degeneration and disc prolapse

Question 1

what type of joints are found between the IV discs

Answer 1

secondary cartilaginous joints

Question 2

name the 2 components of the IV disc

Answer 2

the annulus fibrosis is the tough outer layer and the nucleus purposes is the soft gelatinous area in the middle

Question 3

name the ligaments that connect the IV discs to the vertebral bodies

Answer 3

the anterior longitudinal ligament and the posterior longitudinal ligament

Question 4

what is the most common direction for IV discs to prolapse and why is this the case

Answer 4

posterolateral is the most common direction because the posterior longitudinal ligament is the weakest

Question 5

what happens to the IV discs with age

Answer 5

the water content decreases the disc space narrows

Question 6

how is nerve pain treated

Answer 6

nerve pain usually resolves within 3 months - strong analgesia and physiology can help - surgery is not done until after 3 months if there has been no improvement

Question 7

name the 4 types of disc herniation

Answer 7

1) bulge
2) protrusion - AF is weak but still intact
3) extrusion - NP through the AF but still together
4) sequestration - free disc material in the central canal

Question 8

what disc in the cervical spine is most likely to prolapse

Answer 8

C5/6 (C5 nerve will be affected) - in the cervical spine, it is usually the upper nerve that is affected rather than the lower nerve)

Question 9

what is the most common lumber prolapse

Answer 9

L4/5 (L5 nerve is affected)

Question 10

what are the clinical signs of lumbar disc prolapse

Answer 10

pain in one or both legs, back pain, reduced reflexes in the lower limb and signs of caudal equine syndrome

Question 11

if there is a loss of sensation in the big toe and a reduced ankle reflex, what disc has prolapsed

Answer 11

L4/L5 (L5 nerve is affected)

Question 12

if there is a sensory loss of the little toe and the sole of the foot due to a disc prolapse, what disc has been affected

Answer 12

L5/S1 (S1 nerve has been affected)

Question 13

what are some of the clinical signs of caudal equina syndrome

Answer 13

loss of anal tone, loss of anal reflex, buttocks pain, incontinence, loss of sensation around the buttocks area

Question 14

what is the most common cause of caudal equina syndrome

Answer 14

lumbar disc prolapse

other causes include tumours, trauma, infection and iatrogenic causes

Question 15

when should you be concerned about iatrogenic caudal equina

Answer 15

in post spine op patients who have increasing leg pain and urinary retention

Question 16

what is spondylosis

Answer 16

this is when degenerative changes occur at the facet joints in the spine and cause compression of the nerve roots

Question 17

what type of joints are the facet joints in the spine

Answer 17

synovial plane joints

Question 18

name the ligaments that are found in the spinal column

Answer 18

1) anterior longitudinal ligament
2) posterior longitudinal ligament
3) interspinous ligament
4) supraspinous
5) ligamentum flavum

Question 19

what are the clinical signs of spinal claudication

Answer 19

• bilateral pain
• pain gets worse walking downhill because the canal narrows
• possible weakness in the legs (dragging the feet)

Question 20

what are the different types of spinal stenosis

Answer 20

1) lateral recess stenosis
2) central stenosis
3) foraminal stenosis

Question 21

what is the treatment of lateral recess stenosis

Answer 21

nerve root injections, epidural injections and surgery

Question 22

what is spondylolithesis

Answer 22

this is when a vertebral body slips out of its normal position (either forwards or backwards)

Question 23

what is spondylolysis

Answer 23

this is when there is a fracture in the pars interarticularis (the space between the 2 facets) - this usually occurs in children and young people who carry out sports that put repetitive stress on the back (e.g. gymnastics)

Question 24

why is the prolapse of an IV disc a problem of young people

Answer 24

the IV discs degenerate with age and elderly people are no longer capable of having a prolapsed disc

Question 25

what are the clinical features of a prolapsed disc

Answer 25

the sudden onset of severe back pain, pain is aggravated by movement, usually radiation of the pain (depending on which discs have prolapsed and patients usually have a sideways tilt when standing due to muscle spasms

Question 26

what its he treatment of a prolapsed disc

Answer 26

bed rest on a firm mattress, analgesia, epidural corticosteroid injections and surgery if there is severe or increasing neurological impairment

Question 27

why does an L5/S1 disc prolapse (poster-lateral) usually affect the S1 nerve rather than the L5 nerve

Answer 27

the spinal nerve usually exits at the upper part of the foramen and therefore the disc prolapse usually damages the nerve of the vertebrae below rather than the nerve of the same level