Back Pain - Acute Lumbar Disc Prolapse + Nerve Entrapment Flashcards
Generally occurs in the ?nd to ?th decade.
The nucleus ? of the disc ? into the spinal ?, and will
cause ?-? lower back pain and ? ?.
Can be precipitated by ?, or something as innocuous as a ?.
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This most commonly occurs at L?/?, or L?/S?.
If the herniation is to the extent that it causes compression of one of the
nerve ?, then ? pain will occur.
If the herniation of the disc is ? rather than ?(rare), this can cause ? ? ?, a ? emergency.
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Clinical presentation;
o ? event known, after which patient is ? with pain and unable to ? up.
o The pain will be worse on ?/straining, move into the ? within hours, and into the leg within a ? or two.
o There is often associated ? of the foot.
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Clinical presentation;
o Radicular pain will be present;
• Severe ? pains, and paraesthesia/? in one
leg due to compression of the ? nerve root.
• Rarely, this can affect both ?.
o Always ask about ?/? symptoms that may suggest cauda equina, e.g. any ?/?.
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Examination;
Patient may walk with a ? leg, or with obvious ?.
On spinal examination, there may be ? and palpable ? ?.
? leg raising to ? degrees produces pain;
-> o If positive raising the ? leg, suggests very ? lesion.
? stretch test may be positive (pain in ? thigh);
-> o Suggests ? ? disc prolapse.
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Neurological examination
will show muscle ?, some loss of ? and diminished ? at the affected level;
o The most common muscles involved are ? hallucis ? and
? anterior: L?, ? of great toe, ? of foot.
o ? longus and brevis may also be affected: L4/5, foot ?.
o ?/? are affected in lower lesions: Sl/2, ?
flexion.
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Always examine to rule out ? ?;
o Perform ??: no sensation, loss of ? tone.
o Palpate the ?: signs of ?;
-> • Retention will be ?, ?-?bladder scan can confirm.
o Check sensation of the ‘?’ area
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Investigations/ Management;
Thorough history to separate ? pain in simple lower back pain from ‘true’ nerve ? pain.
The natural history of the disease is ? and ? episodes of pain.
Initial management is conservative;
o Anti-? and ? rest with ?slightly flexed.
o Bed rest for ? weeks reduces the herniation in more than ?%.
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If symptoms persist at ?weeks;
o ? injections are useful to treat radicular symptoms, can be ? fairly frequently.
o At this point, ??? & ? referral is indicated.
o For ? level disease, ? may be performed.
• Removal of the ? material.
o Rehabilitation with the ? is vital part.
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Cauda Equina Syndrome;
Occurs in about ?% of disc ?.
Emergency ??? and urgent ? intervention required to prevent long term
?/?/? sequelae.
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