Common diseases of the spine Flashcards
Describe the intervertebral discs of the spine
Comprised of nucelus pulposus (inner bit) and annular fibrosis (outer bit)
Nucleus pulposus consists mainly of water and collagen and proteoglycans
Disc prolapses are usually postero-lateral
How does the ageing process affect the discs?
Decreased water content of discs
Disc narrowing
Degenrative changes on X-rays
Degenerative chages in the facet joints
What is the pathological process that can affect the disc
Annulus fibrosis tears and the nucelus fibrosis protrudes through the nucleus Nerve root compression by osteophytes Central spine stenosis Abnromal movemetn Spondylolysis Spondylolisthesis
Explain the process of nerve root pain?
Fairly common Limb pain worse than back pain Pain in a nerve root distribution (radicular) Root tension signs Root compression signs Dermatomes and myotomes
How does nerve root pain develop?
Most settle in about 3 months Phsyiotherapy Strogn analgesia Referral after 12 weeks Imaging MRI
What are the common problems that affect the disc?
Bulge-generalised- common,makority asymptomatic, relevance
Protrusion- annulus weakened but still intact
Extrusion- through annulus but in continuity
Sequestration (dissicated disc material free in canal)
What are the common places for disc herniation in the:
Cervical
Thoracic
Lumbar spine
Cervical- C5/C6
Thoracic-T8-T12
Lumbar spine- L4-S1
What is cauda equina syndrome?
Compression of the cauda equina, surgical emergenct
Operation within 48 hours of onset
Sacral nerve roots compresse, can result in permanant bladder and anal sphincter dysfunction
What are the common causes of cauda equina syndrome?
Central lumbar disc prolapse Tumours Trauma Infection Iatrogenic
What are the clinical features of cauda equine syndrome?
Injury or precipitating event Bilateral buttock and leg pain Bowel or baldder dysfunction PR exam, saddle anaesthesia High index of suspicion in spinal post op patients with increasing leg pain
What is the classic cauda equina triad that requires an urgent MRI
Bi lateral leg pain
Urinary incontinence
Numb bumb
What imaging investigations should be carried out?
MRI
Lumbar CT myelogram
operate and decompress within 48 hours
What is Cervical and lumbar spondylosis?
Common degenerative change at the facet joints, discs, ligaments, etc
If severe can compress whole cord (not just nerve roots) causing myelopathy
UMN signs in limbs
What occurs during lumbar spondylosis
OA of facet and disc joints (+degernation of ligaments, etc)
What is spinal caludication
Nerves are compressed in the spine, gradual in pain
