Lumbar spine

Question 1

Mechanical pain

Answer 1

Recurrent and remitting back pain with no neurological symptoms. Worse on exercise and relieved by rest.
No red flag symptoms

Question 2

Causes of mechanical back pain

Answer 2

Obesity, poor posture, poor lifting technique, lack of physical activity, depression, osteoarthritis, spondylosis (loss of water content as age increases in intervertebral discs),

Question 3

Treatment of mechanical spinal pain

Answer 3

Analgesia and physiotherapy.

Patients are encouraged to get back to work and maintain normal function asap.

Question 4

When would spinal stabilisation surgery (fusion) be considered for mechanical back pain?

Answer 4

If the patient has OA on adjacent levels, not responded to physio or conservative management and have no behavioural issues that may affect the outcome of surgery

Question 5

Acute disc tear /discogenic pain and its symptoms

Answer 5

An acute tear can occur in the annulus fibrosis. There are lots of sensory fibres here so it is very painful. Pain also worse on coughing

Question 6

Treatment of an acute disc tear

Answer 6

Symptoms usually resolve in 2-3 months. Treatment in the mean time should be analgesia and physiotherapy.

Question 7

In what situations do acute disc tears occur?

Answer 7

Lifting a heavy object.

Question 8

What is sciatica

Answer 8

Neurological pain that travels down the buttock, thigh and past the knee. Pain is due to compression of the nerves that contribute to the sciatic nerve.

Question 9

What can cause sciatica

Answer 9

In an acute disc prolapse- the herniated nucleus pulposa can compress on the nerve root.

Question 10

If a prolapsed disc occurs- which nerve root is likely to be compressed?

Answer 10

The nerve root below. E.g. if L2/L3 disc prolapse occurs- L3 exiting root will be damaged.

Question 11

Describe the pain in sciatica. What does it do to muscles.

Answer 11

Burning or tingling pain. Also causes weakness in a myotomal distribution.

Question 12

Treatment of sciatica

Answer 12

First line- analgesia, physiotherapy and maintaining mobility.
Second line- drugs for neuropathic leg pain e.g. gabapentin
Third line- very rare but surgery called a discectomy.

Question 13

Other (rarer) causes of sciatica

Answer 13

OA can cause osteophytes to form which compress nerve roots.

Question 14

Treatment of bony causes of sciatica

Answer 14

Surgery to decompress the nerve by trimming osteophytes.

Question 15

Spinal stenosis is

Answer 15

Compression or irritation of the cauda equina due to several conditions.

Question 16

Which conditions cause spinal stenosis

Answer 16

Spondylosis- this doesn’t necessarily cause spinal stenosis however will contribute to it.
Bulging discs, prolapsed discs, bulging ligamentum flavum and osteophytes.

Question 17

Presentation of spinal stenosis

Answer 17

Sciatica

Question 18

Treatment of spinal stenosis

Answer 18

Conservative- weight loss or physiotherapy

If these don’t work discectomy to relieve pressure from the cauda equina.