Common Problems of the Spine

Question 1

Outline the pathophysiology and clinical features of mechanical back pain

Answer 1

Pain when spine is loaded,

worse with exercise relieved by rest

Question 2

Outline the pathophysiology and clinical features of sciatica

Answer 2

Compression of the nerve roots which contribute to the sciatic nerve = L4/5, S1/2/3

Question 3

Outline the pathophysiology and clinical features of cauda equina syndrome

Answer 3

damage to cauda equina = lesions, tumours, trauma, stenosis = loss of function of lumbar plexus (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord

severe back pain, sexual dysfunction, bladder and bowel dysfunction, weakness of lower legs

Question 4

Outline the pathophysiology and clinical features of lumbar canal stenosis and neurogenic claudication

Answer 4

Bone/tissue/both grow in openings of the vertebrae = can squeeze/irritate nerves that branch out from the spinal cord.

Occurs in elderly.

Claudication = pain in legs when walks = venous engorgement

Question 5

Outline the pathophysiology and clinical features of spondylolisthesis

Answer 5

forward displacement of vertebral bone in relation to the natural curve

commonly occurring after fracture

most often 5th lumbar vertebra

Question 6

What are the types of spondylolisthesis?

Answer 6

1) Dysplastic: congenital abnormality in shape of facet joint.
2) Isthmic: defect in pars interacticularis.
3) Degenerative: arthritis and joint remodelling.
4) Pathological: infection or malignancy

Question 7

Outline the pathophysiology and clinical features of the 4 stages of a slipped disk

Answer 7

1) Disc Degeneration: chemical changes with aging = discs dehydrate = BULGE.
2) Prolapse: protrusion of nucleus pulposus, slight impingement into spinal canal (contained).
3) Extrusion: nucleus pulposus breaks through annulus fibrosus, remains within disc space.
4) Sequestration: nucleus pulposus breaks through annulus fibrosus, separates from main body of disc in spinal canal.

Question 8

Where does a slipped disk most commonly occur?

Answer 8

L4/5, L5/S1 = posterolaterally with compression of spinal nerve roots

Question 9

What is marginal osteophytosis?

Answer 9

Compression of spinal nerves by bone growth = dehydration of nucleus pulposus = load stresses on IV disk alter = marginal osteophytosis = increased stress of facet joint = osteoarthritis = decreased size of intervertebral foramen

Question 10

Suggest a suitable vertebral level for a lumbar puncture

Answer 10

(L2/3), L3/4 or L4/5

(after the conus medullaris so only mobile spinal nerve roots not cord; least chance of neurological damage)

Question 11

State the structures through which a lumbar puncture needle will pass

Answer 11

(Skin),

subcutaneous tissue,

supraspinous ligament,

interspinous ligament,

ligamentum flavum,

epidural fat and veins,

dura mater,

arachnoid mater,

(subarachnoid space)