Lumbar Spine (Session 2) Flashcards
What is Mechanical Back Pain?
Pain when Spine is loaded
Worsens with exercise
Relieved by rest
How common is mechanical back pain?
Extremely -50% of UK Population reported lumbar back pain for at least 24 hrs in one year. 80% of Population will experience pain lasting more that 24 hrs
What are the risk factors for mechanical back pain?
Obesity, poor posture, sedentary lifestyle, weak core muscles, incorrect manual handling techniques
What is marginal osteoporosis?
Syndesmophytes (bony spurs) develop-adjacent to end plate of disc due to nucleus pulposus of intervertebral disc dehydrating with age- decreases height of disc. Increased stress on facet joints.
What causes radicular nerve pain?
Compression of spinal nerves (intervertebral foramina shrink)
Which Population are most affected by herniation of an intervertebral disc (‘slipped disc’)?
= common. 30-50years- 90% cases resolved in 3 months.
What are the 4 stages of disc herniation?
- Disc degeneration- dehydrate and bulge- chemical changes due to age
- Prolapse- nucleus pulposus protrudes
- Extrusion- nucleus pulposus- breaks through annulus fibrosis
- Sequestration- nucleus pulposus enters disc canal
What are the most common sites for a slipped disc?
L4/5 L5/S1
At which sites are the nerve roots most vulnerable to herniation?
1-where they cross intervertebral disc (paracentrally) 2- where they exit spinal canal in neural foramen (laterally)
In which direction does the nucleus pulposus usually herniate? 96% cases
Posterolaterally (paracentral prolapse)
Apart from posterolateral- where else might the nucleus pulposus herniate?
Far lateral (2% cases) Central (2% cases) (ie toward spinal chord)
What does a central herniation of the nucleus pulposus carry a risk of (developing)?
Cauda equina syndrome
Which nerve root is most at risk with a ‘far lateral disc herniation’?
Exiting nerve root- nerve root that emerges at same level as intervertebral disc
Which nerve root is most at risk with a ‘paracentral herniation’?
Transversing nerve root- nerve root that emerges at the level below.
What is Sciatica?
Radicular leg pain
Pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
What causes sciatica?
Irritation of one or more nerve roots contributing to sciatic nerve:
e. g.
- Osteophytosis (bone spurs- form around damaged joints)
- Slipped disc
What are the causes of cauda equina syndrome?
1- Disc prolapse (5% cases)
2-Tumours
3-Spinal infection/abscess
4-Spinal stenosis secondary to arthritis
5- Vertebral fracture
6- Spinal haemorrhage
7-Late stage ankylosing spondylitis
(ankylosis= stiffening and immobility of joint due to fusion of bones)
What are the red flag symptoms for Cauda Equina Syndrome?
1-Bilateral sciatica 2-Perianal numbness 3-Painless retention of urine 4- Urinary/faecal incontinence 5-Erectile dysfunction
How is Cauda Equina treated?
Surgical decompression within 48hrs- onset of sphincter symptoms. IF NOT prognosis = poor
What happens if Cauda Equina syndrome is not diagnosed quickly?
Chronic neuropathic pain
Impotence
Faecal incontinence
Lower limb weakness
Having to perform self catheterisation
What is Spinal chord stenosis?
Abnormal narrowing of spinal canal-compressing spinal cord/nerve roots
What age group does spinal chord stenosis usually affect?
Elderly
What are the potential causes of spinal chord stenosis?
- Disc bulging
- Facet joint osteoarthritis
- Ligamentum flavum hypertrophy
- Compression fractures of vertebral bodies
- Spondylolisthesis
- Trauma
What are the symptoms of spinal chord stenosis?
- Discomfort standing
- Discomfort in shoulder/arm/hand/lower limb
- Bilateral symptoms in approximately 70% patients
- Numbness/weakness below level of stenosis
- Neurogenic claudication (claudication= cramping)
What is the prognosis of a lumbar canal stenosis?
70% symptoms=unchanged 15% symptoms= get worse 15% symptoms= get better
What is neurogenic claudication?
Symptom (not diagnosis) Patient reports pain/pins and needles in legs when prolonged standing and walking- radiating in sciatica distribution - patient tends to limp
What causes neurogenic claudication?
Compression of spinal nerves–> venous engorgement during exercise–> reduced arterial flow–> transient arterial ischaemia - results in pain
What may relieve neurogenic claudication?
Rest, change in position/ flexion of spine e.g. climbing stairs
What is Spondylolisthesis?
Anterior displacement of vertebra above on the vertebra below. (had various underlying causes e.g. traumatic/pathological)
What is a ‘Lumbar puncture’?
Withdrawal of fluid from subarachnoid space of lumbar cistern (cistern= subaracnoid space).
How is a lumbar puncture carried out?
Skin anesthetized
Lumbar puncture needle in midline between L3 and L4 or L4 and L5 vertebrae
Located by finding plane transecting highest point of iliac crests
Needle ‘pops’ through ligamentum flavum- then dura and arachnoid. Enters lumbar cistern
CSF escapes- collected
