Prolapsed Intervertebral Disc And Spinal Stenosis

Question 1

Intervertebral disc outer layer?

Answer 1

Annulus fibrosis

Question 2

Inner layer of intervertebral disc?

Answer 2

Nucleus purposus

Question 3

What connects intervertebral discs and vertebral bodies?

Answer 3

Anterior longitudinal ligament and Posterior longitudinal ligament

Question 4

What happens to intervertebral discs as a result of ageing?

Answer 4

Decreased water content of discs,

Disc space narrowing

Question 5

If someone presents with nerve root pain what is the primary intervention?

Answer 5

Physiotherapy,
Strong analgesia
As about 90% settle in 3 months

Question 6

When should you refer a patient with nerve root pain?

Answer 6

After 12 weeks,

After physiotherapy and analgesia

Question 7

What imaging should be used with someone with nerve root pain?

Answer 7

MRI

Question 8

What intervertebral disc problems can occur?

Answer 8

Bulge,
Protrusion (annulus still intact),
Extrusion (through annulus),
Sequestration (dessicated disc material free in canal)

Question 9

Common area for cervical disc prolapse?

Answer 9

C5/C6

Question 10

Presentation of L5/S1 disc prolapse?

Answer 10

Sensory loss in little toe and sole of foot,
Weakness in plantar flexion of foot,
Change in ankle jerk reflex

Question 11

Presentation of L4/5 disc prolapse?

Answer 11

Sensory loss in great toe and 1st dorsal web space,
Motor weakness in EHL,
No reflex change

Question 12

Presentation of L3/4 disc prolapse?

Answer 12

Sensory loss in medial aspect of lower leg,
Motor weakness in quads,
Reflex change in knee jerk

Question 13

Sacral nerve root compression complication?

Answer 13

Permanent bladder and anal sphincter dysfunction and incontinence

Question 14

Within what time should you operate on cauda equine syndrome

Answer 14

48hours

Question 15

Cause of Cauda equine syndrome?

Answer 15

Central lumbar disc prolapse, 
Tumour, 
Trauma, 
Spinal stenosis,
Infection (epidural abscess),
Iatrogenic (spinal surgery, manipulation, spinal epidural injection)

Question 16

CES presentation?

Answer 16

Bilateral buttock and leg pain, 
Bowel or bladder dysfunction,
Saddle anaesthesia, 
Loss of anal tone,
Loss of anal reflex

Question 17

Investigations for CES?

Answer 17

MRI,

Lumbar CT myelogram (if contraindicated MRI)

Question 18

Surgery for CES?

Answer 18

Discectomy

Question 19

Causes of cervical and lumbar spondylosis?

Answer 19

Degenerative changes in facet joints, disc, ligaments etc

Question 20

Ligaments in the spine?

Answer 20

Anterior longitudinal ligament, 
Posterior longitudinal ligament, 
Ligamentum flavum, 
Interspinous and supraspinous ligament, 
Intertransverse ligament

Question 21

Causes of lumbar spondylosis?

Answer 21

OA of facet and disc joints

Question 22

Vascular claudication presentation?

Answer 22

Bilateral,
Sensory dysaesthesia,
Drop foot or tripping (due to possible weakness),
Takes several minutes to ease after stoppping activity,
Worse walking down hills

Question 23

Why is vascular claudication worse when walking down hills?

Answer 23

Because the spinal canal becomes smaller in extension

Question 24

Types of spinal stenosis

Answer 24

Lateral recess stenosis,
Central stenosis,
Foraminal stenosis

Question 25

Lateral recess stenosis?

Answer 25

Nerve root injection,
Epidural injection,
Surgery

Question 26

Central stenosis treatment

Answer 26

Epidural steroid injection,

Surgery

Question 27

Foraminal stenosis treatment?

Answer 27

Nerve root injection,
Epidural injection,
Surgery