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MSK > Mini Symposium: Spine > Flashcards

Mini Symposium: Spine Flashcards

1
Q

What is the pathophysiology of intervertebral disc herniation?

A

1 - Annulus fibrosis is torn and the nucleus protrudes through posterior longitudinal ligament (PLL)

2- Nerve root becomes compressed by osteophytes

3 - Central spine becomes stenosed

4 - Disc herniation is usually postero-lateral

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2
Q

What are the common causes of lower back pain?

A

1 - Prolapsed disc

2 - Trauma

3 - Fractures

4 - Ankylosing Spondylitis

5 - Degenerative

6 - Osteoporotic vertebral prolapse

7 - Cauda Equina syndrome

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3
Q

What is the epidemiology of spinal cord injuries?

A
  • 1000/year
  • Male > Female
  • Peak 20-29 years
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4
Q

What are the most common causes of spinal cord injury?

A

1 - Falls

2 - RTA’s

3 - Sport

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5
Q

What are the red-flag symptoms of lower back pain?

A

Age - <20 years or > 55 years

Acute onset in elderly people

Constant or progressive pain

Nocturnal Pain

Worse pain lying supine (face upwards)

Fever, night sweats, weight loss

History of malignancy

Bilateral or alternating leg pain

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6
Q

What is the pathology of intervertebral disc degeneration during the normal ageing processes?

A

1 - Decreased water content of discs

2 - Disc space narrowing

3 - Degenerative changes observed on x-rays

4 - Degenerastive changes in the facet joints

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7
Q

What are the clinical features of intervertebral disc herniation and sciatica?

A
  • Limb pain > back pain
  • Pain occurs in a nerve root distribution
  • Root tension & compression signs
  • Dermatomes & myotome involvement
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8
Q

What are the clinical features of cauda equina syndrome?

A
  • Injury or precipitating event
  • Location of symptoms: bilateral buttock + leg pain with weakness
  • Bowel or bladder dysfunction (urinary retention +- incontinence overflow)
  • PR exam: saddle anaesthesia, perianal loss of sensation, loss of anal tone
  • High index of suspicion in spinal post-op patients
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9
Q

What are the classic symptoms that cauda equina patients complain of?

A
  • Bilateral leg pain
  • Numb bum
  • Incontinence
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10
Q

How is cauda equina syndrome managed?

A
  • MRI
  • If MRI contraindicated, then lumbar CT myelogram
  • Treatment = Operation within 48hrs
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11
Q

What are the 2 different types of lumbar disc prolapse?

A

1 - Lateral disc protrusion

2 - Central disc protrusion

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12
Q

What type of joints are found at intervertebral discs?

A

Secondary cartilaginous

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13
Q

What is the tough outer layer surrounding the intervertebral discs called?

A

Annulus Fibrosus

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14
Q

What is the name of the gelatinous core found in the centre of intervertebral discs?

A

Nucleus pulposus

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15
Q

Which part of the intervertebral disc most commonly tears in disc prolapse?

A

Annulus Fibrosus

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16
Q

What condition occurs as a result of the annulus fibrosus tearing and the intervertebral disc prolapsing?

A

Nerve/cord root compression

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17
Q

What ligaments attach the vertebral discs to the vertebral bodies?

A

Anterior longitudinal ligament

Posterior longitudinal ligament

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18
Q

In root/cord compression (due to disc prolapse) which ligament does the disc prolapse through?

A

Posterior longitudinal ligament

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19
Q

What is the nucleus pulposus mainly composed of?

A

Water (88%) is collagen & proteoglycans

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20
Q

In which direction do most disc prolapses mostly occur?

A

Postero-lateral

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21
Q

What is the normal ageing process associated with the intervertebral discs?

A

1 - Discs water content decreases

2 - As a result, the disc space narrows

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22
Q

What can speed up the normal ageing process of the intervertebral discs?

A

Smoking

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23
Q

What are the features of nerve root pain?

A
  • Limb pain > Back pain
  • Pain occuring in a nerve root distribution (radicular)
  • Associated with dermatomes and myotomes
24
Q

How is nerve root pain treated?

A
  • Most cases of nerve root pain resolve on their own due to bodies own inflammatory cells helping
  • Physiotherapy
  • Strong analgesia
25
Q

How long after onset of nerve root pain should a patient be referred for specialist treatment?

A

12 weeks

26
Q

What imaging modality should be used to investigate nerve root pain?

A

MRI

27
Q

What are the different classes of intervertebral disc problems?

A

Bulge - common and mostly asymptomatic

Protrusion - Annulus fibrosus weakened but still intact

Extrusion - Nucleus pulposus has burst through annulus fibrosus

Sequestration - Nucleus pulposus has broken up and disc material is free in the vertebral canal

28
Q

At which vertebral level is cervical disc prolapse mostl likely to occur?

A

C5/6

29
Q

At what vertebral levels are thoracic disc herniations most likely to occur?

A

T11/12

30
Q

At what vertebral levels are LUMBAR disc herniations most likely to occur?

A

L4/5

31
Q

What is the difference between lateral disc protrusions and central disc protrusions?

A

Central disc protrusion:

  • Both nerve roots at vertebral level will be affected
  • Both legs can be affected
32
Q

What should be done once cauda equina syndrome has been diagnosed?

A

1 - Urgent MRI scan

2 - Emergency operation within 48h

33
Q

Which nerve roots can become compressed in cauda equina syndrome?

A

Sacral nerve roots

34
Q

What can be the outcome of cauda equina syndrome?

A

Permanent bladder and anal sphincter dysfunction and incontinence

35
Q

What is cauda equina syndrome?

A

Sudden pressure or compression to the spinal cord at the level of the cauda equina

36
Q

What is the most common cause of cauda equina syndrome?

A

Central lumbar disc prolapse

37
Q

What questions should be asked when taking a history in a suspected case of cauda equina syndrome?

A

1 - Do you have normal sensation when passing urine?

2 - Do you have a feeling of bladder fullness

38
Q

What are the most classic symptoms of cauda equina syndrome?

A

Bilateral leg pain

Numb bum

Incontinence

39
Q

What is the 1st step to take after identifying cauda equina syndrome?

A

MRI scan

40
Q

If MRI scan is contraindicated for cauda equina syndrome, what imaging modality should then be used?

A

CT myelogram

41
Q

In cauda equina syndrome, how many patients did not fully recover normal urinary function?

A

30%

42
Q

What is spondylosis of the cervical and lumbar spine?

A

The age-related wear and tear of the vertebral column

Degenerative change observed at the facet joints, discs and ligaments

Often known as spinal osteoarthritis

43
Q

What is thought to be the cause of spondylosis of the cervical and lumbar spine?

A
  • Dehydration of the vertebral discs occuring due to the normal ageing process
  • Causes a reduction in height of the spinal column, meaning the facet joints become misaligned, leading to osteoarthritis and production of osteocytes
  • The shrinking of the spine also causes the ligamentum flavum to buckle leading to spinal cord compression
44
Q

If the cervical or lumbar spondylosis is severe enough, what condition can occur?

A

Myelopathy - compression of the whole spinal cord (not just roots as happens in less severe cases)

45
Q

What category of symptoms occur when the entire spinal cord is being compressed?

A

UMN signs - increased tone, brisk reflexes

46
Q

What movements occur at the facet joints in the lumbar spine?

A

Flexion

Extension

47
Q

What are the ligaments of the vertebral column?

A

1 - Anterior longitudinal ligament

2 - Posterior longitudinal ligament

3 - Ligamentum flavum (between laminae)

4 - Interspinous & supraspinous ligaments (between spinous processes)

5 - Intertransverse ligament (between transverse processes)

48
Q

What is spinal claudication?

A

Stenosis of the spine causing impingement or inflammation of the nerves emmenating from the spinal cord

49
Q

What are the symptoms of spinal claudication?

A
  • Bilateral pain
  • Abnormal sensation
  • Weakness (foot drop - resulting in tripping over)
  • Pain may continue after stopping walking
  • Pain worse walking downhill
50
Q

What are the different types of spinal stenosis?

A

1 - Lateral recess stenosis

2 - Central stenosis

3 - Foraminal stenosis

51
Q

How is lateral recess stenosis treated?

A

1 - Non-operative

2 - Nerve root injection

3 - Epidural injection

4 - Surgery

52
Q

What is the cause of lateral recess stenosis?

A

Bony overgrowth of facet joints

Loss of vertebral disc height and subsequent disc bulging

53
Q

What is the cause of central spinal stenosis?

A

Enlarged spinal ligaments

Bony overgrowth of the facet joints

54
Q

What is foraminal stenosis?

A

Narrowing of the cervical disc space caused by enlargement of the uncinate process

55
Q

What is spondylolisthesis?

A

Slipping of a vertebral body

56
Q

What is the treatment for spondylolisthesis?

A
  • Conservative with lifestyle changes
  • Surgery for persistent pain

MSK (31 decks)

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