Clincal Conditions Of The Lumbar Spine

Question 1

What worsens and eases back pain?

Answer 1

Worsens- exercise
Eases - rest

Question 2

Risk factors for back pain

Answer 2

Obesity
Poor posture
Poorly designed seating
Inactivity
Incorrect manual handling techniques

Question 3

Outline disc degeneration and how to leads to marginal osteophytosis

Answer 3

• nucleus pulposus of IV discs dehydrate with age&raquo_space; reduced height + bulging of discs
• osteophytes called syndesmophytes develop adjacent to end plates of discs
• this is called marginal osteophytosis

Question 4

What is sciatica?

Answer 4

Pain caused by irritation or compression of 1+ nerve roots of sciatic nerve L4-S3

Question 5

Causes of sciatica

Answer 5

Marginal osteophytosis
Slipped disc

Question 6

Where does pain occur in sciatica?

Answer 6

Back + buttock + radiates to affected dermatome

Question 7

Where does paraesthesia occur in sciatica?

Answer 7

Only in affected dermatome no radiation

Question 8

Where is pain typically in L4 sciatica?

Answer 8

Anterior thigh
Anterior knee
Medial leg

Question 9

Where is pain typically in L5 sciatica?

Answer 9

Lateral thigh
Lateral leg
Dorsum of foot

Question 10

Where is pain typically in S1 sciatica?

Answer 10

Posterior thigh
Posterior leg
Heel
Sole of foot

Question 11

Who is cauda equina syndrome typically seen in?

Answer 11

30-50 year olds

Question 12

What is the most common cause of cauda equina syndrome?

Answer 12

Disc prolapse

Question 13

Causes of cauda equina

Answer 13

• Disc prolapse
• Tumours affecting vertebral column or meninges
• Spinal infection/abscess or haemorrhage
• Spinal stenosis
• Vertebral fracture
• Late stage ankylosing spondylitis

Question 14

Red flag symptoms of cauda equina syndrome

Answer 14

• Urinary/faecal incontinence
• Erectile dysfunction
• Painless retention of urine
• Perianal numbness (saddle anaesthesia)
• Bilateral sciatica

Question 15

Treatment of cauda equina syndrome

Answer 15

Surgical decompression within 48 hours of onset

Question 16

Consequences of missing diagnosis of cauda equina syndome

Answer 16

Impotence - ED
Faecal incontinence
Loss of sensation + weakness to lower limbs
Self catheterisation to pass urine

Question 17

What are the 4 stages of disc herniation?

Answer 17

1- disc degeneration - ageing causes disc to dehydrate + bulge
2- prolapse - protrusion of nucleus pulposus with slight impingement into spinal canal
3- extrusion - nucleus pulposus breaks through annulus fibrosus, contained within disc space
4- sequestration - nucleus pulposus separates from disc + enters spinal canal

Question 18

What happens in disc degeneration?

Answer 18

Chemical changes due to ageing cause discs to dehydrate and bulge

Question 19

What happens in disc prolapse?

Answer 19

Protrusion of nucleus pulposus with slight impingement into spinal canal

Question 20

What happens in disc extrusion?

Answer 20

Nucleus pulposus breaks through annulus fibrosus
Still contained within disc space

Question 21

What happens in disc sequestration?

Answer 21

Nucleus pulposus separates from disc
Enters spinal canal

Question 22

Where is the most common site for a slipped disc and why?

Answer 22

L4/5
L5/S1

Due to mechanical loading on joints

Question 23

Where are nerve roots most vulnerable?

Answer 23

• Where they cross the IV disc (paracentrally)
• Where they exit the spinal canal in the IV foramen (far laterally)

Question 24

How does the nucleus pulposus most commonly herniate?
What does this cause?

Answer 24

Posteolaterally
Paracentral prolapse

Compression on spinal nerves within IV foramen

Question 25

What nerve root is most at risk in far lateral disc herniation?

Answer 25

**Exiting nerve root** - emerges at same level as IV disc

Question 26

What type of disc herniation is the exiting nerve root most likely to be impacted by?

Answer 26

Far lateral disc herniation

Question 27

What nerve root is most at risk in paracentral disc herniation?

Answer 27

**Transversing nerve root** - emerges at level below IV disc

Question 28

What type of disc herniation is the transversing nerve root most likely to be impacted by?

Answer 28

Paracentral

Question 29

What nerve root is most at risk in a Paracentral herniation of L4/L5 IV disc?

Answer 29

L5 - transversing root

Question 30

What nerve root is most at risk in a Paracentral herniation of L5/S1 IV disc?

Answer 30

S1 - transversing nevre root

Question 31

What does central herniation have a risk of?

Answer 31

Cauda equina syndrome

Question 32

What is spinal canal stenosis?

Answer 32

Abnormal narrowing of spinal canal Compresses spinal cord or nerve roots

Question 33

Who is most commonly affected by spinal canal stenosis?

Answer 33

Elderly people

Question 34

Causes of spinal canal stenosis

Answer 34

Disc bulging Facet joint OA Ligamentum flavum hypertrophy Compression fractures of vertebral bodies Spondyolistheis Trauma

Question 35

Where is spinal canal stenosis most common?

Answer 35

Lumbar spine Then cervical

Question 36

Symptoms of spinal cord stenosis

Answer 36

- Discomfort standing - Numbness + weakness at or below level of stenosis - Neurogenic claudications Lumbar - discomfort in lower limbs Cervical - discomfort in shoulder, arm or hand

Question 37

What is neurogenic claudication?

Answer 37

Limp due to nerve injury/compression Pain +/- Paraesthesia in legs on prolonged standing or walking Cramping pain or weakness in leg

Question 38

Cause of neurogenic claudications

Answer 38

1- Compression of spinal nerves 2- venous engorgement of nerve roots during exercise 3- decreased arterial flow 4- transient arterial ischaemia 5- pain +/- paraesthesia

Question 39

What is neurogenic claudication relieved by?

Answer 39

**Rest** - most effective Change in position Flexion of spine *e.g. walking up stairs, pushing a trolley*

Question 40

What is spondylolisthesis?

Answer 40

Anterior displacement of vertebra from vertebra below

Question 41

Types of spondylolisthesis?

Answer 41

Congential Isthmic - defect in pars inter articularis Degenerative Traumatic Pathological Iatrogenic

Question 42

What is spondylolysis?

Answer 42

Complete fracture of pars interartuclauris

Question 43

What is typically seen on an x ray of a patient with sponylolisthesis?

Answer 43

Scottie dog shape Visible anterior displacement of vertebra

Question 44

What is a lumbar puncture?

Answer 44

Withdrawal of fluid from subarachnoid space of lumbar cistern

Question 45

What is a lumbar puncture used for?

Answer 45

To test for CNS disorders *e.g. MS + meningitis*

Question 46

Outline the process of a lumbar puncture

Answer 46

1- patient must be lying on side with back + hips flexed 2- skin is anaesthetised 3- lumbar puncture needle inserted between L3+L4 4- needle goes through supraspinous ligament, interspinous ligament, ligamentum flavum, dura + arachnoid, lumbar cistern 5- CSF is removed

Question 47

How must a patient be lying for a lumbar puncture and why?

Answer 47

- Lying on side with back and hips flexed - Flexes vertebral column > spreads apart vertebral laminae + spinous processes

Question 48

What structures does the lumbar puncture needle go through in order?

Answer 48

- skin - SC tissue - supraspinous ligament - interspinous ligament - Ligamentum flavum - Dura + arachnoid - Lumbar cistern

Question 49

What is cauda equina syndrome?

Answer 49

Condition which occurs when the cauda equina is compressed due to herniated disc, tumour, infection or trauma in lower spine