Lumbar Spine Disorders

Question 1

What is mechanical back pain?

Answer 1

Pain when spine is loaded that worsens with exercise and is relieved with rest

Question 2

What are risk factors for mechanical back pain?

Answer 2

Obesity 
Poor posture 
Sedentary life style 
Poorly designed seating 
Incorrect manual handling

Question 3

What is Cauda Equina syndrome?

Answer 3

When there is a canal filling disc that compresses the lumbar and sacral nerve roots

Question 4

What are causes of cauda equina syndrome?

Answer 4

Disc prolapse

Tumours of vertebral column
Spinal infections
Vertebral fracture
Spinal haemorrhage

Question 5

What are the symptoms of cauda equina syndrome?

Answer 5

Bilateral sciatica 
Perianal numbness 
Painless retention of urine 
Incontinence 
Erectile dysfunction

Question 6

Wha is a herniated disc?

Answer 6

Slipped disc

Herniated disc material pressing on spinal nerve

Question 7

What are the 4 stages to disc herniation?

Answer 7

Disc degeneration- dehydration and bulging of disc

Prolapse- protrusion of nucleus pulposus with slight impingement into spinal canal

Extrusion- nucleus pulposus breaks through annulus fibrosus but still in disc space

Sequestration- nucleus pulposus separates from main body of disc and enters spinal canal

Question 8

What is a paracentral disc prolapse?

Answer 8

When the disc herniates posterolaterally causing compression of spinal nerve root within intervertebral foramen

Transversing nerve root at risk (eg, one of disc below)
In L4/L5 would be L5 nerve damaged

Question 9

What directions can disc prolapse occur in?

Answer 9

Paracentral
Far lateral
Central (can cause Cauda Equina syndrome)

Question 10

What is another term for radicular leg pain and what is it?

Answer 10

Sciatica

Pain caused by irritation/ compression of one or more of the nerve roots that contribute to the sciatic nerve.

Question 11

What type of pain is felt in sciatica?

Answer 11

Back and buttock that radiates to dermatome supplied by affected nerve root

Eg. L4 sciatica- anterior thigh, anterior knee, medial leg

Question 12

Other than pain what can sciatic cause?

Answer 12

Paraestesia

Only in effected dermatome

Question 13

What is neurological claudication?

Answer 13

A symptom rather than a diagnosis

Pain and pin&needles in legs from prolonged standing and walking radiating in sciatic distribution

Question 14

What causes neurological claudication?

Answer 14

Compression of spinal nerve roots as emerge from lumbosacral spinal cord
Venous engorgement of nerve roots in exercise causing reduced arterial inflow and transient ischeamia
Ischemia of affected nerve roots= pain

Question 15

What relieves neurological claudication?

Answer 15

Rest

Flexion if the spine (eg, bending forwards, cycling)

Question 16

What is Spondyloisthesis?

Answer 16

Anterior displacement of the vertebra above relative to vertebra below

Question 17

What are the causes of Spondylolosthesis?

Answer 17

Congenital instability of facet joints 
Defect in pars interacticularis 
Facet joint arthritis 
Traumatic (fractures in neural arch)
Infection/ malignancy 
Iatrogenic (from surgery)

Question 18

What are the symptoms of Spondylolisthesis

Answer 18

Instability vertebral column
Mechanical lower back pain
Sciatic nerve root compression
Neurogenic claudication

Question 19

Where is the needle inserted in a lumbar puncture?

Answer 19

Between L3/L4 or L4/L5 spinous processes

Question 20

What is a lumbar puncture?

Answer 20

Withdrawal of fluid from subarachnoid space of lumbar cistern