Disc hernia and Lower back pain

Question 1

In case of lower back pain, what needs to be excluded?

Answer 1

• Infection
  *malignancy

Question 2

What are red flags in pt with lower back pain?

Answer 2

Over 70 yrs or under 20
Systemically ill pt
Signs of malignancy or infection
Trauma? -significant or small if over 50yo
Unrealistic pain at rest
! Persistant pain for more than 4 weeks

Question 3

When can lumbar fusion for lower back pain w/o stenosis or spondylolisthesis be an alternative?
-WHat surgery?

Answer 3

• More than 2 year of pain
• Radiologic evidence of disc degeneration
• Failed best medical management
• ALIF or ALIF+instrumentation

Question 4

Failed back surgery syndrome

Question 5

What nerve is usually affected in lumbar disc herniation ( a so called posterolateral disc herniation)?

Answer 5

The one exiting at the level below. eg L4-L5 herniation affect Lumbar nerve 5. That is the deschending nerve root.

Question 6

WHat nerve is affaceted in a lumbar foraminal disc herniation?

Answer 6

AT level L4-L5, that would be the L4 root.

Question 7

What is spondylolisthesis?

Answer 7

FÖrskjutning av kotor i relation till varandra.

Question 8

What is the most common gender and level of degenerative spondylolisthesis?

Answer 8

Females, L4-L5.

Question 9

What is an isthmic spondylolisthesis?

Question 10

Does the vertebral slip more in a degenerative or in an isthmic spondylolisthesis?

Answer 10

In an Isthmic.

Question 11

WHat should be tested clinically?

Answer 11

Sciatic vs hip-pathology should be destinguished.

*Lasegues test - straight leg sign
* leg pain/paresthesia along the leg?

Question 12

WHat is a FABER test?

Answer 12

A “hip joint disease test”
- foot on knee and press the knee outwards. Pain in the hipjoint?

Question 13

What is the risk if going through ALL in the L5-S1 area?

Answer 13

Puncture of the iliaca artery

Question 14

What nerve is usually affected in cervical disc herniation?

Answer 14

If C5-C6 hernia it will be C6.
The nerve roots in the cervical area exit above the pedicle of its like-numbered vertebra. Due to different vertebral anatomy in the C and L region, it will still most often be the same nerve as the number of the lower vertebra.

Question 15

What are the signs of C4 radiculopathy?

Answer 15

Radiating pain is unkommon. Instead the pt. get nonradiating axial neck pain.

Question 16

What interresting sign might appear as a C6 radiculopathy?

Answer 16

If its the left nerve, it might mimic a heart attack.

Question 17

What interresting findings might correlate to C8-Th1 nerve root involvement?

Answer 17

A partial horner syndrome!

Question 18

What is the most common lumbar disc herniation?

Question 19

What is the most common cervical disc herniation?

Question 20

HOw many cervical disc herniations improve w/o surgery?

Answer 20

90%

Question 21

What is the treatment of cervical disc herniation?

Answer 21

ACDF, usually combined w interbody fusion (a plate and an artificial disc, usually filled w bone.)

Question 22

What are the complication risks with ACDF?

Answer 22

• swallowing difficulties
• hoarsness -4% permanent
• INj to esophagus, trachea, carotids, SC, nerves