Lumbar Spine Flashcards
What is spondylosis?
Intervertebral disks lose water with age resulting in less cushioning and increased pressure on facet joints.
What does spondylosis often end to?
Facet joint osteoarthritis.
Treatment for none pathological mechanical back pain.
Analgesia and physiotherapy. Reassure patient there is nothing serious and advise against bed rest.
Any surgical options for OA or instability.
If two adjacent vertebrae affected and symptoms persist despite conservative treatment then some are admitted for spinal stabilisation.
Acute disc tear
Usually due to poor lifting technique the richly innervated annulus pulposus is ripped
Characteristic pain of acute disc .
Pain is worse when coughing
Treatment for acute disc tear
Symptoms usually resolve 2-3 months later.
Analgesia and physiotherapy are mainstay.
Sciatica/Lumbar radiculopathy
Disc material impinges on the exiting nerve resulting in pain and altered sensation.
What nerves are involved with sciatica
L4,L5,S1
Sciatic pain
Neuralgic burning or severe tingling pain that radiates down the back of the thigh to below the knee.
L3/L4 prolapse
L4 root entrapment
Pain to medial ankle.
Loss of quadriceps power.
Reduced knee jerk.
L4/5 prolapse
L5 entrapment.
Pain down to drum of foot.
Reduced power of extensor Hallucis Longus and tibialis anterior.
L5/S1 prolapse
S1 entrapment.
Pain to sole of foot, reduced power of planar flexion, reduced ankle jerks.
Treatment for sciatica
Analgesia, maintain mobility and physiotherapy..
Gabapentin can be used for severe pain.
Surgery in sciatica
Pain is unresolving with identifiable specific nerve root issues.
Surgery has small risk of neurological damage.
Bony nerve root entrapment
Osteophytes can form of facet joints due to OA or improper healing of microfractures.
Bony nerve root entrapment treatment
Surgical decompression, trim the impinging osteophytes.
Spinal stenosis
Due to a combination of bulging discs osteophytes the caudal equine is compressed.
Spinal stenosis symptoms
Claudication
Difference in spinal stenosis to peripheral arterial disease?
The distance taken to start is inconsistent.
Pain is burning rather than cramping.
Pain relieved by walking up hill.
Pedal pulses are preserved.
Treatment for spinal stenosis
Physiotherapy weight loss analgesics.
Surgery if failure of symptoms to resolve to decompress area.
Cauda equina
A large prolapse compresses the whole sauna equine.
MEDICAL EMERGENCY
Cauda equina symptoms
Bilateral leg pain.
Saddle anaesthesia.
Urinary/faecal retention or incontinence.
Diagnosis of caudal equina.
Urgent MRI and PR exam to determine origin of prolapse and whether there has been a loss of muscular tone.
Treatment of cauda equina
Urgent discectomy.
Red flags of signs
New back pain in <20 or >60.
Pain is constant unremitting and worse at night.
Systemic upsets e.g fever malaise anorexia.
Osteoporotic crush fractures
Due to thinning of the pone spontaneous fractures in spinal body lead to acute pain and kyphosis.
Treatment for osteoporotic crush fractures.
Usually conservative.
Some surgeons use balloon vertebroplasty.
What is balloon vertebroplasty?
Balloon is inserted in vertebral body inflating the balloon to lift vertebrae and injecting cement to fill void.
Cervical spondylosis
Slow onset stiffness and pain in the neck with can radiate locally to shoulders
