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MI2 > Lumbar Spine Pathology > Flashcards

Lumbar Spine Pathology Flashcards

1
Q

What percentage of patients with back pain have a recurrence within two years?

A

60-80%

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2
Q

What are the three types of low back pain?

A

Acute: < 6 weeks
Sub-acute: 6-12 weeks
Chronic: > 12 weeks

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3
Q

What are the 3 categories of low back pain?

A
  1. Simple musculoskeletal pain (95%)
  2. Spinal nerve root compression (4%)
  3. Serious spinal pathology (1%)
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4
Q

What do intervertebral discs consist of?

A

Nucleus pulposus

  • Centre of disc
  • 3D lattice of collagen fibres
  • Gel-like structure, retains water

Annulus fibrosus

  • Outer layer
  • Fibrocartilage & elastin

Vertebral endplates

  • Between disc & vertebral body
  • Provides nutrition for the disc
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5
Q

When does intradiscal pressure increase?

A

With any activity that increase intra-abdominal pressure

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6
Q

What are the causes of discogenic pain?

A
  • Fissures in annulus fibrosis (usually chronic)
  • Bulge
  • Herniating
  • Extrusion of contents
  • Impingement of spinal cord/nerve roots
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7
Q

How is the nucleus pulpous affected by degenerative disc disease?

A

Loss of volume, pressure and hydration from 25 years onward

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8
Q

How is the annulus fibrosis affected by degenerative disc disease?

A

Fissures, can result in herniation

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9
Q

How is the endplate affected by degenerative disc disease?

A
  • Collapse/microfracture of endplate, becomes concave
  • Reduced nutrition of nucleus pulpous as subchondral plate forms
  • Schmorl’s nodes
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10
Q

What are Schmorl’s nodes?

A

When the disc herniates vertically through the endplate

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11
Q

What is facet joint OA often preceded by?

A

Degenerative disc disease

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12
Q

What is spondylolysis (pars interarticularis injury)?

A

Defect of pars interarticularis (runs between two articular processes of spine)

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13
Q

What are the different types of spondylolysis?

A
  • Unilateral/bilateral
  • Congenital
  • Degenerative
  • Traumatic
  • Isthmic (stress #)
  • Pathological (bone disease)
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14
Q

What is spondylolisthesis?

A
  • Develops from spondylolysis
  • Complete fracture of the pars interarticularis
  • Vertebral body moves anteriorly due to lack of support
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15
Q

How is spondylolisthesis graded?

A

I: 1-25% slip
II: 26-50% slip
III: 51-75% slip
IV: 76-100% slip

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16
Q

What are the medical red flags of the lumbar spine?

A
  • Cauda equine syndrome
  • Ankylosing spondylitis
  • Compression fractures
  • Spinal canal stenosis
  • Visceral afferents & referred pain
17
Q

What is caudal equine syndrome?

A
  • Compression of caudal equine (bundle like structure of nerves extending from L1/L2)
  • Medical emergency
18
Q

What are the symptoms of caudal equina syndrome?

A
  • Saddle anaesthesia
  • Bowel or bladder dysfunction (e.g. cannot pass urine)
  • Bilateral leg weakness
19
Q

What is ankylosing spondylitis?

A
  • Bamboo appearance in spine
  • Pain/stiffness in entire spine
  • Usually between 20-30 years
  • Spine starts to fuse, loss of curvature
  • Pelvis is the first place to show any changes
20
Q

What is ankylosing spondylitis commonly associated with?

A
  • Inflammation in eyes

- Inflammatory bowel disease

21
Q

What population are commonly affected by compression fractures?

A

Elderly with sudden, severe pain & low bone density

22
Q

What is spinal canal stenosis?

A

Ischemia of lumbosacral nerve root secondary to compression (e.g. disc herniation, osteophytes, ligamentum flavum hypertrophy)

23
Q

What are the symptoms of spinal canal stenosis?

A
  • Presents with neurogenic claudication (leg pain/discomfort originating from a nerve)
  • Unilateral/bilateral pain
  • Numbness (non- dermatomal)
  • Weakness (non-myotomal)
  • Cramping in thighs/calves with prolonged standing/walking
  • Eased by flexion
24
Q

How does visceral pain present in the spine?

A

Perceived as being from an area of skin innervated by the same segmental level as the visceral afferent

25
Q

What are the spinal causes of leg pain/neurological symptoms?

A
  • Somatic referred pain
  • Radicular pain
  • Claudication
  • Peripheral nerve injury
26
Q

What is nociceptive back pain?

A
  • Evoked by a noxious stimulus of structures within lumbar spine
  • No leg pain or neurological symptoms
27
Q

What is somatic referred pain?

A
  • Noxious stimulus of LS structures produces referred pain into leg
  • Pain is perceived in regions with same segmental innervation (cross-talk)
  • No stimulation of nerve roots
  • No neurological signs
28
Q

What are the symptoms of somatic referred pain?

A

Leg pain, usually dull, aching, poorly localised

29
Q

What is radicular pain?

A
  • Pain evoked by ectopic discharges from dorsal root or ganglion
  • Caused by anything that puts pressure on the nerve root (usually disc herniation)
30
Q

What are the symptoms of radicular pain?

A
  • Sharp, shooting, electric pain

- Usually well defined in a narrow band into the leg

31
Q

What is a radiculopathy?

A
  • Refers to neurological symptoms of radicular pain
  • Nerve conduction problem along a spinal nerve/nerve root
  • Presents with pins & needles, numbness (dermatomal), weakness (myotomal), reduced reflexes
32
Q

What is an example of peripheral nerve sensitivity?

A

Piriformis syndrome

  • Due to excessive tightness in piriformis or sitting on edge of hard chair
  • May also have general sensitivity of nerve

MI2 (10 decks)

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