Disc Herniations Flashcards
What is the true definition of a disc herniation?
Projection of nuclear material through the annulus into the canal
Are disc herniations common?
NO; only 5% of back pain patients suffer from disc herniation
What is the gold standard imaging procedure to diagnosis a disc herniation?
MRI
How does the pain typically present with a disc herniation?
IMMEDIATELY
What is the most common complaint of patients with a disc herniation?
Back pain
What kinds of activities make the pain of a disc herniation work?
Sneezing, flexion, sitting, bowel movement
What is one of the most serious complications of a disc herniation?
Cauda Equina syndrome (1-16%)
What is cauda equina syndrome?
Compression of multiple nerve roots leading to altered bowel and bladder function, saddle paresthesia, muscle atrophy, and impotence
What neurological test can be used to assess for myelopathy?
Lhermitte’s
What kind of canal can lead to asymptomatic herniations?
Increased canal size
What is the most common treatment for a herniated disc?
Discectomy
What is the most common age range for a disc herniation?
25-40 (which discs are juicy)
A C5/C6 disc herniation would compress which nerve root?
C6
What kinds of symptoms arise from a midline disc herniation in the cervicals?
Myelopathies
What kind of directional disc herniation causes nerve route compression below in the cervicals?
Lateral
What type of disc herniation in the lumbars will compress the nerve root BELOW? The nerve root at the same level?
BELOW = midline/paracentral
SAME LEVEL = foraminal
A L5/S1 foraminal disc herniation will compress what nerve root?
L5 nerve root
A L5/S1 midline disc herniation will compress what nerve root?
S1
Which types of disc herniations in the cervicals is most significant due to the compressive of the nerve root below? Lumbars?
Cervicals = lateral Lumbars = midline/paracentral
What is the function of the IVD?
Dampen forces
What three things must be intact and functional for the IVD to successful work to dampen forces?
1 stability of annulus
2 hydration of nucleus
3 separation offed by endplates
What is the technique used by injecting a water-based or oil-based contrast into subarachnoid space to asses for disc herniations?
Myelography
What is the technique used by injected radiopaque contrast into the nucleus pulpous to image morphology?
Discography
How does discography show a present disc herniation?
Contrast will leak into spinal canal
Why are discography and myelography considered inferior to CT or MRI?
Invasive due to injection
If a disc herniation is visible on CT, what would be the FINDING?
Paracentral protrusion
What are the contents of the spinal canal?
1 thecal sac 2 epidural fat 3 internal vertebral plexus 4 ligamentum flavus 5 PLL
What are the MRI findings of a disc herniation?
1 focal bulge 2 obliterated epidural fat 3 deformed theca 4 displaced nerve roots 5 decreased MRI signal
What are the four steps of classification for a disc herniation?
1 bulge
2 protrusion
3 extrusion
4 sequestration
Which step of a disc herniation involves more than 25% of the disc diameter?
Bulge
Which step of a disc herniation involves a free fragment of disc material with no connection to the disc?
Sequestration
Which step of a disc herniation involves less than 25% of the disc diameter and the base is wider than the herniation?
Protrusion
Which step of a disc herniation involves less than 25% of the disc diameter and the base is narrower than the herniation?
Extrusion
Which step of a disc herniation is a true focal lesion and a complete disruption of the annulus?
Extrusion
An area of high signal intensity on T2-weighted MRIs of a disc can indicate what?
Fissure or tear of the annulus
Which congenital condition can lead to spinal stenosis?
Achondroplasia
Spinal stenosis of the cervical spine is seen at what measurement? Lumbar spine?
Cervicals = less then 12 mm Lumbars = less than 15 mm
How is the spinal canal measurement obtained?
Anterior line (through posterior aspect of vertebrae) to posterior line (through spinolaminar line)
What imaging system is best used to determine spinal stenosis?
CT or MRI (X-rays are prone to distortion and only 2D)
What are the three types of spinal stenosis?
1 central
2 neuroforaminal
3 lateral recess
What are the general symptoms of spinal stenosis?
Radicular in nature