Lumbar Spine Flashcards
What is mechanical back pain?
Recurrent relapsing and remitting back pain with no neurological symptoms
What is Spondylosis?
Where intervertebral disks lose water content with age
How do you treat mechanical back pain?
Analgesia and physiotherapy
What is an acute disc tear?
a tear that classically occurs after lifting a heavy object in the outer annulus fibrosis of an intervertebral disc
When is pain worse in an acute disc tear?
on coughing
How long does it take for an acute disc tear to settle?
2-3 months
What are the treatment of an acute disc tear?
Analgesia and physiotherapy
What can the gelatinous nucleus pulposis do in a disc tear?
Herniate or prolapse through the tear
What is sciatica?
herniated disc around L4, L5 and S1 with the nerve roots contributing to sciatic pain
Describe radicular pain
neuralgic burning or severe tingling pain like a toothache down the back of the thigh
What does radicular pain do in a sciatic stretch test?
testing on the opposite side may evoke pain on the affected side
Which nerve is compressed in a lumbar prolapse?
the lower nerve
what does the patient experience in a L3/4 prolapse?
Pain down to medial ankle, loss of quadriceps power and reduced knee jerk
what does the patient experience in a L4/5 prolapse?
pain down dorsum foot, reduced power extensor hallucis longus and tibialis anterior
what does the patient experience in a L5/S1 prolapse?
pain to sole of foot, reduced power plantarflexion, reduced ankle jerks
Which nerve is affected in a very lateral disc prolapse?
the one above
What is the first line treatment for prolapsed disc caused nerve pain?
analgesia, maintaining mobility and physio
what drugs are used if the leg pain is severe?
drugs like Gabapentin
What is bony nerve root entrapment?
OA of the facet joints leading impingement of nerve roots
How is bony nerve root entrapment treated?
surgical decompression
What is spinal stenosis?
the cauda equina of the lumbar spine has less space
How does spinal stenosis contrast to vascular claudication?
claudication distance is inconsistent, pain is burning and not cramping, pain is less uphill and pedal pulses are preserved
What is cauda equina syndrome?
a very large central disc prolapse can compress all the nerve roots of the cauda equina
Why is cauda equina syndrome a surgical emergency?
Because it can effect the nerves responsible for urination and defecation
What are the symptoms of cauda equina syndrome?
bilateral leg pain, paraesthesia or numbness and saddle anaesthesia
What are the lumbar spine red flags?
- back pain in younger patients
- new onset back pain in the elderly
- constant, severe and pain worse at night
- systemic upset
What does a spontaneous crush fracture result in?
acute pain and kyphosis
