Lumber Spine Disorders Flashcards
Describe the pain characterised in mechanical back pain
Pain when the spine is loaded Worsens in exercise Intermittent and triggered by innocuous activity
Name some risk factors for mechanical back pain
-obesity -poor posture -sedentary lifestyle -poor seating position -incorrect manual handling
What are syndesmophytes?
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
Describe the 4 stages of disc herniation (slipped disc)
- Disc degeneration - chemical chances due to ageing causes disc to dehydrate and bulge
- Prolapse: nucleus pulposus starts to protrude onto the spinal canal- still contained within rim of annulus fibrosis
- Extrusion- nucleus pulposus breaks through annulus fibrosis but still contained in disc space
- Sequestration- nucleus pulposus separates from the disc and enters the spinal canal
What are the 2 most common sites for a slipped disc ?
Between L4/5 and L5/ S1
At which two sites are nerve roots most vulnerable to slipped disc?
- Where they cross the intervertebral disc (paracentrically)
- Where they exit the spinal canal in the neural foremen (far lateral)
What is the most common type of prolapse?
Paracentral prolapse (herniating posterolaterally)
What are the other two, least common types of disc prolapse?
Central - directly towards the spinal cord (carries risk of cauda equina)
Or Far lateral
What is sciatica and how is it caused?
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
Which nerve roots contribute to the sciatic nerve?
L4, L5, S1, S2 and S3
Describe the distribution of pain in sciatica
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)
There are 5 red flag symptoms in cauda equina syndrome, what are they?
- Bilateral sciatica
- Perianal numbness (saddle anaesthesia)
- Painless urinary retention
- Urinary/ faecal incontinence
- Erectile dysfunction
What is cauda equina syndrome?
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
How must cauda equina be treated?
Surgical decompression within 48 hours
What is spinal canal stenosis?
An abnormal narrowing of the spinal canal that compresses either the spinal cord or the nerve roots
Spinal canal stenosis is often caused by a combination of 3 things, what are they?
- Disc bulging
- Facet joint osteoarthritis
- Ligamentum flavum hypertrophy
Give some of the symptoms of spinal canal stenosis?
- 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
What is neurogenic claudication?
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
What is spondylolisthesis?
Anterior displacement of the vertebra above of the vertebra below
Between which vertebra should lumbar puncture be performed?
Between L3 and L4 Or between L4 and L5
