Clinical anatomy of the spine and some syndromes

Question 1

Describe the composition of the intervertebral disc?

Answer 1

Outer annulos fibrosa. Made out of fibrous tissue in layers.
In nucleus pulposa- gelitanous substance.

Question 2

Affect of ageing on the intervertebral discs

Answer 2

as you get older, the water content in the intervertebral discs decreases. This makes it saggier and therefore is not as good at supporting the spine.

Question 3

How is movement of the spine brought about?

Answer 3

Each segment offers only a small amount of movement- but collectively they offer a great amount of movement.

Question 4

Spondylosis

Answer 4

Decrease in water content of the intervertebral disc which leads to overloading of the facet joints. Pain becomes worse with extension- therefore people tend to be hunched over.

Question 5

Treatment of spondylosis

Answer 5

Facet joint injection- steroids and local anaesthetic under flouroscopy.

Question 6

Osteoarthritis in the spine

Answer 6

If in only one or two segments can be treated with spinal fusion. However if multi-level- won’t be effective.

Question 7

Where is acute disc prolapse likely to occur?

Answer 7

L4/L5 and L5/S1

Question 8

How do people cause prolapsed discs?

Answer 8

They lift heavy objects causing a sudden tear in the annulus fibrosa.

Question 9

How do people with prolapsed discs characteristically present?

Answer 9

Pain on coughing- due to coughing squashing the spine.

Question 10

What is the cauda equina?

Answer 10

Means the horses tail. The spinal cord is called this when it reaches L1.

Question 11

Where does the spinal cord run?

Answer 11

Inside a thecal sac inside the vertebral foramen. The roots then exit via the intervertebral foramen.

Question 12

Exiting root

Answer 12

The nerve root passes out of the thecal sac under the pedicle of that vertebrae and exits

Question 13

Transverse root

Answer 13

Remains anterior in the thecal sac until at the vertebra below and then crosses the disc and exits through that vertebrae’s exiting root.

Question 14

Which nerve root is more likely to be damaged in a prolapsed disc?

Answer 14

The transverse nerve root is more likely to be damaged because it crosses over the disc to the vertebrae below. The exiting root would only be damaged if it were a far lateral prolapse.

Question 15

What symptoms does compression of the lumbar nerve roots cause?

Answer 15

Radiculopathy- pain down the sensory distribution (dermatome) of the nerve roots
In the lower leg known as sciatica

Question 16

Sciatica

Answer 16

L4, L5 and S1 nerve roots contribute to the sciatic nerve (along with S2 and S3). Radiation of pain down the sensory division of the sciatic nerve is sciatica.

Question 17

Spinal stenosis

Answer 17

Nerve root compression by hypertrophic ligaments and osteophytes.

Question 18

Presentation of spinal stenosis

Answer 18

Burning leg pain on walking- neuropathic claudication. Differs to cardiogenic claudication because it occurs at variable distances and is better going uphill due to the spine not being compressed.

Question 19

Treatment of spinal stenosis

Answer 19

Surgery to remove osteophytes.

Question 20

Spinal cord compression

Answer 20

Myelopathy- weakness and hyperspasisity. Causes upper neuron signs. It could be due to tumours or disc prolapses.

Question 21

How to test for myelopathy

Answer 21

Scratch the bottom of the foot- normally the big toe would move down, in this it moves up.

Question 22

Cauda Equina Syndrome

Answer 22

Compression of all lumbar and sacral nerve roots affecting the bladder and bowel as well as the lower limb.
It is a medical emergency

Question 23

Presentation of cauda equina syndrome

Answer 23

Could present differently- incontinence, urinary retention, numbness at the tail end (saddle anaesthesia), loss of anal tone.

Question 24

Ligaments of the spine

Answer 24

Anterior longitudinal ligament- infront of the vertebral body.
Posterior longitudinal ligament- behind vertebral body before vertebral foramen.
Interspinous ligament- between spinous processes
Supraspinous ligament- on the outside of the spinous process.
Ligamentum flavum- right next to the vertebral foramen- more superficial.