disorders of the spine Flashcards
mechanical back pain
characterised:
pain when spine is loaded, worsens with exercise and relieved by relaxing
risk factors:
obesity, poor posture, sedentery lifestyle
disc degeneration
characterisation:
nucleus pulposus dehydrates => decrease in heights of disc, bulging of discs
syndesmophytes (bony spurs) - develop adjacent to the disc = marginal osteophytosis
osteoarthritic changes - stress placed on the facet joints
summary:
disc height decreases + athritis develops + intervertebral formaina decrease = nerve pain
slipped disc
characteristic:
pain occurs due to herniated disc material pressing on spinal nerve
4 stages:
disc degeneration = disc dehydrate and bulge
prolapse = protrusion of nucleus pulposus
extrusion = nucleus pulposus breaks through the annulus fibrosus
sequestration = nucleus pulposus leaks and enters spinal chord
most common sites:
L4/5 amd L5/S1
what 2 sites are nerve roots vulnerable at
1) where they cross intervertebral disc
2) where they exit spinal canal in intervertebral foramen
paracentral prolapse
nucleus pulposus commonly herniates posterolaterally = compression of a spinal nerve root within intervertebral foramen
It is the traversing nerve root that is at risk ( nevre root that passes between the intervertebral disk and the vertebreal foramen) eg paracentrl disk prolapse of C4/C5 will effect the C5 spinal nerve
exiting nerve root
nerve root emerging from spinal canal at same level of intervertebral disc
traversing nerve root
nerve root emerging below the intervertebral disc
eg.
in paracentral herniation of L4/5 disc, L5 root is compressed but not L4 since its above
sciatica (radicular leg pain)
characteristic:
irritation or compression of one/more nerve roots that contribute to the sciatic nerve
causes:
slipped disc
site:
back and buttock and radiates to dermatome supplied by affected root
cauda equina syndrome
characteristsic:
prolapsed intervertebral disc compressing lumbar and sacral nerve roots
Red
Red flags of cauda equina syndrome
Bilateral sciatica Perianal numbness Painless retention of urine Urinary / faecal incontinence Erectile disfunction
Treatment of cauda equina syndrome
- surgical decompression within 48 hours Consequence of missing diagnosis: Chronic neuropathic pain Impotence Self catherisation to pass urine
Spinal canal stenosis
Characteristic: abnormal narrowing of spinal canal compressing either spinal cord of nerve roots Causes: Disc bulging Facet joint osetoarthritis Ligamentum flavum hypertrophy Trauma Symptoms: Depend in region of cord/nerve roots that are effected Discomfort in: Standing Shoulder Numbness
Neurogenic claudication
A Symptom! Characteristic: Pain/ pins and needles during prolonged standing and walking Neurogenic = problem originates from nerve Claudication = limp/pain Cause: Compression of spinal nerves as they emerge from lumbrosacral Relieved: Rest Change in position by flexion of spine
Spondylolisthesis
Anterior displacement of the upper vertebra
Classifications: - congenital / dysplastic - isthmic -degenerative - traumatic - pathological - latrigenic Isthmic type develops in the pars interarticularis Which is between the superior and inferior articular process Treatment: Surgical screws and rods to stabilise spine
Spondylolysis
Fracture in the pars interarticularis without displacement
