Disorders Of The Lumbar Spine

Question 1

What happens in intervertebral disc herniation?

Answer 1

Nucleus pulposus ruptures and breaks though the annulus fibrosus and irritates the spinal nerves

Question 2

In terms of syndromes what is kyphosis?

Answer 2

Excessive thoracic curvature leading to hunchback appearance

Question 3

In terms of syndromes what is lordosis?

Answer 3

Excessive curvature of lumbar spine, causing a swayback deformity

Question 4

How is mechanical back pain characterised?

Answer 4

Pain that occurs when the spine is loaded, worsens on exercise and eases on rest

Question 5

What are risk factors of mechanical back pain?

Answer 5

Obesity, bad posture, poor manual handling techniques and lack of core muscles

Question 6

What is marginal osteophytosis?

Answer 6

Where osteophytes known as syndesmophytes develop adjacent to the end plates of intervertebral discs

Question 7

What changes occur in disc degeneration with age?

Answer 7

The discs dehydrate and so appear shorter and they bulge

Question 8

What are the four stages of disc herniation?

Answer 8

1. Degeneration
2. Prolapse- still contained in annulus fibrosus
3. Extrusion- out of annulus fibrosus, still in disc space
4. Sequestration- nucleus pulposus enters the spinal canal

Question 9

Where are the most common sites for slipped discs?

Answer 9

L4/5 and L5/S1

Question 10

In a paracentral hernoation of the L4/5 disc which nerve root is most likely compressed?

Answer 10

L5

Question 11

What is sciatica?

Answer 11

Pain caused by irritation of one of the nerve roots contributing to the sciatic nerve

Question 12

Where is the pain and paraesthesia usually experienced in sciatica?

Answer 12

Pain is experienced in back and buttock and radiates to dermatome of nerve affected
Paraesthesia only experienced in affected dermatome

Question 13

What are the symptoms to look for in cauda equina syndrome?

Answer 13

Bilateral sciatica
Perianal numbness
Painless urine retention
Erectile disfunction
Incontinence (faecal/urinary)

Question 14

How is cauda equina syndrome treated and within what time frame will this need to happen?

Answer 14

Surgical decompression, within 48hours or risking poor prognosis with nerves unable to recover

Question 15

What is spinal canal stenosis?

Answer 15

Abnormal narrowing of the spinal canal leading to compression of spinal cord or nerve roots

Question 16

What are the symptoms associated with spinal canal stenosis?

Answer 16

Discomfort while standing, numbness and weakness t or below level of stenosis, neurogenic claudication. Lumbar-bilateral lower limb pain. Cervical- bilateral shoulder and arm pain

Question 17

What is neurogenic claudication?

Answer 17

A symptom describing pain and/or pins and needles in legs on prolonged standing and walking

Question 18

What causes the symptom neurogenic claudication?

Answer 18

Compression of spinal nerves as they exit lumbosacral spinal cord which leads to venous engorgement during exercise and then reduced arterial flow. The transient ischaemia of nerves gives the pain and paraesthesia

Question 19

What is spondylothesis?

Answer 19

The anterior displacement of a vertebra above another

Question 20

What is the treatment for spondylothesis?

Answer 20

Surgical-use screws and rods to stabilise the spine

Question 21

Where is fluid withdrawn from in a lumbar puncture?

Answer 21

The subarachnoid space of the lumbar cistern