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Lumbar spine clinical conditions Flashcards

1
Q

What is the centre of gravity?

A

Weight of body projected into lower limbs

about a line that passes centrally through natural curvatures of spine

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2
Q

What is the centre of gravity in the vertebral column?

A

C1, C2
C7, T1
T12, L1
L5, S1

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3
Q

What is senile kyphosis?

A

Refers to secondary curvatures disappearing
primary curvature re-appearing
with old age

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4
Q

What is an example of an abnormal curvature that is physiological?

A

Exaggeration of lordosis
of lumber spine
during pregnancy

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5
Q

What is a suitable vertebral level for a lumbar puncture? Why?

A

L2/L3
L3/L4
L4/L5

After conus medullaris
only have spinal roots, not cord, least chance of neurological damage

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6
Q

What structures does the needle pass through in a lumbar puncture in order to reach the CSF?

A 
Skin
Subcutaneous tissue
Supraspinous ligament
Interpsinous ligament
Ligamentum flavum
Epideral fat and veins 
Dura matter
Arachnoid matter
Subarachnoid space
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7
Q

Not having lower back pain - is it normal or abnormal?

A

Abnormal

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8
Q

What are the exacerbating factors of mechanical back pain?

A

When spine is bearing weight e.g. standing, sitting

Exercising

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9
Q

What are the relieving factors of mechanical back pain?

A

Lying down

Rest

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10
Q

How long does mechanical back pain last?

A

Intermittent - comes and goes

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11
Q

What triggers mechanical back pain?

A

Normal activity

e.g. bending down to pick something up

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12
Q

What predisposes to mechanical back pain?

A

Obesity

Deconditioned core muscles - muscles have to work harder to maintian posture

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13
Q

What is disc degeneration?

A

Nucleus polposus dehydrates with age

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14
Q

How does disc degeneration affect height?

A

Height of disc decreases

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15
Q

What are the results of a decrease in disc height?

A

Reactive marginal osteophytosis

Increased stress placed on facet joints
Leads to osteoarthritis
Pain via meningeal nerve

Decreased size of intervertebral foramen
Compression of spinal nerves

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16
Q

What does spondylosis deformans mean?

A 
Spondylosis = degeneration of vertebral column
Deformans = deform
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17
Q

What does senile ankylosis mean?

A 
Senile = old age
Ankylosis = abnormal fusion of bones of a joint, giving stiffness
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18
Q

What do young discs look like on an MRI scan?

A

Appear white

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19
Q

What do degerated discs look like on an MRI scan?

A

Appear grey/black

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20
Q

What are the four stages of a slipped disc?

A

Disc degeneration
Prolapse
Extrusion
Sequestration

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21
Q

What happens in disc degeneration?

A

Dehydration of discs with age

Causes them to bulge

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22
Q

What happens in disc prolapse?

A

Protrusion of nucleus polposus

Slight impingement into vertebral canal

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23
Q

What happens in disc extrusion?

A

Nucleus polposus breaks through annulus fibrosus

But still within disc space

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24
Q

What happens in sequestration?

A

Nucleus polposus breaks through annulus fibrosus

Separates from main body of disc
Enters vertebral canal

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25
Q

Which disc does slippage most commonly occur in?

A

L4/L5 disc

L5/S1 disc

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26
Q

What are the different types of disc herniation? What is the relative prevalence of each?

A

Paracentral - most common

Far lateral - rare

Canal filling - rare

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27
Q

What is a paracentral disc herniation?

A

Disc herniates into spinal canal

next to the spinal cord

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28
Q

What is a far lateral disc herniation?

A

Disc herniates laterally where nerve root is exiting

not in spinal canal

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29
Q

What is a canal filling disc herniation?

A

Large disc herniation

Fills spinal canal

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30
Q

What does a canal filling disc herniation result in?

A

Cauda equina syndrome

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31
Q

What is sciatica?

A

Compression of nerve roots which contribute to the sciatic nerve L4-S3

NOT compression of the sciatic nerve!

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32
Q

What is the most common cause of sciatica?

A

Disc prolapse

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33
Q

Which nerve roots are most commonly compressed in sciatica?

A

L4, L5, S1

34
Q

Why is sciatica of S2, S3 rare?

A

Because they exit from the sacrum

which doesn’t have any discs in it

35
Q

What are the symptoms of sciatica?

A

Pain - along whole course of nerve

Paraesthesia - only end point that nerve supplies

36
Q

Where does pain occur with L4 sciatica?

A

Anterior thigh
Anterior knee
Medial shin

37
Q

Where does paraesthesia occur with L4 sciatica?

A

Medial shin

38
Q

Where does pain occur with L5 sciatica?

A

Lateral thigh
Lateral calf
Dorsum of foot

39
Q

Where does paraesthesia occur with L5 sciatica?

A

Lateral calf

Dorsum of foot

40
Q

Where does pain occur with S1 sciatica?

A

Posterior thigh
Posterior calf
Heel
Sole of foot

41
Q

Where does paraesthesia occur with S1 sciatica?

A

Heel

Sole of foot

42
Q

Which nerve root is compressed by a paracentral disc prolapse?

A

The lower nerve root

Because upper nerve root has already left
Lower nerve root is starting to leave spinal cord
gets compressed

43
Q

What nerve root would be compressed by an L5/S1 disc prolapse?

A

S1

44
Q

Which nerve root is affected by a far lateral disc prolapse?

A

The upper nerve root

Because the upper nerve root is leaving laterally
gets compressed

45
Q

What age group do slipped discs mostly occur in?

A

30-50 year olds

46
Q

Are slipped discs usually resolved?

A

Yes

47
Q

What is cauda equina syndrome caused by?

A

Canal filling disc prolapse

48
Q

What is compressed in cauda equina syndrome?

A

Cauda equina - lumbar and sacral nerve roots

49
Q

What age group does cauda equina mostly occur in?

A

30-50 year olds

same as slipped discs, since it’s the cause

50
Q

What are the symptoms and signs of cauda equina syndrome?

A

Bilateral sciatica - both nerve roots compressed

Perianal numbness - loss of S3, S4 supply

Painless retention of urine

Urinary and faecal incontinence - loss of sphincter control

51
Q

What does CSF normally look like on an MRI?

A

Appears white

52
Q

What does cauda equina syndrome look like on an MRI?

A

Disc prolapse appears dark - grey/black

where CSF should be

53
Q

How quikcly should cauda equina syndrome be treated?

A

Within 48 hours of sphincter symptoms

54
Q

What are the consequences of cauda equina syndrome that’s untreated or treated too late?

A

Intermittent self catheterisation

Digital rectal examinations

Sexual dysfunction

55
Q

What is lumbar canal stenosis?

A

Narrowing of spinal canal in lumbar region

56
Q

What are the causes of lumbar canal stenosis?

A

Disc bulge

Facet joint osteoarthritis

Ligamentum flavum hypertrophy

57
Q

What age group does lumbar canal stenosis mostly occur in?

A

Elderly

58
Q

What does lumbar canal stenosis look like on an MRI scan?

A

Little CSF, white

Appears darker - grey black

59
Q

What is claudication?

A

Pain in legs when walking

60
Q

What are the causes of claudication?

A

Neurogenic - lumbar canal stenosis

Vascular - problems with perfusion of legs

61
Q

Does lumbar canal stenosis improve?

A

No

most people stay the same

62
Q

Which group of people should be treated for lumbar canal stenosis?

A

Restricted walking distance affects their quality of life

63
Q

What is spondylolisthesis?

A

Slip forwards of vertebra above

on vertebra below

64
Q

What are the types of spondylolisthesis?

A 
Dysplasic
Isthmic
Degenerative
Iatrogenic
Pathological
65
Q

What is dysplastic spondylolisthesis?

A

Abnormality in shape of facet joints is the cause

66
Q

What is isthmic spondylolisthesis?

A

Defect in pars interarticularis is the cause

67
Q

What is pars interarticularis?

A

Bone that joins facet joints to vertebral body

68
Q

What is degenerative spondylolisthesis?

A

Arthritis is the cause

69
Q

What is iatrogenic spondylolisthesis?

A

Caused by medical process e.g. surgery

70
Q

What is pathological spondylolisthesis?

A

Caused by disease e.g. tumour

71
Q

What are the causes of a defective pars interarticularis?

A

Abnormality in development

Fractures

72
Q

What happens with a fractured pars interarticularis?

A

Vertebral body detached from vertebral arch
Vertebral body moves forwards
no compression of spinal cord

73
Q

How does isthmic spondylolisthesis present?

A

Back pain
L5 sciatica
arch not intact so no spinal canal stenosis

74
Q

What does disc prolapse look like on an MRI?

A

Dark grey area in white CSF

75
Q

What happens to the prolapsed disc material?

A

Triggers inflammatory reactions

broken down by it

76
Q

Where does isthmic spondylolisthesis commonly occur?

A

L5 vertebrae

77
Q

In what age groups does isthmic spondylolisthesis present? Why?

A

Adolescence
Adulthood

Disc has started to age

78
Q

How does degenerative spondylolisthesis present?

A

Presents with claudication

79
Q

Why does degenerative spondylolisthesis present with claudication?

A

Posterior arch intact
as vertebrae moves forward it compresses the spinal cord within the canal

Facet joint osteoarthritis gives stenosis of canal

80
Q

How is spondylolisthesis treated?

A

Put vertebrae back into place

Screws and rods hold it in place

Back (8 decks)

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