Disc prolapse + spinal stenosis

Question 1

What is radiculopathy?

Answer 1

Pressure on nerve root

Question 2

What is myelopathy?

Answer 2

Pressure on the spinal cord itself

Question 3

What occurs during the normal ageing process to the spine?

Answer 3

• Decreased water content of discs
• Disc space narrowing
• “Degenerative” changes on X-rays
• Degenerative changes in the facet joints
• Aggravated by smoking, etc.

Question 4

In which age groups are disc prolapses common?

Answer 4

20s/30s/40s

Question 5

What is a disc bulge and what is the relevance?

Answer 5

• They are common
• Normally assymptomatic
• Therefore not that relevant

Question 6

What is a disc protrusion?

Answer 6

• The annulus is weakened but is still intact

Question 7

What is disc extrusion?

Answer 7

Disc protrudes through annulus in continuity

Question 8

What is disc sequestration?

Answer 8

Dessicated disc material free in canal

Question 9

Which cervical disc is most likely to prolapse?

Answer 9

C5/6

Question 10

Which thoracic discs are most likely to prolapse? In which way’s do they herniate?

Answer 10

• Mid to lower levels (75% T8-12)
• Most at T11/12
• Central, posterolateral and lateral herniations

Question 11

Which lumbar discs are most likely to prolapse? In which way do they herniate? What pain may a central disc herniation give?

Answer 11

• Usually L4/5 (45%), followed by L5/S1 (40%), then L3/4 (10%)
• Most are posterolateral
  
  • (Posterior Longitudinal Lig weakest)
• Central disc may give pain in both legs, or may be back pain only

Question 12

Give a brief low-down of Cauda Equina syndrome.

Answer 12

it is bad news

• Sudden compression of cauda equina
• Medical emergency
• Can result in permanent bladder and anal sphincter dysfunction and incontinence

Question 13

What is the required actions when suspected cauda equina syndrome?

Answer 13

• Admission
• Urgent MRI scan
• Emergency operation within 48h of onset; delay results in permanent dysfunction

Question 14

Aetiology of cauda equina?

Answer 14

• central lumbar disc prolapse (commonest)
• tumours
• trauma (burst or Chance #, disc) or spinal stenosis
• infection (epidural abscess)
• iatrogenic

Question 15

SSx of cauda equina syndrome?

Answer 15

• Bilateral buttock & leg pain
• Varying dysaethesiae + weakness
• Bowel or bladder dysfunction
• Saddle anaesthesia loss of anal tone & anal reflex
• High index of suspicion in spinal post-op patients with increasing leg pain in presence of urinary retention

Question 16

Questions to ask determining cauda equina syndrome?

Answer 16

• Can you feel your bladder filling?
• Does it feel normal to urinate?

Question 17

What is the treatment of Cauda Equina syndrome?

Answer 17

• OPERATIVE
• within 48hrs
• –(statistically significant improvement and difference if surgery < 48 hrs)

Question 18

What is cervical and lumbar spondylosis?

Answer 18

It’s osteoarthritis’ other name lol.

• It is common
• If severe, can compress whole cord (not just nerve roots) causing myelopathy

Question 19

What is spinal stenosis?

Answer 19

Narrowing of the spaces within your spine

Question 20

What is spinal claudication?

Answer 20

A common symptom of spinal stenosis.

• Usually bilateral
• Sensory dysaesthesiae
• Poss weakness (drop foot – tripping)
• Takes several minutes to ease after stopping walking
• Worse walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding bicycle

Question 21

What are the three main types of spinal stenosis?

Answer 21

• Lateral recess stenosis
• Central stenosis
• Foraminal stenosis

Question 22

How do we treat lateral spinal stenosis?

Answer 22

• Non-operative
• Nerve root injection
• Epidural injection
• Surgery

Question 23

How can we treat central spinal stenosis?

Answer 23

• Non-operative
• Epidural steroid injection
• Surgery (80% improve)

Question 24

What is the treatment of foraminal stenosis?

Answer 24

• Non-operative
• Nerve root injection
• Epidural injection
• Surgery