Case 2 - Back Pain Flashcards
what is sciatica
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
what does sciatic feel like
sharp, shooting or jolts of pain and others describe it as burning, electric or stabbing.
is the pain constant?
can be constant or may come and g0
where is the pain more severe
leg compared to the lower back
what is the epidemiology of sciatica
40% of people in the US experience sciatica during their life. back pain is the third most common reason people visit their GP
what are the causes of sciatica
- herniated or slipped disc
- degenerative disc disease
- spinal stenosis
describe a herniated disc
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
what is degenerative disc disease
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
what is spinal stenosis
the abnormal narrowing of the spinal canal. this narrowing reduces the available space for the spinal cord and nerves
what is the most common cause of sciatica
herniated/slipped disc
what are the symptoms of sciatica
- 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
how is sciatica diagnosed
spinal X-rays look for spinal fractures, disc problems
what confirms the diagnosis of sciatics
an MRI
what determines if a vertebrae or disc is causing pain
myelogram
what is the other uncomfortable test used
straight leg raise test
what are spinal injections
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
what is a microdiscectomy
minimally invasive procedure used to remove fragments of a herniated disc that are pressing on a nerve
what is a laminectomy
the lamina that is causing pressure on the sciatic nerve is removed
what is a prolapsed - herniated disc
when some of the nucleus pushes out through tear in the annulus
where does a herniated disc occur most often
the lower back
what are the symptoms of a herniated disc
arm or leg pain
numbness or tingling
what are the causes of a herniated disc
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
what does degenerative disc disease usually consist of
low level chronic pain with intermittent episodes of more severe pain
what areas of the spine are most susceptible to disc degeneration
the cervical and lumber spines
what are the causes of degenerative disc disease
inflammation and abnormal micro-motion instability
describe how inflammation causes degenerative disc disease
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
describe how abnormal micro-motion instability causes degenerative disc disease
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
what happens in the spine during disc degeneration
- cartilaginous endplate erosion
- disc space collapse
what is cartilaginous endplate erosion
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.
what is disc space collapse
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
