Disorders of the lumbar spine Flashcards
ageing physiology of the spine
Nucleus pulposus dehydrates with age
- Loss of disc height- DISC BULGE
- Increased load stresses reactive marginal osteophytosis at the endplates SYNDESMOPHYTES
- Increased load stress on facet joint FACET JOINT ARTHRITIS
Mechanical Back Pain
back pain when the spine is loaded (sitting, standing and not lying)
relieving and aggravating factors of mechanical back pain
that worsens with activity and is relieved with rest.
how common is mechanical back pain
- 50% of the UK population report lumbar back pain at least 24 hours in a year
- 80% will experience LBP lasting >24 hours in lifetime
- It is not abnormal to have episodes of mechanical LBP
risk factors of mechanical back pain
poor posture, sedentary lifestyle, poor lifting technique and being overweight.
Natural history of mechanical back pain
intermittent. Often triggered by innocuous activity e.g. tying shoes- predisposition in overweight, unhealthy lifestyle, deconditioned core muscles
management of mechanical back pain
Management involves lifestyle modifications and pain management, commonly with NSAIDS.
Spondylosis
Spondylosis is the name for chronic degenerative osteoarthritis (spinal osteoarthritis) affecting intervertebral discs of the lumbar (or cervical) spine.
risk factors of spondylosis
having a genetic tendency
having obesity or being overweight
having a sedentary lifestyle with a lack of exercise
having injured the spine or undergone spinal surgery
smoking
having a job that requires repetitive or weight-bearing movements that involve the spine
having a mental health condition, such as anxiety or depression
having psoriatic arthritis
causes of spondylosis
It is usually caused by disc degeneration and marginal osteophytosis (bony spurs developing adjacent to the end plates of the disc).
As a person ages, the discs become drier, thinner, and harder, and they lose some of their cushioning ability. This is why an older person is more likely to have a compression fracture of the vertebra than a younger person.
A vertebral compression fracture results from bone collapsing in the spine. It commonly occurs with osteoporosis.
The facet joints between the vertebrae also function less well with age because of wear and tear on their cartilage surfaces.
As the cartilage erodes, the bones start to rub together, causing friction. This can result in the formation of bony growths, called bone spurs.
The loss of rubbery tissues and the development of spurs make the spine stiffer. Back movement also becomes less smooth, and friction increases.
marginal osteophytosis
bony spurs developing adjacent to the end plates of the disc
symptoms of spondylosis
- It can present with radiculopathy causing dermatome/myotome symptoms.
- Stiffness and mild pain that gets worse following certain movements or long periods without moving, while sitting for a long time, for example.
- More severe symptoms include:
- a grinding or popping feeling when moving the spine
- weakness in the hands or legs
- poor coordination
- muscle spasms and pain
- headaches
- loss of balance and difficulty walking
- loss of bladder or bowel control
spotting spondylolysis
- Trace the outline of scottie dog in oblique view of the spine
- Displaced fractures through the pars interarticularis (i.e. spondylolysis), look like a collar on a dog (look at blue outline)
X-ray of spondylosis
Spondylolisthesis
Spondylolisthesis is the anterior displacement of the above vertebra on the below vertebra (commonly the 5th lumbar vertebra on the sacrum).
causes of spondylolisthesis
Causes are divided into five categories: congenital/dysplastic, isthmic, degenerative, traumatic and pathological.
congenital cause of spondylolisthesis
congenital instability of the facet joints
Isthmic causes of spondylolisthesis
A defect in the pars interarticularis
degenerative causes of spondylolisthesis
results from facet joint arthritis and joint remodelling (age >50
years)
traumatic causes of spondylolisthesis
Acute fractures in the neural arch, other than the pars
interarticularis
pathological causes of spondylolisthesis
Infection or malignancy
iatrogenic causes of spondylolisthesis
Caused by surgical intervention e.g. if too much lamina and facet joint is excised during a laminectomy operation
difference ebtween spondylolysis and spondylolisthetis
Spondylolysis- A complete fracture in this location without displacement
Spondylolisthesis- Once anterior displacement (usually forward) of the upper vertebra occurs, this is Spondylolisthesis may, or may not, be associated with gross instability of the vertebral column.