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MSK > Mini Symposium: Spine > Flashcards

Mini Symposium: Spine Flashcards

1
Q

What are some anatomical feature of an intervertebral disc?

A
  • Secondary cartilaginous joint
  • Largest avascular structure in the body
  • Tough outer layer - annulus fibrosus
  • Gelatinous core - nucleus pulposus
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2
Q

Which ligaments connect the discs with vertebral bodies?

A

The anterior and posterior longitudinal ligaments

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3
Q

How do the fibres of the annulus fibrosis run?

A

Obliquely and alternately between layers

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4
Q

How does ageing affect the intervertebral discs?

A
  • Decreased water content
  • Disc space narrowing
  • Degenerative changes on x-rays
  • Degenerative changes in facet joints
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5
Q

What are the features of nerve root pain?

A
  • Fairly common
  • Limb pain worse than back pain
  • Pain in a nerve root distribution
  • Root tension signs
  • Root compression signs
  • Dermatomes and myotomes
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6
Q

What is the outcome of nerve root pain?

A
  • Most will settle, about 90% in 3 months
  • Physiotherapy
  • Strong analgesia
  • Referral after 12 weeks
  • Imaging - MRI
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7
Q

What are the 4 ways an intervertebral disc can prolapse?

A
  • Bulge - common, majority asymptomatic
  • Protrusion - annulus weakened but still intact, elongated nucleus
  • Extrusion - annulus ruptured, nucleus has herniated through
  • Sequestration - desiccated disc material free in canal
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8
Q

In which vertebrae do cervical disc prolapses most commonly occur?

A

•C5/6

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9
Q

How common are lumbar, cervical and thoracic prolapses?

A

•lumbar>cervical>thoracic

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10
Q

Where are thoracic disc prolapses most likely to occur?

A
  • T8-12

* Particularly T11/12

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11
Q

In which directions do thoracic prolapses occur?

A
  • Central
  • Posterolateral
  • Lateral
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12
Q

Where do lumbar disc prolapses occur?

A
  • Usually L4/5 (45%)
  • L5/S1 (40%)
  • L3/4 (10%)
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13
Q

In which directions do lumbar prolapses occur?

A
  • Most are posterolateral - PLL weakness

* Central disc may give pain in both legs or may be back pain only

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14
Q

What is cause equina syndrome?

A

Compression of cauda equina

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15
Q

How is cauda equina approached?

A
  • Surgical emergency
  • MRI
  • Operation with 48hr - delay results in permanent dysfunction
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16
Q

What can be the outcome of cauda equina?

A

•Sacral nerve roots compressed – can result in permanent bladder and anal sphincter dysfunction and incontinence

17
Q

What is the aetiology of cauda equina syndrome?

A
  • Central lumbar disc prolapse (commonest)
  • Tumours
  • Trauma (burst or Chance #, disc) or spinal stenosis
  • Infection (epidural abscess)
  • Iatrogenic (spinal surgery or manipulation, spinal epidural injection)
18
Q

What are the clinical features of cauda equina syndrome?

A
  • Injury or precipitating event
  • Location of symptoms - bilat buttock & leg pain + varying dysaethesiae + weakness – beware
  • Bowel or bladder dysfunction - urinary retention +/- incontinence overflow, bowel presentation unlikely
  • PR exam - saddle anaesthesia (perianal loss of sensation), loss of anal tone & anal reflex
  • High index of suspicion in spinal post-op patients with increasing leg pain in presence of urinary retention, bi-lateral leg pain
19
Q

What imaging is used for CES?

A
  • MRI

* If MRI not possible, lumbar CT myelogram

20
Q

What imaging is used for CES?

A
  • MRI

* If MRI not possible, lumbar CT myelogram

21
Q

What treatment for CES?

A

•Always operative

22
Q

What are the outcome of CES?

A
  • 30% undergoing discectomy for cauda equina syndrome did NOT regain normal urinary function
  • 25% with motor deficits never regained full power
  • 33% with sensory deficits never regained normal sensation
  • 25% with perianal paraesthesiae did not return to normal
  • 26% had persitent sexual dysfunction
23
Q

What is cervical and lumbar spondylosis (OA)?

A 
Degenerative change at:
•Facet joints
•Discs
•Ligaments etc.
COMMON
24
Q

What can happen insecure spondylosis?

A
  • Whole cord can be compressed - not just nerve roots

* This causes myelopathy - UMN signs in limbs (increased tone, brisk reflexes)

25
Q

What are the ligaments of the lumbar spine? (5)

A
  • Anterior Longitudinal Ligament (ALL) – along the front of the vertebral bodies – broad, strong
  • Posterior Longitudinal Ligament (PLL) – along the backs of the vertebral bodies, i.e. front of the spinal canal; narrower
  • Ligamentum Flavum - between laminae
  • Interspinous and Supraspinous Ligaments - between spinous processes
  • Intertransverse Ligament - between transverse processes
26
Q

What are the x-ray features of lumbar spondylosis?

A

•OA of facet and disc joints (+ degradation of ligaments)

27
Q

What is spinal claudication?

A

Pain in lower limbs due to compression of cauda equina

28
Q

How can spinal claudication be distinguished from vascular claudication?

A
  • Usually bilateral
  • Sensory dysaesthesiae
  • Motor weakness - foot drop (tripping)
  • Takes several minutes to ease after walking
  • Worse walking downhill as the spinal canal becomes smaller in extension
29
Q

Name some causes of spinal stenosis

A
  • Osteoarthritis - breakdown of cartilage, bone spurs
  • Herniated discs
  • Thickened ligaments
30
Q

What are the 3 groups of spinal stenosis?

A
  • Lateral recess stenosis
  • Central stenosis - usually bilateral
  • Foraminal stenosis
31
Q

What is the treatment for lateral recess stenosis?

A
  • Patients have radicular symptoms
  • Non-operative
  • Nevre root injection - steroid
  • Epidural injection (steroid) - useful for bilateral symptoms as not specific
  • Surgery
32
Q

How is central stenosis treated?

A
  • Canal shape important - trefoil canal can increase risk, congenital, ageing creates more of a trefoil shape
  • Non-operative
  • Epidural steroid injection
  • Surgery - 80% improve
33
Q

How is foraminal stenosis treated?

A
  • Non-Operative
  • Nerve root injection
  • Epidural injection
  • Surgery
34
Q

What is spondylolithesis?

A

When a vertebra slips out of position

35
Q

What is spondylolysis?

A
  • Defect in pars interarticularis

* Posterior and anterior elements separated (fracture)

36
Q

What are the symptoms of spondylolisthesis?

A

Vary with type

37
Q

How is spondylolisthesis treated?

A
  • Depends on symptoms
  • Conservative with lifestyle changes
  • Surgery for persistent pain +/- nerve root entrapment

MSK (28 decks)

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