Lumber Spine Disorders

Question 1

Describe the pain characterised in mechanical back pain

Answer 1

Pain when the spine is loaded Worsens in exercise Intermittent and triggered by innocuous activity

Question 2

Name some risk factors for mechanical back pain

Answer 2

-obesity -poor posture -sedentary lifestyle -poor seating position -incorrect manual handling

Question 3

What are syndesmophytes?

Answer 3

They are bony spurs (osteophytes)that develop adjacent to end plates of vertebral discs

Increased stress is placed on facet joints which can develop osteoarthritic changes

Question 4

Describe the 4 stages of disc herniation (slipped disc)

Answer 4

1. Disc degeneration - chemical chances due to ageing causes disc to dehydrate and bulge
2. Prolapse: nucleus pulposus starts to protrude onto the spinal canal- still contained within rim of annulus fibrosis
3. Extrusion- nucleus pulposus breaks through annulus fibrosis but still contained in disc space
4. Sequestration- nucleus pulposus separates from the disc and enters the spinal canal

Question 5

What are the 2 most common sites for a slipped disc ?

Answer 5

Between L4/5 and L5/ S1

Question 6

At which two sites are nerve roots most vulnerable to slipped disc?

Answer 6

1. Where they cross the intervertebral disc (paracentrically)
2. Where they exit the spinal canal in the neural foremen (far lateral)

Question 7

What is the most common type of prolapse?

Answer 7

Paracentral prolapse (herniating posterolaterally)

Question 8

What are the other two, least common types of disc prolapse?

Answer 8

Central - directly towards the spinal cord (carries risk of cauda equina)

Or Far lateral

Question 9

What is sciatica and how is it caused?

Answer 9

Pain due to compression or irritation of one or more nerve roots contributing to the sciatic nerve

Can be due to marginal ostephytosis or slipped disc etc

Question 10

Which nerve roots contribute to the sciatic nerve?

Answer 10

L4, L5, S1, S2 and S3

Question 11

Describe the distribution of pain in sciatica

Answer 11

Pain typically starts in the back and buttock and radiates to the dermatome supplied by the affected nerve root

If nerve compression causes PARAESTHESIA (tingling) then only the dermatome will be affected (not the full path from the lumbar spine to the dermatome)

Question 12

There are 5 red flag symptoms in cauda equina syndrome, what are they?

Answer 12

1. Bilateral sciatica
2. Perianal numbness (saddle anaesthesia)
3. Painless urinary retention
4. Urinary/ faecal incontinence
5. Erectile dysfunction

Question 13

What is cauda equina syndrome?

Answer 13

Something that is compressing the lumbar and sacral nerve roots within the spinal cord

5% of cases- due to a canal filling disc prolapse

Other causes; rumours of vertebral column, spinal infection or abscess, spinal stenosis secondary to arthritis, vertebral fracture, spinal haemorrhage or late stage ankylosis spondylitis

Question 14

How must cauda equina be treated?

Answer 14

Surgical decompression within 48 hours

Question 15

What is spinal canal stenosis?

Answer 15

An abnormal narrowing of the spinal canal that compresses either the spinal cord or the nerve roots

Question 16

Spinal canal stenosis is often caused by a combination of 3 things, what are they?

Answer 16

1. Disc bulging
2. Facet joint osteoarthritis
3. Ligamentum flavum hypertrophy

Question 17

Give some of the symptoms of spinal canal stenosis?

Answer 17

• discomfort whilst standing
• discomfort or pain in the shoulder, arm or hand for cervical stenosis
• discomfort in the lower limb for lumbar stenosis
• numbness and weakness at or below level of stenosis
• neurogenic claudication

Question 18

What is neurogenic claudication?

Answer 18

A symptom rather than a diagnosis

Pain/ pins and needles in the legs after prolonged standing or walking, radiating in a sciatica distribution

Results from compression of the spinal nerves as they leave the lumbosacral spinal cord causing venous engorgement of nerve roots in exercise , in turn this leads to transient arterial inflow and ischemia which causes the pain

Question 19

What is spondylolisthesis?

Answer 19

Anterior displacement of the vertebra above of the vertebra below

Question 20

Between which vertebra should lumbar puncture be performed?

Answer 20

Between L3 and L4 Or between L4 and L5