Lumbar Spine

Question 1

how is mechanical back pain characterised

Answer 1

pain when the spine is loaded that worsens with exercise and relieved by rest

Question 2

risk factures for back pain

Answer 2

obesity
poor posture
sedentary lifestyle

Question 3

how does a spilled disc cause pain

Answer 3

herniated disc material presses oon the spinal nerve

Question 4

4 stages to disc herniation

Answer 4

Disc Degeneration
Prolaspe
extrusion
sequestration

Question 5

disc degeneration

Answer 5

chemical changes associated with ageing cause discs to

dehydrate and bulge

Question 6

prolaspe

Answer 6

Protrusion of the nucleus pulposus occurs with slight impingement into
the spinal canal. The nucleus pulposus is contained within a rim of annulus fibrosus

Question 7

Extrusion

Answer 7

The nucleus pulposus breaks through the annulus fibrosus but is still
contained within the disc space

Question 8

sequestration

Answer 8

The nucleus pulposus separates from the main body of the disc
and enters the spinal canal.

Question 9

most common site for slipped disc

Answer 9

L4/L5 and L5/S1

Question 10

Paracentral prolapse

Answer 10

nucleus pulposus most commonly herniates posterolaterally (lateral to
the posterior longitudinal ligament), causing compression of a spinal nerve
root within the intervertebral foramen

Question 11

central herniations carries a risk of causing

Answer 11

cauda equina syndrome

Question 12

which exiting nerve root is likely to be damaged ina a paracentral disc herniation

Answer 12

transversing nerve root

Question 13

Sciatica

Answer 13

Sciatica is the name given to pain caused by irritation or compression of one or
more of the nerve roots that contribute to the sciatic nerve (i.e. L4, L5, S1, S2
and S3)

Question 14

sciatica origins

Answer 14

L4,L5,S1,S2,S3

Question 15

When do you get paraesthesia with sciatica

Answer 15

if the nerve compression

will be in the effected dermatome

Question 16

Causes of Cauda Equina Syndrome

Answer 16

tumours
meninges
abscess
prolasped intervertable disc

Question 17

cauda equina red flag symptoms

Answer 17

Bilateral sciatica
 Perianal numbness (saddle anaesthesia)
 Painless retention of urine
 Urinary / faecal incontinence
 Erectile dysfunction

Question 18

how do you treat cuada equina

Answer 18

surgical decompression 48 hours

Question 19

what is spinal canal stenosis

Answer 19

abnormal narrowing of the spinal canal that compresses either the spinal cord or the nerve root

Question 20

spinal canal stenosis is due to

Answer 20

Spinal canal stenosis tends to affect the elderly
and is often due to a combination of:
 Disc bulging
 Facet joint osteoarthritis
 Ligamentum flavum hypertrophy
Other causes include:
 Compression fractures of the vertebral
bodies
 Spondylolisthesis (see below)
 Trauma

Question 21

symptoms of spinal canal stenosis

Answer 21

Discomfort whilst standing (95% of patients)
 Discomfort or pain in the shoulder, arm or hand (for cervical stenosis) or
in the lower limb (for lumbar stenosis)
 Bilateral symptoms in approximately 70% of patients
 Numbness at or below the level of the stenosis
 Weakness at or below the level of the stenosis
 Neurogenic claudication (see below)

Question 22

what is Neurogenic claudication

Answer 22

symptoms rather that a diagnosis
The patient reports pain and/or pins and needles in the legs on
prolonged standing and on walking, radiating in a sciatica distribution.

Question 23

pathology of neurogenic claudication

Answer 23

ompression of the spinal nerves as they emerge from the
lumbosacral spinal cord (see spinal canal stenosis above). This leads to
venous engorgement of the nerve roots during exercise, leading to reduced
arterial inflow and transient arterial ischaemia. The ischaemia of the
affected nerve(s) results in the pain and/or paraesthesia.

Question 24

spondylolisthesis

Answer 24

anterior displacement of the vertebra above on the verte below

Question 25

what breaks in a spondyolisthesis

Answer 25

pars interarticularis