Lumbar Disk Herniation and Radiculopathy Flashcards
The nerve root en passant is the nerve in lateral recess that passes through the neural foramen of the level below; for example, for L4–L5 level, it would be L5 nerve root while exiting nerve root at this level would be L4 nerve root. Most of the herniated lumbar disks are paramedian which cause compression on which of the following?
● A. Exiting nerve root
● B. Traversing nerve root
● C. Both A and B
● D. It causes thecal sac compression only
● E. None of the above
B. Traversing nerve root
Which of the following statements is incorrect regarding clinical findings with herniated lumbar disk?
● A. Symptoms may start off with back pain, which after days or weeks gradually or sometimes suddenly yields to radicular pain often with reduction of the back pain
● B. Pain is relieved upon flexing the knee and thigh (e.g., with a pillow under the knees)
● C. Remaining in any position (sitting, standing, or lying) for too long may also exacerbate the pain, sometimes necessitating position changes at intervals that range from every few minutes to 10 to 20 minutes
● D. Pain is increased with coughing, sneezing, or straining at the stool
● E. Bladder symptoms are never present with a herniated lumbar disk
E. Bladder symptoms are never present with a herniated lumbar disk
Which of the following signs are used to test tension on nerve roots in case of radiculopathy?
● A. Lasegue’s sign also known as straight leg raise sign (with the patient supine, the afflicted limb is raised by the ankle until pain is solicited, which should occur at angle less than 60 degrees and consists of leg pain or paresthesias in the distribution of pain)
● B. Cram test (with the patient supine, the symptomatic leg is raised with the knee slightly flexed and then extending the knee will produce pain similar to Lasegue’s sign)
● C. Crossed straight leg raising test also known as Fajersztajn’s sign (SLR on the painless leg cause contralateral limb pain)
● D. Femoral stretch test also known as reverse straight leg raising, which is positive with L2, L3, or L4 nerve root compression
● E. All of the above
E. All of the above
The most common level of herniated lumbar disk is L5–S1 which is 45 to 50%, the second most common level is L4–L5 which is 40 to 45%, while L3–L4 is involved in only 3 to 10% of cases. Which of the following are the symptoms caused by the S1 nerve root compression?
● A. Diminished ankle jerk (Achilles)
● B. Motor weakness of gastrocnemius causing weak plantar flexion
● C. Decreased sensations in the area of lateral malleolus and lateral foot
● D. Pain distribution in the posterior lower extremity often up to the ankle
● E. All of the above
E. All of the above
Cauda equina syndrome causes urinary retention, saddle anesthesia, significant motor weakness, and low-back pain. Following are the causes of this syndrome except?
● A. Compression of the cauda equina by massive disk herniation or tumor or free fat graft following surgery or trauma or spinal epidural hematoma
● B. Infection which may cause compression by epidural abscess or vascular compromise resulting from local septic thrombophlebitis
● C. Neuropathy caused by inflammation or ischemia
● D. Rheumatoid arthritis
● E. Ankylosing spondylitis
D. Rheumatoid arthritis
What is the desirable time of surgery after development of cauda equina syndrome?
● A. Within 48 hours
● B. Within 24 hours
● C. Within 12 hours
● D. Within 6 hours
● E. None of the above
B. Within 24 hours
Which of the following is an indication of surgery in a patient with herniated lumbar disk?
● A. Failure of nonsurgical management which is done for almost 5 to 8 weeks
● B. Patients with cauda equina syndrome
● C. Patients with progressive motor deficit
● D. Intolerable pain despite the use of adequate narcotic pain medication
● E. All of the above
E. All of the above
Surgical options for lumbar radiculopathy include transcanal approaches like standard open lumbar laminectomy and diskectomy, microdiskectomy, or sequestrectomy. Which of the following indications are utilized by proponents for intradiskal procedures like automated percutaneous lumbar diskectomy (nucleoplasty), laser disk decompression, percutaneous endoscopic lumbar diskectomy, and intradiskal endothermal therapy?
● A. Contained disk herniation
● B. Best for L4–L5 herniated disk
● C. Not recommended in severe neurologic deficit
● D. All of the above
D. All of the above
Common complications after operation for herniated lumbar disk include superficial wound infection, deep wound infection, increased motor deficit, unintended incidental durotomy, recurrent herniated lumbar disk, and postoperative urinary retention. What are the rates of superficial infection, deep infection, and incidental durotomy, respectively?
● A. 0.9 to 5%, less than 1%, and 0.3 to 13%
● B. 1%, 5%, and 13%
● C. 0.1%, 0.5%, and 0.3%
● D. None of the above
A. 0.9 to 5%, less than 1%, and 0.3 to 13%
What is the possible sequalae of dural opening?
● A. CSF leak (contained or pseudomeningocele or external, CSF fistula)
● B. Herniations of nerve roots through the opening
● C. Associated nerve root contusion, laceration, or injury to the cauda equina
● D. CSF leak may collapse thecal sac and cause bleeding from epidural blood vessels
● E. All of the above
E. All of the above
Most herniated lumbar disks occur posteriorly and slightly off to one side within which of the following?
● A. Central canal zone
● B. Foraminal zone
● C. Extraforaminal zone
● D. Far lateral zone
● E. Intravertebrally
A. Central canal zone
A herniated disk at the level of L4–L5 mostly involves root of which of the following?
● A. L3
● B. L4
● C. L5
● D. S1
● E. Filum terminale
C. L5
A foraminal herniated disk at the level of L4–L5 mostly involves root of which of the following?
● A. L3
● B. L4
● C. L5
● D. S1
● E. Filum terminale
B. L4
Which of the following is the most specific nerve root tension sign?
● A. Lasegue’s test
● B. Cross SLR
● C. Reverse SLR
● D. Hoover test
● E. FABER/Patrick test
B. Cross SLR
Which of the following is a hip motion test for sacroiliitis?
● A. Lasegue’s test
● B. Cross SLR
● C. Reverse SLR
● D. Hoover test
● E. FABER/Patrick test
E. FABER/Patrick test
