Lumbar Spine Conditions

Question 1

What is mechanical back pain?

Answer 1

• Pain when the spine is loaded
• Worse with exercise and relived by rest
• Intermittent
• Often triggered by innocuous activity

Question 2

Why do discs degenerate?

Answer 2

• Nucleus pulpous can dehydrate with age

- Height of IV disc decreases

Question 3

How does disc degeneration lead to marginal osteophytosis?

Answer 3

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.

Question 4

What is disc degeneration?

Answer 4

Chemical changes associated with raging causing discs to dehydrate and bulge.

Question 5

What is a disc prolapse?

Answer 5

Protrusion of the nucleus pulposus with slight impingement into the spinal canal (contained)

Question 6

What is disc extrusion?

Answer 6

Nucleus pulposus breaks through the annulus fibrosis but remains in the disc space

Question 7

What is disc sequestration?

Answer 7

Nucleus pulposus breaks through the annulus fibrosis and separated from the main body of the disc in the spinal canal.

Question 8

What is sciatica?

Answer 8

Sciatica is compression of the nerve roots which contribute to the sciatic nerve usually due to disc prolapse.

Question 9

Which nerve roots contribute towards the sciatic nerve?

Answer 9

L4,L5,S1,S2,S3

Question 10

Which nerve root is compressed in a paracentral disc prolapse?

Answer 10

Traversing nerve = lower one

Question 11

Which nerve root is compressed in a far lateral disc prolapse?

Answer 11

Exiting nerve = higher one

Question 12

What is cauda equina syndrome?

Answer 12

• Compression of the cauda equina
• Due to canal filling disc compression the lumbar and sacral nerve roots
• Occurs in 30-50 year olds

Question 13

What are the symptoms of cauda equina syndrome?

Answer 13

• Bilateral sciatica
• Perianal numbness
• Painless retention of urine
• Urinary/ faecal incontinence

Question 14

What is lumbar canal stenosis?

Answer 14

Narrowing of the spinal canal that occurs in the elderly

Question 15

What is claudication?

Answer 15

Pain in the legs when walking (such that they have to stop)

Question 16

What is the cause of claudication?

Answer 16

Neurogenic - lumbar canal stenosis

Vascular - problem with circulation in legs

Question 17

What is the pathophysiology behind the vascular cause of claudication?

Answer 17

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

Question 18

Which patients with lumbar canal stenosis are treated?

Answer 18

Those for whom the restricted walking distance affects the quality of life.

Question 19

What is spondylolisthesis?

Answer 19

A slip forwards of the vertebra above on the vertebra below.

Question 20

What are the types of spondylolisthesis?

Answer 20

Dysplastic - abnormality in the shape of the facet joints
Isthmic - defect in the pars interarticularis
Degenerative - old age
Iatrogenic - surgery
Pathological

Question 21

Who usually develops isthimic spondylolisthesis?

Answer 21

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.

Question 22

How do patients with degenerative spondylolisthesis present?

Answer 22

Claudication as posterior arch is intact therefore develop stenosis