Clinical conditions affecting the spine Flashcards
Characteristics of mechanical back pain
Pain when spine loaded that worsens with exercise and relieved by rest.
Risk factors of mechanical back pain
- Obesity
- Poor posture
- Sedentary lifestyle
4 stages of disc herniation/slipped disc
- Disc degeneration = disc dehydration + bulge
- Prolapse = protrusion of nucleus pulposus but still contained in annulus fibrosus
- Extrusion = nucleus pulposus breaks through annulus fibrosis but still in disc space
- Sequestration = nucleus pulposus enters spinal canal
2 places nerve roots most vulnerable in disc herniation
- Where they cross intervertebral disc
2. Where they exit spinal canal in intervertebral foramen
Most common sites for slipped disc
L4/L5 and L5/S1
What is the traversing root?
Nerve root that emerges at level below disc
Paracentral prolapse
Compression of spinal nerve root whilst in intervertebral foramen = traversing nerve root
Which nerve root will be compressed in paracentral herniation of L4/5 disc?
L5
Rare directions of herniation
- Far lateral = exiting nerve root at risk
- Central = towards spinal cord
Sciatica
Irritation or compression of nerve roots that contribute to sciatic nerve
Where is pain experienced in sciatica?
Buttock and back and radiates to dermatome supplied by effect root/s:
- L4 sciatica = anterior thigh, anterior knee, medial leg
- L5 sciatica = lateral thigh, lateral leg, dorsum of foot
- S1 sciatica = posterior thigh and leg, heel, sole of foot
Cauda equina syndrome
Prolapsed intervertebral disc that compresses lumbar and sacral nerve roots in spinal canal
5 red flag symptoms of cauda equine syndrome
- Bilateral sciatica
- Saddle anaesthesia
- Painless urine retention
- Incontinence
- Erectile dysfunction
How is cauda equine syndrome treated?
Surgical decompression within 48 hours
Spinal canal stenosis
Abnormal narrowing of spinal canal that compresses either spinal cord or nerve roots.
Lumbar stenosis most common, then cervical.
