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E - MSK > Prolapsed Disc and Spinal Stenosis > Flashcards

Prolapsed Disc and Spinal Stenosis Flashcards

1
Q

What type of joints are intervertebral discs

A

Secondary cartilaginous

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2
Q

What are the components of intervertebral discs

A

Annulus fibrosus

Nucleus pulposus

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3
Q

What happens to the components of a IV disc in prolapse

A

The annulus fibrosis can tear and the nucleus pulpous can prolapse out of the disc and result in compression of the spinal cord

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4
Q

What sorts of movements do IV discs resist and in what movements do they fail

A

Resist - rotational

Fail - with twisting

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5
Q

Which direction do discs usually prolapse

A

Postero-lateral

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6
Q

What is the normal ageing process of IV discs

A

Decreased water content
Disc scape narrowing
Degenerative changes seen on x-ray
Degenerative changes seen on facet joints

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7
Q

Presentation of nerve root pain

A

Limb pain worse than back pain
Nerve root tension signs
Nerve root compression signs
Pain in a nerve distribution

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8
Q

Management of nerve root pain

A

Most settle after 12 weeks
Physio and strong analgesia
Refer for MRI if not settled after 12 weeks

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9
Q

What are the 4 stages of a prolapsed disc

A

Bulge - common, mostly asymptomatic
Protrusion - annulus fibrosus is weak but still intact
Extrusion - nucleus pulposus herniates through annulus
Sequestration - disc material migrates and is free in canal

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10
Q

At what vertebral level do central disc prolapses most often occur

A

C5/6

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11
Q

What symptoms and signs does cervical disc prolapse cause

A 
Spinal cord compression 
Posterolateral 
- stiff neck
- pain radiating to arm
- weakness of muscles affected by nerve root
- depressed reflexes
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12
Q

Where do most thoracic disc prolapses occur

A

T11/12

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13
Q

Where do disc prolapses most commonly occur

A

Lumbar

  • L4/5
  • L5/S1
  • L3/4
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14
Q

Why are posterolateral disc prolapses more common

A

Posterior longitudinal ligament is weakest

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15
Q

What may a central lumbar disc protrusion cause

A

Pain in both legs, or just back pain

Compressed roots within the cauda equine

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16
Q

What may a lateral lumbar disc protrusion cause

A

Compression of the nerve root

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17
Q

What nerve root is affected by a L5/S1 disc protrusion

  • what is the sensory loss
  • what is the motor weakness
  • what is the reflex change
A
  • S1
  • Little toe and sole of foot
  • Weak foot plantar flexion
  • Ankle jerk
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18
Q

What nerve root is affected by a L4/5 disc protrusion

  • what is the sensory loss
  • what is the motor weakness
  • what is the reflex change
A
  • L5
  • Great toe + 1st dorsal web space
  • EHL weak
  • no reflex change
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19
Q

What nerve root is affected by a L3/4 disc protrusion

  • what is the sensory loss
  • what is the motor weakness
  • what is the reflex change
A
  • L4
  • Medial aspect of lower leg
  • Quads
  • Knee jerk
20
Q

Rx of lumbar disc protrusion

A

Brief rest and early mobilisation

Pain relief

21
Q

What is the clinical presentation of cauda equina syndrome

A

Bilateral sciatica
Saddle anaesthesia
Bladder or bowel dysfunction

Injury or precipitating event
Loss of anal tone and reflex

22
Q

Aetiology of cauda equina syndrome

A 
Central lumbar disc prolapse (commonest)
Tumours
Trauma - #, spinal stenosis
Infection - epidural abscess 
Iatrogenic - spinal surgery, epidural
23
Q

What investigations would you do for suspected cauda equina

A

Admission
PR exam
URGENT MRI
Lumbar CT pyelogram if MRI CI

24
Q

Management of cauda equina syndrome

A

Emergency discectomy within 48h of onset

25
Q

What can delayed treatment of cauda equina syndrome result in

A

The sacral nerve roots are compressed and can result in permanent bladder and anal sphincter dysfunction and incontinence

26
Q

What percentage of those undergoing discectomy for cauda equina syndrome do not regain normal urinary function

A

30%

27
Q

What percentage of those with motor deficits with CE do not regain full power

A

25%

28
Q

What percentage of those with sensory deficits with CE do not regain normal sensation

A

33%

29
Q

What percentage of those with perianal paraesthesiae with CE do not return to normal

A

25%

30
Q

What percentage of those with CE have persistent sexual dysfunction

A

26%

31
Q

What is spondylosis

A

A broad term meaning degeneration of the spinal column from any cause

32
Q

What can occur in severe spondylosis

A

Can compress the whole cord, not just the nerve roots, causing myelopathy and UMN signs in limbs (increased tone, brisk reflexes)

33
Q

What are the ligaments of the spine

A

Anterior Longitudinal - along the front of the vertebral bodies, broad and strong

Posterior Longitudinal - along the backs of the vertebral bodies (in front of spinal canal) - narrow

Ligament Flavum - between laminae

Interspinous and Supraspinous - between spinous processes

Intertransverse Ligament - between transverse processes

34
Q

Where on the disc does lumbar spondylosis occur

A

OA of facet and disc joints with degeneration of ligaments

35
Q

How can spinal claudication be distinguished from vascular claudication

A
  • Usually bilateral
  • Sensory dysaesthesiae
  • Poss. weakness - foot drop
  • Takes several mins to ease after stopping walking
  • Worse walking down hills because the spinal canal becomes smaller in extension, better when walking uphill or riding bicycle
36
Q

Treatment of lateral recess spinal stenosis

A

Non-operative
Nerve root injection
Epidural injection
Surgery

37
Q

Treatment of central spinal stenosis

A

Canal shape important
Non-op
Epidural steroid injection
Surgery

38
Q

Treatment of foraminal spinal stenosis

A

Non-op
Nerve root injection
Epidural injection
Surgery

39
Q

What is spondylolysis

A

A crack or stress fracture develops through the pars interarticularis

40
Q

What is the pars interarticularis

A

A small, thin portion of the vertebra connecting the upper and lower facet joints

41
Q

Where does spondylolysis most commonly occur

A

L5 then L4

42
Q

Why do fractures occur through the pars interarticularis

A

It is the weakest point of the vertebra, and so the most vulnerable to injury from repetitive stress and overuse

43
Q

What is spondylolisthesis

A

Where spondylolysis is left untreated and the pars interarticularis separates and weakens the vertebra so that it shifts or slips forward on the vertebra directly below it

44
Q

Symptoms of spondylolisthesis

A

Varying

Lower back pain

45
Q

Treatment of spondylolisthesis

A

Depends on symptoms

  • conservative with lifestyle changes
  • surgery for persistent pain with nerve root entrapment

E - MSK (29 decks)

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