Mini Symposium: Spine (Degeneration, Low Back Pain, Disc Prolapse) Flashcards
What type of disc protrusion causes cauda equina syndrome?
Central disc protrusion
What type of joints are intervertebral discs?
Secondary cartilagenous
What are the components of the intervertebral discs?
Annulus fibrosus iis the though outer layer
Nucleus pulposus is the gelatinous core
•Annulus may tear and nucleus prolapse
–Can cause cord / nerve root compression
What connects the discs with the vertebral bodies?
The ALL and the PLL
- The fibres of the annulus fibrosis (collagen) run obliquely and alternately between layers
- They resist rotational movements
- Discs fail with twisting movements
What is the nucleus pulposus made up of?
Mainly of water
and collagen and proteoglycans (very hydrophilic)
The disc is kidney bean shaped - what dircetion are disc prolapses usually?
Usually posterolateral
What is the normal ageing process of the intervertebral discs?
Water content decreases, disc space is narrowed. This process is usually increased by smoking
What are the possible courses of pathology after the annulus fibrosis has been torn and the nucleus pulposus starts to protrude outwards?
Nerve root compression by osteophytes
Central spinal stenosis
Abnormal movement: spondylolysis - (this is a stress fracture of the pars interarticularis of the vertebral arch)
Spondylolisthesis - The displacement of one vertebra in relation to another
What are the key features of radiculopathy?
Limb pain is worse than back pain
Pain in a nerve root distribution
What is the therapy for nerve root pain?
- Most will settle, about 90% in 3 months
- Physiotherapy
- Strong analgesia
- Referral after 12 weeks
- Imaging
–MRI
What are the different classification of slipped disc?
Bulge
Protrusion - annulus is weakened but still intact
Extrusion Through annulus but in continuity
Sequestration - dessicated disc material free in canal
What is the most ocmmonly affected disc prolapse in the cervical spine?
Most commonly the C5/C6 disc
What percentage of slipped discs are thoracic slippled discs?
Less than 1%
They are mid to lower levels (most are at the T11 - T 12 part)
Herniations are central, posterolateral and lateral
Where are the common places for lumbar herniations?
•Usually L4/5 (45%), followed by L5/S1 (40%), then L3/4 (10%)
Most prolapses are posterolateral (posterior longitudinal ligament is the weakest)
Central dis may give pain in both legs, or may be back pain only