Clinical Lumbar Spine Flashcards
Which part of the spine dehydrates with age which is why you get shorter with age?
Nucleus pulposus in the intervertebral discs
Causes loss in disc height
How does dehydration of the nucleus pulposus cause further degenerative changes of the spine?
Decreased height of discs , leads to bulging of discs and therefore alteration of the load stresses on the joints
What is marginal osteophytosis?
Osteophytes called syndesmophytes develop next to the end plates of the discs due to the altered load stresses on the vertebral joints
What is Facet Joint Osteoarthritis?
Increased stress being put on facet joints due to dehydrated nucleus pulposus of intervertebral disc
Why is arthritis in the facet joints so painful?
Joint supplied by meningeal branch of spinal nerve
Intervertebral foramina narrow which can compress spinal nerves = radicular or nerve pain
What is the definition of mechanical back pain?
Pain when the spine is loaded that is worsened by exercise but relieved by rest
What are the 3 main contributing lifestyle factors to getting mechanical back pain?
Weight
Posture
Exercise
Why does lack of exercise increase chances of mechanical back pain?
Muscles around spine deconditioned (core/paraspinal)
Why does poor posture lead to mechanical back pain?
Bulges of the intervertebral discs
When flexed, posters bulge
When extended, anterior bulge
Why does heavier weight increase chances of mechanical back pain?
More force on abdomen
Osteoarthritis more likely/easier to develop
How does a patient with mechanical back pain present?
Intermittent pain
Severity of pain doesn’t scale to the action
Usually triggered by a very minor incident like tying a shoe
What is a herniation?
When an organ/tissue protrudes out of the body cavity/place it normally lies in
What are the 4 stages to a prolapsed invertebrates disc/slipped disc/Herniated disc?
Degeneration (Disc bulges with age as nucleus pulposus dehydrates)
Prolapse
Extrusion
Sequestration
What happens at the prolapse stage of a slipped disc?
Protrusion of the nucleus pulposus occurs slightly impinging the spinal canal
Acidic nucleus pulposus still contained in annulus fibrosus
What happens at the extrusion stage of disc herniation/slipped disc?
Nucleus pulposus breaks through the annulus fibrosus but still stays in the disc space or doesn’t sink down
What happens at the sequestration stage of a slipped/prolapsed/herniated disc?
Nucleus pulposus breaks through annulus fibrosis and separates from main body of the disc in the spinal canal
Why does the nucleus pulposus normally herniate posterolaterally? (Paracentral prolapse)
Passes to the side of the posterior longitudinal ligament
In a paracentral herniation what nerve root is at risk of being irritated/compressed (lumbar spine)?
How does this compare to the cervical spine?
Traversing root
Almost always the nerve root associated with the lower vertebra affected
L4/L5 paracentral herniation = compressed L5 nerve root
Cervical spine = emerging root since cervical spinal nerves emerge above their associated vertebrae
What condition can central herniation/prolapse of an intervertebral disc cause?
Cauda equina syndrome
Prolapsed intervertebral discs usually heal, why is some of the nucleus pulposus permanently lost?
White cells in the CSF resorb the portion protruding into the spinal canal
Do paracentral herniation of an invertebral disc usually cause unilateral or bilateral effects?
Usually unilateral
Side effected which has the compressed root
What is Sciatica?
Pain cause by the irritation or compression of 1 or more of the nerve roots which contribute to the sciatic nerve (L4-S3)
What are the nerve roots of the sciatic nerve?
How to remember nerve roots of sciatic?
L4
L5
S1
S2
S3
Split scia_tic in half. 4 Letters = L4. 3 letters = S3
So sciatic = L4 - S3
What can cause sciatica?
Marginal osteophytosis
Slipped disc
