fracture
- Bony spur growth
- Neurological deficit
- Myelopathy
- Vertebral artery compression
Chronic Disc Disease definition
Associated with degenerative changes in the lower lumbar discs and facet joints (joining the vertebral bones together)
Clinical manifestations of chronic disc disease
- Pain is usually of the mechanical type i.e. aggravated by movement
- Sciatic radiation may occur with pain in the buttocks radiating into the posterior thigh
- Usually the pain is long-standing and there is no cure
Management of Chronic disc disease
- NSAIDs, physiotherapy and weight reduction can be useful
- Surgery can be done when pain arises from a single identifiable level -
fusion at this level with decompression of the affected nerve roots
Cervical spondylosis definition
Osteoarthritis of the spine, which includes the spontaneous degeneration of either disc or facet joints.
