Intervertebral disc disease & spinal nerve root lesions

Question 1

acute disc disease

Answer 1

prolapse of intervertebral disc results in acute back pain +/- sciatica

Question 2

acute disc disease affects?

Answer 2

younger people

Question 3

likely cause of sciatica in older people

Answer 3

compression of nerve root by osteophytes

Question 4

clinical features acute disc disease

Answer 4

sudden onset of severe back pain often following strenuous activity
lowest three discs most commonly affected

Question 5

Root lesion:  S1
Pain ?
Sensory loss ?
Motor weakness ?
Reflex lost ?
Other signs ?

Answer 5

Root lesion: S1
Pain from buttock down back of thigh and leg to ankle and foot
Sensory loss - sole of foot and post. calf
Motor weakness - plantar flexion of ankle and toes
Reflex lost : ankle jerk
Other signs : diminished straight leg rising

Question 6

Root lesion: L5
Pain ?
Sensory loss ?
Motor weakness ?
Reflex lost ?
Other signs ?

Answer 6

Root lesion: L5
Pain- from buttock to lateral aspect of leg and dorsum of foot
Sensory loss- dorsum of foot and anterolateral aspect of lower leg
Motor weakness- dorsiflexion of foot and toes
Reflex lost- none
Other signs- diminished straight leg rising

Question 7

Root lesion: L4
Pain ?
Sensory loss ?
Motor weakness ?
Reflex lost ?
Other signs ?

Answer 7

Root lesion: L4
Pain - lateral aspect of thigh to medial side of calf
Sensory loss - medial aspect of calf and shin
Motor weakness - dorsiflexion of inversion of ankle; extension of knee
Reflex lost - knee jerk
Other signs - positive femoral stretch test

Question 8

management acute disc disease

Answer 8

symptom relief
bed rest on firm mattress, analgesia, corticosteroid injec if severe
surgery for severe impairment eg foot drop or bladder symps
physio