Clinical conditions (lumbar spine)

Question 1

What are risk factors to mechanical back pain?

Answer 1

• Obesity
• Poor posture
• Sedentary lifestyle
• Poorly designed seating
• Incorrect manual handling

Question 2

What is marginal osteophytosis?

Answer 2

Syndesmophytes (osteophytes) formation adjacent to end plates of degenrating discs

Question 3

What is a slipped disc?

Answer 3

Herniation of an intervertebral disc

Question 4

What are the 4 stages of disc herniation?

Answer 4

1) Disc degeneration
2) Prolapse = protrusion of nucleus pulposus
3) Extrusion = nucleus pulposus breaks through annulus fibrosus but still in disc shape
4) Sequestration = nucleus pulposus separates from main body

Question 5

What is a paracentral prolapse?

Answer 5

Herniation posterolaterally

-compression of spinal nerve root within intervertebral foramen

Question 6

What are the common sites for a slipped disc and why?

Answer 6

L4/5
L5/S1
-mechanical loading

Question 7

What is the difference between an exiting nerve root and a traversing nerve root?

Answer 7

Exiting = nerve root emerges at the same level as intervertebral disc (common in far lateral herniation)
Traversing = nerve root emerges the level below (common in paracentral herniation)

Question 8

What is sciatica/radicular leg pain?

Answer 8

Pain caused by irritation or compression of one or more nerve roots that contribute to sciatic nerve (L4, L5, S1, S2 and S3)

Question 9

What is cauda equina syndrome?

Answer 9

Compression of the lumbar and sacral nerve roots within the spinal canal

Question 10

What are the red flag symptoms of cauda equina syndrome?

Answer 10

• Bilateral sciatica
• Perianal numbness
• Painless retention of urine
• Urinary/faecal incontinence
• Erectile dysfunction

Question 11

What is the treatment for cauda equina syndrome and how urgent is it?

Answer 11

Surgical decompression

-must be done within 48 hours otherwise life long complications follow

Question 12

What is spinal canal stenosis (and give a few causes)?

Answer 12

Abnormal narrowing of spinal canal that compresses the spinal cord or nerve roots

• disc bulging
• ligamentum flavum hypertrophy
• trauma
• spondylolisthesis

Question 13

What is neurogenic claudication?

Answer 13

A symptom resulting from compression of spinal nerves as they emerge from lumbosacral spinal cord

• venous engorgement = reduced arterial inflow
• ischaemia

Question 14

What is spondylolisthesis?

Answer 14

Anterior displacement of the vertebra above relative to the vertebra below

Question 15

Whats the difference between spondylolisthesis and spondylolysis?

Answer 15

Spondylolysis is a complete fracture of pars interarticularis without displacement whilst spondylolisthesis involves anterior displacement.

Question 16

What is a lumbar punture?

Answer 16

Withdrawal of fluid (CSF) from the subarachnoid space of the lumbar cistern
-diagnostic tool (e.g. meningitis, MS)