Lumbar Spine

Question 1

What is mechanical back pain?

Answer 1

Recurrent relapsing and remitting back pain with no neurological symptoms

Question 2

What is Spondylosis?

Answer 2

Where intervertebral disks lose water content with age

Question 3

How do you treat mechanical back pain?

Answer 3

Analgesia and physiotherapy

Question 4

What is an acute disc tear?

Answer 4

a tear that classically occurs after lifting a heavy object in the outer annulus fibrosis of an intervertebral disc

Question 5

When is pain worse in an acute disc tear?

Answer 5

on coughing

Question 6

How long does it take for an acute disc tear to settle?

Answer 6

2-3 months

Question 7

What are the treatment of an acute disc tear?

Answer 7

Analgesia and physiotherapy

Question 8

What can the gelatinous nucleus pulposis do in a disc tear?

Answer 8

Herniate or prolapse through the tear

Question 9

What is sciatica?

Answer 9

herniated disc around L4, L5 and S1 with the nerve roots contributing to sciatic pain

Question 10

Describe radicular pain

Answer 10

neuralgic burning or severe tingling pain like a toothache down the back of the thigh

Question 11

What does radicular pain do in a sciatic stretch test?

Answer 11

testing on the opposite side may evoke pain on the affected side

Question 12

Which nerve is compressed in a lumbar prolapse?

Answer 12

the lower nerve

Question 13

what does the patient experience in a L3/4 prolapse?

Answer 13

Pain down to medial ankle, loss of quadriceps power and reduced knee jerk

Question 14

what does the patient experience in a L4/5 prolapse?

Answer 14

pain down dorsum foot, reduced power extensor hallucis longus and tibialis anterior

Question 15

what does the patient experience in a L5/S1 prolapse?

Answer 15

pain to sole of foot, reduced power plantarflexion, reduced ankle jerks

Question 16

Which nerve is affected in a very lateral disc prolapse?

Answer 16

the one above

Question 17

What is the first line treatment for prolapsed disc caused nerve pain?

Answer 17

analgesia, maintaining mobility and physio

Question 18

what drugs are used if the leg pain is severe?

Answer 18

drugs like Gabapentin

Question 19

What is bony nerve root entrapment?

Answer 19

OA of the facet joints leading impingement of nerve roots

Question 20

How is bony nerve root entrapment treated?

Answer 20

surgical decompression

Question 21

What is spinal stenosis?

Answer 21

the cauda equina of the lumbar spine has less space

Question 22

How does spinal stenosis contrast to vascular claudication?

Answer 22

claudication distance is inconsistent, pain is burning and not cramping, pain is less uphill and pedal pulses are preserved

Question 23

What is cauda equina syndrome?

Answer 23

a very large central disc prolapse can compress all the nerve roots of the cauda equina

Question 24

Why is cauda equina syndrome a surgical emergency?

Answer 24

Because it can effect the nerves responsible for urination and defecation

Question 25

What are the symptoms of cauda equina syndrome?

Answer 25

bilateral leg pain, paraesthesia or numbness and saddle anaesthesia

Question 26

What are the lumbar spine red flags?

Answer 26

• back pain in younger patients
• new onset back pain in the elderly
• constant, severe and pain worse at night
• systemic upset

Question 27

What does a spontaneous crush fracture result in?

Answer 27

acute pain and kyphosis