Prolapsed Disc and Spinal Stenosis Flashcards
What type of joints are intervertebral discs
Secondary cartilaginous
What are the components of intervertebral discs
Annulus fibrosus
Nucleus pulposus
What happens to the components of a IV disc in prolapse
The annulus fibrosis can tear and the nucleus pulpous can prolapse out of the disc and result in compression of the spinal cord
What sorts of movements do IV discs resist and in what movements do they fail
Resist - rotational
Fail - with twisting
Which direction do discs usually prolapse
Postero-lateral
What is the normal ageing process of IV discs
Decreased water content
Disc scape narrowing
Degenerative changes seen on x-ray
Degenerative changes seen on facet joints
Presentation of nerve root pain
Limb pain worse than back pain
Nerve root tension signs
Nerve root compression signs
Pain in a nerve distribution
Management of nerve root pain
Most settle after 12 weeks
Physio and strong analgesia
Refer for MRI if not settled after 12 weeks
What are the 4 stages of a prolapsed disc
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
At what vertebral level do central disc prolapses most often occur
C5/6
What symptoms and signs does cervical disc prolapse cause
Spinal cord compression Posterolateral - stiff neck - pain radiating to arm - weakness of muscles affected by nerve root - depressed reflexes
Where do most thoracic disc prolapses occur
T11/12
Where do disc prolapses most commonly occur
Lumbar
- L4/5
- L5/S1
- L3/4
Why are posterolateral disc prolapses more common
Posterior longitudinal ligament is weakest
What may a central lumbar disc protrusion cause
Pain in both legs, or just back pain
Compressed roots within the cauda equine
What may a lateral lumbar disc protrusion cause
Compression of the nerve root
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
- S1
- Little toe and sole of foot
- Weak foot plantar flexion
- Ankle jerk
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
- L5
- Great toe + 1st dorsal web space
- EHL weak
- no reflex change
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
- L4
- Medial aspect of lower leg
- Quads
- Knee jerk
Rx of lumbar disc protrusion
Brief rest and early mobilisation
Pain relief
What is the clinical presentation of cauda equina syndrome
Bilateral sciatica
Saddle anaesthesia
Bladder or bowel dysfunction
Injury or precipitating event
Loss of anal tone and reflex
Aetiology of cauda equina syndrome
Central lumbar disc prolapse (commonest) Tumours Trauma - #, spinal stenosis Infection - epidural abscess Iatrogenic - spinal surgery, epidural
What investigations would you do for suspected cauda equina
Admission
PR exam
URGENT MRI
Lumbar CT pyelogram if MRI CI
Management of cauda equina syndrome
Emergency discectomy within 48h of onset
