Disorders Of The Lumbar Spine Flashcards
What happens in intervertebral disc herniation?
Nucleus pulposus ruptures and breaks though the annulus fibrosus and irritates the spinal nerves
In terms of syndromes what is kyphosis?
Excessive thoracic curvature leading to hunchback appearance
In terms of syndromes what is lordosis?
Excessive curvature of lumbar spine, causing a swayback deformity
How is mechanical back pain characterised?
Pain that occurs when the spine is loaded, worsens on exercise and eases on rest
What are risk factors of mechanical back pain?
Obesity, bad posture, poor manual handling techniques and lack of core muscles
What is marginal osteophytosis?
Where osteophytes known as syndesmophytes develop adjacent to the end plates of intervertebral discs
What changes occur in disc degeneration with age?
The discs dehydrate and so appear shorter and they bulge
What are the four stages of disc herniation?
- Degeneration
- Prolapse- still contained in annulus fibrosus
- Extrusion- out of annulus fibrosus, still in disc space
- Sequestration- nucleus pulposus enters the spinal canal
Where are the most common sites for slipped discs?
L4/5 and L5/S1
In a paracentral hernoation of the L4/5 disc which nerve root is most likely compressed?
L5
What is sciatica?
Pain caused by irritation of one of the nerve roots contributing to the sciatic nerve
Where is the pain and paraesthesia usually experienced in sciatica?
Pain is experienced in back and buttock and radiates to dermatome of nerve affected
Paraesthesia only experienced in affected dermatome
What are the symptoms to look for in cauda equina syndrome?
Bilateral sciatica Perianal numbness Painless urine retention Erectile disfunction Incontinence (faecal/urinary)
How is cauda equina syndrome treated and within what time frame will this need to happen?
Surgical decompression, within 48hours or risking poor prognosis with nerves unable to recover
What is spinal canal stenosis?
Abnormal narrowing of the spinal canal leading to compression of spinal cord or nerve roots
What are the symptoms associated with spinal canal stenosis?
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
What is neurogenic claudication?
A symptom describing pain and/or pins and needles in legs on prolonged standing and walking
What causes the symptom neurogenic claudication?
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
What is spondylothesis?
The anterior displacement of a vertebra above another
What is the treatment for spondylothesis?
Surgical-use screws and rods to stabilise the spine
Where is fluid withdrawn from in a lumbar puncture?
The subarachnoid space of the lumbar cistern
