Lumbar Spine

Question 1

What is spondylosis?

Answer 1

Intervertebral disks lose water with age resulting in less cushioning and increased pressure on facet joints.

Question 2

What does spondylosis often end to?

Answer 2

Facet joint osteoarthritis.

Question 3

Treatment for none pathological mechanical back pain.

Answer 3

Analgesia and physiotherapy. Reassure patient there is nothing serious and advise against bed rest.

Question 4

Any surgical options for OA or instability.

Answer 4

If two adjacent vertebrae affected and symptoms persist despite conservative treatment then some are admitted for spinal stabilisation.

Question 5

Acute disc tear

Answer 5

Usually due to poor lifting technique the richly innervated annulus pulposus is ripped

Question 6

Characteristic pain of acute disc .

Answer 6

Pain is worse when coughing

Question 7

Treatment for acute disc tear

Answer 7

Symptoms usually resolve 2-3 months later.

Analgesia and physiotherapy are mainstay.

Question 8

Sciatica/Lumbar radiculopathy

Answer 8

Disc material impinges on the exiting nerve resulting in pain and altered sensation.

Question 9

What nerves are involved with sciatica

Answer 9

L4,L5,S1

Question 10

Sciatic pain

Answer 10

Neuralgic burning or severe tingling pain that radiates down the back of the thigh to below the knee.

Question 11

L3/L4 prolapse

Answer 11

L4 root entrapment
Pain to medial ankle.
Loss of quadriceps power.
Reduced knee jerk.

Question 12

L4/5 prolapse

Answer 12

L5 entrapment.
Pain down to drum of foot.
Reduced power of extensor Hallucis Longus and tibialis anterior.

Question 13

L5/S1 prolapse

Answer 13

S1 entrapment.

Pain to sole of foot, reduced power of planar flexion, reduced ankle jerks.

Question 14

Treatment for sciatica

Answer 14

Analgesia, maintain mobility and physiotherapy..

Gabapentin can be used for severe pain.

Question 15

Surgery in sciatica

Answer 15

Pain is unresolving with identifiable specific nerve root issues.
Surgery has small risk of neurological damage.

Question 16

Bony nerve root entrapment

Answer 16

Osteophytes can form of facet joints due to OA or improper healing of microfractures.

Question 17

Bony nerve root entrapment treatment

Answer 17

Surgical decompression, trim the impinging osteophytes.

Question 18

Spinal stenosis

Answer 18

Due to a combination of bulging discs osteophytes the caudal equine is compressed.

Question 19

Spinal stenosis symptoms

Answer 19

Claudication

Question 20

Difference in spinal stenosis to peripheral arterial disease?

Answer 20

The distance taken to start is inconsistent.
Pain is burning rather than cramping.
Pain relieved by walking up hill.
Pedal pulses are preserved.

Question 21

Treatment for spinal stenosis

Answer 21

Physiotherapy weight loss analgesics.

Surgery if failure of symptoms to resolve to decompress area.

Question 22

Cauda equina

Answer 22

A large prolapse compresses the whole sauna equine.

MEDICAL EMERGENCY

Question 23

Cauda equina symptoms

Answer 23

Bilateral leg pain.
Saddle anaesthesia.
Urinary/faecal retention or incontinence.

Question 24

Diagnosis of caudal equina.

Answer 24

Urgent MRI and PR exam to determine origin of prolapse and whether there has been a loss of muscular tone.

Question 25

Treatment of cauda equina

Answer 25

Urgent discectomy.

Question 26

Red flags of signs

Answer 26

New back pain in <20 or >60.
Pain is constant unremitting and worse at night.
Systemic upsets e.g fever malaise anorexia.

Question 27

Osteoporotic crush fractures

Answer 27

Due to thinning of the pone spontaneous fractures in spinal body lead to acute pain and kyphosis.

Question 28

Treatment for osteoporotic crush fractures.

Answer 28

Usually conservative.

Some surgeons use balloon vertebroplasty.

Question 29

What is balloon vertebroplasty?

Answer 29

Balloon is inserted in vertebral body inflating the balloon to lift vertebrae and injecting cement to fill void.

Question 30

Cervical spondylosis

Answer 30

Slow onset stiffness and pain in the neck with can radiate locally to shoulders