Lumbar Spine Conditions Flashcards
What is mechanical back pain?
- Pain when the spine is loaded
- Worse with exercise and relived by rest
- Intermittent
- Often triggered by innocuous activity
Why do discs degenerate?
- Nucleus pulpous can dehydrate with age
- Height of IV disc decreases
How does disc degeneration lead to marginal osteophytosis?
Load stress of the IV disc alter and it loses its ability to transfer forces evenly across the disc space. Leads to the the development of marginal osteophytes.
What is disc degeneration?
Chemical changes associated with raging causing discs to dehydrate and bulge.
What is a disc prolapse?
Protrusion of the nucleus pulposus with slight impingement into the spinal canal (contained)
What is disc extrusion?
Nucleus pulposus breaks through the annulus fibrosis but remains in the disc space
What is disc sequestration?
Nucleus pulposus breaks through the annulus fibrosis and separated from the main body of the disc in the spinal canal.
What is sciatica?
Sciatica is compression of the nerve roots which contribute to the sciatic nerve usually due to disc prolapse.
Which nerve roots contribute towards the sciatic nerve?
L4,L5,S1,S2,S3
Which nerve root is compressed in a paracentral disc prolapse?
Traversing nerve = lower one
Which nerve root is compressed in a far lateral disc prolapse?
Exiting nerve = higher one
What is cauda equina syndrome?
- Compression of the cauda equina
- Due to canal filling disc compression the lumbar and sacral nerve roots
- Occurs in 30-50 year olds
What are the symptoms of cauda equina syndrome?
- Bilateral sciatica
- Perianal numbness
- Painless retention of urine
- Urinary/ faecal incontinence
What is lumbar canal stenosis?
Narrowing of the spinal canal that occurs in the elderly
What is claudication?
Pain in the legs when walking (such that they have to stop)
What is the cause of claudication?
Neurogenic - lumbar canal stenosis
Vascular - problem with circulation in legs
What is the pathophysiology behind the vascular cause of claudication?
As the nerves narrow the blood supply to the nerves/ venous drainage gets worse. There is a pooling of blood that causes the nerve roots to become ischemic. Recovery takes 10-15 mins
Which patients with lumbar canal stenosis are treated?
Those for whom the restricted walking distance affects the quality of life.
What is spondylolisthesis?
A slip forwards of the vertebra above on the vertebra below.
What are the types of spondylolisthesis?
Dysplastic - abnormality in the shape of the facet joints
Isthmic - defect in the pars interarticularis
Degenerative - old age
Iatrogenic - surgery
Pathological
Who usually develops isthimic spondylolisthesis?
Teenagers - present once the disc has started to age with back pain and L5 sciatic
Pars interarticularis is thinner that it should be as it has developed abnormally in utero.
How do patients with degenerative spondylolisthesis present?
Claudication as posterior arch is intact therefore develop stenosis
