Orthopaedics unit 2 backache and neckache - deck 2 Flashcards
What is the cause of bony nerve root entrapment ?
- The cause of the condition is commonly due to bony overgrowth around the vertebral foramina where the nerve roots emerge. The cause of the bony overgrowth would appear to be secondary to degenerative changes in the adjacent facet joints.
- These may degenerate from primary osteoarthritis or as a result of disc degeneration (causing spondylosis)
(not prolapse!).
Describe the typical presentation of someone who develops bony nerve root entrapment
Typically a person of either sex usually over forty who has a previous history of backache of a mechanical type.
These patients are usually known back sufferers who develop new symptoms of leg pain radiating to the foot, usually made worse by exercise (spinal claudication)
- Episodes are usually acute and recurrent they may remain mild or may progress to affect the patient’s lifestyle.
What is the management of bony nerve entrapment ?
Physiotherapy is unlikely to help and should pain be severe then surgery may be necessary.
Removal of the disc in such patients may make the condition worse and removal of bone is needed to free trapped nerve roots. This may result in disturbance in spinal stability and lead to a need for fusion of the affected vertebrae. The decision to operate is entirely determined by the severity of the patient’s symptoms.
Define what spinal claudication is
back and leg pain radiating to the foot (nerve root pain), usually made worse by exercise
What is cervical spondylosis ?
This is degeneration of the intervertebral disc in the cervical spine leading to increased loading of the facet joints, which then develop secondary osteoarthritis.
Who does cervical spondylosis typically occur in ?
People who are aged over forty and is more frequent in females than males
What are the main clinical features of cervical spondylosis ?
Patients will complain of slow onset stiffness and dull neck pain which can radiate locally to shoulders/upper arms and the occiput. They may also experience tingling in the arms
Spondylosis can be progressive resulting in localising neurological signs such as loss of sensation, muscle weakness, numbness to develop as bony nerve root entrapment can occur possibly due to osteophyte formation with the progression of secondary OA potentially developing
What is the treatment of cervical spondylosis ?
If there are no localising neurological signs, treatment consists of analgesics, non steroidal anti-inflammatory (NSAI) agents, the use of a soft collar, and physiotherapy to relieve muscle spasm
The patient should be warned that it is usual, as in the lumbar spine, for recurrent attacks to occur.
If nerve root entrapment is confirmed (localising neurological signs will be present), surgical fusion of the vertebrae and decompression of the nerve root may be necessary.
Which discs in the cervical region are more likely to prolapse ?
The lower cervical discs are most likely, just like in the lumbar region
Describe the presentation of someone with a cervical disc prolapse
They cause neck pain and potentially nerve root compression. So therefore present very similar to cervical spondylosis
Neck pain which can radiate locally to shoulders/upper arms and the occiput.
If nerve root compression occurs then localising neurological signs of muscle weakness, loss of sensation/ numbness can be present
What are some useful ways to help distinguish between cervical spondylosis and cervical disc prolapse ?
Differentiating between the conditions can be difficult, although sufferers from disc disease tend to have no previous history of neck trouble. Also, following disc prolapse, the neck muscles may be in spasm and the movement of the neck is severely restricted.
What is the management of Cervical disc prolapses ?
Most people recover with resting, gentle traction and wearing a supporting collar.
If localising signs are marked, or symptoms do not regress, then surgery and fusion of the affected vertebrae may be necessary.
