clinical syndromes of the lumbar spine 2 Flashcards
how common is caudal equina syndrome?
-1-3 people per 100,000
-2% of all herniated discs
what clinical pattern is seen with caudal equina syndrome?
-bladder and bowel changes - incontinence, constipated (not being able to go)
-saddle paraesthesia (lack of sensation when wiping etc )
-gait difficulty eg tredelenburg gait
-altered neuro exam
what is the treatment of cauda equina syndrome?
-emergency surgery decompression
-Nb the greater the time the nerve is compressed the greater chance of nerve damage
what is the cauda equina?
the roots of the lumbar and sacral spinal nerves
what is considered normal age related change within the spine?
-decrease in proteoglycan content by 30% in the nucleus
-nucleus becomes more collagenous
-the nucleus dries out and becomes solid and granular (ie less able to weight bear etc)
-with age, there is less distinction between the nucleus and the annulus
-the disc becomes stiffer with age and takes longer to recover from long standing loading
-osteophytes can develop along the facet joints
-bone density can decrease (esp women post menopause)
what is lumbar spondylosis (arthritis) or age related degenerative disc disease (DDD)?
-it is osteoarthitis of the spine
what kind of complaints would a patient with degenerative disc disease have?
-significant pain
-significant stiffness in spine
what changes can be seen with imaging with spondylosis?
-disc degeneration
-osteophytes develop
- height loss of the disc ie flattened disc
-facet joints may become hyperextended
describe the clinical pattern of spondylosis
-LBP +/- leg pain (due to referred pain)
-may have no pain just stiffness
-pain is worse at end of day (depending on how much load during the day eg weekend vs weekday)
-stiffness worse in morning - but short period!!
- range of motion would be reduced but there also may be compensatory movement from hips etc
-PAIVM - hypomobility
-the narrowing of the intervertebral foramen may cause a radiculopathy
what is facet joint arthropathy?
-arthritis that affects joints in the spine
-can occur after disc degeneration
what is the clinical pattern associated with facet joint arthropathy?
-facet joint pain tends to remain lateral and can radiate below the knee but most commonly causes pain in the gluteal region, thigh or groin (more common in glute region)
-pain on standing after prolonged sitting, prolonged standing, hyperextension exercises and position, knees to chest (fowlers)eg sitting
-physical exam: central PA- nothing found and unilateral PA- painful
what population of facet joint pain more prevalent with?
-older population
what is spinal stenosis?
the abnormal narrowing of the spinal canal that can result in pressure on the spinal cord or nerve roots
-can cause radiating pain and numbness to buttock, thigh or leg particular during walking or standing for a long time
-related to aging - affecting people aged 60+ years
what position can ease spinal stenosis?
fowlers position
if disc pathology persists over time, what can it become?
-spondylosis (OA) and facet joint arthropathy
what are consequences of spondylosis?
-can lead to radiculopathy
-spondylolisthesis (spinal vertebrae slips out of place - forward)
what is spondylolysis?
a bilateral defect/ stress fracture in the pars interarticularis probably due to genetics, congenital weakness and minor or macro trauma eg repetitive hyeprflexion, hyperextension or twisting - bowlers, cricket, gymnastics, rugby
- separation may occur at defect slip forward and turn into a spondylolisthesis
-NEEDS MRI to detect
what is spondylolisthesis?
it is the slippage of one vertebral body with respect to the adjacent body causing mechanical or radicular symptoms of pain
- it is graded based on degree of slippage
-can be degenerative, traumatic (micro or macro), congenital, pathologic
what movement is most painful with spondlyolisthesis?
extension
what is a step up deformity?
-a step off sign is palpated at the lumbosacral area due to slippage of the vertebrae
