Case 2 - Back Pain

Question 1

what is sciatica

Answer 1

a nerve pain from an injury or irritation to the sciatic nerve, which originates in the gluteal area. the sciatic nerve is the longest and thickest nerve in the body. it is made up of 5 nerve roots: two from the lumbar spine, and three from the sacral spine. they come together to form a right and left sciatic nerve on each side of your body

Question 2

what does sciatic feel like

Answer 2

sharp, shooting or jolts of pain and others describe it as burning, electric or stabbing.

Question 3

is the pain constant?

Answer 3

can be constant or may come and g0

Question 4

where is the pain more severe

Answer 4

leg compared to the lower back

Question 5

what is the epidemiology of sciatica

Answer 5

40% of people in the US experience sciatica during their life. back pain is the third most common reason people visit their GP

Question 6

what are the causes of sciatica

Answer 6

• herniated or slipped disc
• degenerative disc disease
• spinal stenosis

Question 7

describe a herniated disc

Answer 7

causes pressure on a nerve root. discs are the cushioning pads between each vertebrae. pressure form vertebrae can cause the gel-like centre of a disc to bulge (herniate) through a weakness in the outer wall

Question 8

what is degenerative disc disease

Answer 8

the natural wear down of the discs between vertebrae of the spine. the wearing down of these discs shortens their height and leads to nerve passageways becoming narrower. can pinch the sciatic nerve roots as they leave the spine

Question 9

what is spinal stenosis

Answer 9

the abnormal narrowing of the spinal canal. this narrowing reduces the available space for the spinal cord and nerves

Question 10

what is the most common cause of sciatica

Answer 10

herniated/slipped disc

Question 11

what are the symptoms of sciatica

Answer 11

• moderate to severe pain in lower back, buttock or down your leg
• numbness or weakness in lower back
• pain that worsens with movement: loss of movement
• pins and needles
• loss of bowel and bladder control

Question 12

how is sciatica diagnosed

Answer 12

spinal X-rays look for spinal fractures, disc problems

Question 13

what confirms the diagnosis of sciatics

Answer 13

an MRI

Question 14

what determines if a vertebrae or disc is causing pain

Answer 14

myelogram

Question 15

what is the other uncomfortable test used

Answer 15

straight leg raise test

Question 16

what are spinal injections

Answer 16

they are usually corticosteroids - an anti inflammatory medicine into the lower back might help reduce the pain and swelling around the affected nerve roots. these typically last three months and given under local anaesthesia as an outpatient treatment

Question 17

what is a microdiscectomy

Answer 17

minimally invasive procedure used to remove fragments of a herniated disc that are pressing on a nerve

Question 18

what is a laminectomy

Answer 18

the lamina that is causing pressure on the sciatic nerve is removed

Question 19

what is a prolapsed - herniated disc

Answer 19

when some of the nucleus pushes out through tear in the annulus

Question 20

where does a herniated disc occur most often

Answer 20

the lower back

Question 21

what are the symptoms of a herniated disc

Answer 21

arm or leg pain
numbness or tingling

Question 22

what are the causes of a herniated disc

Answer 22

usually a result of a gradual ageing related wear and tear called disc degeneration. as people age, the discs become less flexible and more prone to tearing or rupturing with even a minor strain or twist

Question 23

what does degenerative disc disease usually consist of

Answer 23

low level chronic pain with intermittent episodes of more severe pain

Question 24

what areas of the spine are most susceptible to disc degeneration

Answer 24

the cervical and lumber spines

Question 25

what are the causes of degenerative disc disease

Answer 25

inflammation and abnormal micro-motion instability

Question 26

describe how inflammation causes degenerative disc disease

Answer 26

inflammatory proteins from the disc space interior can leak out as the disc degenerate causing swelling in the surrounding spinal structures. this inflammation can produce muscle tension, muscle spasms and local tenderness in the back or neck. if a nerve root becomes inflamed, pain and numbness may radiate into the arm, shoulder or hips

Question 27

describe how abnormal micro-motion instability causes degenerative disc disease

Answer 27

the cushioning and support a discs usually provides decreases as the discs outer layer (annulus fibrosis) degenerates, leading to small, unnatural motions between the vertebrae. these micro motions can cause tension and irritation in the surrounding muscle joint or nerve roots as the spinal segment becomes progressively more unstable causing intermittent episodes of more intense pain

Question 28

what happens in the spine during disc degeneration

Answer 28

• cartilaginous endplate erosion
• disc space collapse

Question 29

what is cartilaginous endplate erosion

Answer 29

each vertebral segment is a joint that has cartilage in it. in between a spinal disc and each vertebral body is a layer of cartilage known as the endplate.

the endplate sandwiches the spinal disc and acts as a gatekeeper for oxygen and nutrients entering or leaving the disc

as the disc wears down, and the endplate begins to erode, this flow of nutrition is compromised which can hasten disc degeneration. as the disc goes through this process, the disc space will collapse.

Question 30

what is disc space collapse

Answer 30

as a disc degenerates the disc space will collapse, placing undue strain on the surrounding muscles as they support the spine and shortening the space between vertebrae, leading to additional micro-motion and spinal instability

the degenerative process typically progresses gradually rather than all at once. endplate erosion and disc space collapse can add to spinal instability, tension in the surrounding muscles, and both local and nerve root pain