Lumbar spine conditions Flashcards
Where is a lumbar puncture perfromed and what does the needle pass through to get to the CSF?
L3/4
- skin
- Subcutaneous tissue
- supraspinatus ligament
- interspinatus ligament
- ligamentum flavum
- epidural fat
- dura marter
- arachnoid mater
Describe mechanical back pain and its causes?
- pain when spine is loaded, worse with exersize and releived by rest
- Often triggered by a low energy activity (eg bending over)
- common in overweight, elderly, unhealthy
- Usually no speicific cause and the muscle/ bone/ ligament injury will repair its self within 2 weeks
What are the 4 stages to a disc herniation?
- disc denegeration: chemical changes that occur with age cause the disc to dehydrate and bulge
- prolapse: the nucleus pulposus protrudes with impingement on spinal canal (usual time when pt presents)
- Extrusion: nucleus pulposus breaks through annulus fibrosis but remains in disc space
- sequestration: nucleus pulposus breaks through and separates from main body of disc space
In what direction do most discs prolapse? Which nerve root is compressed?
Posteriolaterally/ paracentrally
the spinal root below (if its between L4/L5, L5 is affected)
Where are disc prolapses most common?
L4/5 and L5/S1
If the disc prolapses laterally which spinal root is affected?
the one above
What is sciatica?
Compresion of the nerve roots that contribute to the sciatic nerve (L4,5, S1,2,3), usually by disc prolapse so will resolve in 3 months. This causes pain in lower back, radiating down the posterior leg and weak flexion of knee. Only in one leg
How can you tell which nerve root has been effected in sicatica?
There will be loss of sensation/ pins and needles in the affected dermatome
What is cauda equina syndrome?
compression of the spinal canal at the cauda equina, (below L2) ususally due to disc hernation but can also be due to trauma or tumours. Must be treated within 48hrs of sphincter symptoms for good prognosis
What is experienced in cauda equina syndrome?
Loss of bladder and/ or anus sphincter control, reduced sensation in perineal area, sexual dysfunction, loss of motor and or sensory control in both legs, painless water retention
What is lumbar spine stenosis?
Narrowing of the spinal canal. This is most often caused by narrowing of disc space (w/age), osteophytes (w/ osteoarthiritis) and hypertrophic ligamentum flavum combined.
Why do people with lumbar spine stenosis often experience neurogenic claudication? (pain in buttocks, lower limbs and sometimes also lower back on walking/ standing and relieved by resting and leaning forward)
Veins in the spinal canal get narrowed, blood pools in them, and then arterioles supplying the spinal nerves become narrowed too, this leads to ischaemia of spinal nerves when demand for blood is greater
What is spondylolysis and spondylolisthesis?
Spondyloysis is a break in the pars inter articularis, can be congenital (dysplastic or isthmic), degenerative or caused by surgery
Spondylolisthesis is the process of the vertebrae slipping forward as a result of the pars interarticularis break
How do spondylolysis present?
lower back pain tingling down legs weak hamstrings lordosis waddling gait
What are isthmic and dysplatic spondyloysis?
- isthmic= aquired defect in pars interarticularis that only becomes noticable in teens around growth spurt stage
- dysplastic is much more rare and is due to malformed pars
