S2 (spine) Flashcards
Mechanical back pain
Worse with exercise
Risk factors lifestyle, poor core, obesity, poor seating and manual hsndling etc
Disc degeneration and marginal osteophytosis
Nuc pulposus dehydrates with age.
Decrease in height of disc bulge at this.
Osteophytes (bony spurs) and syndesmophytes develop adjacent end plates of discs-– marginal osteophytosis.
Arthritis here is painful (meninges, branch of spinal nerve).
IV foramina gets smaller-compresses spinal nerves-radiculaire or nerve pain.
Slipped disc
Disc degeneration
Prolapse
Extrusion
Sequestration
Commonly L4/5 and L5/S1 (mechanical loading here)
Paracentral 96%and far lat2% (where exit in IV foramen)
Usually lat to post long lig
Exiting nerve root at risk in far lat
Transferring nerve root at rink in para central
So, paracent of L4/5 disc compresses L5 root (L4 émergées above)
Sciatica (radicular leg pain)
Irritation or compression of one or more nerve roots of the sciatic (L4-S3)
Eg marginal osteophysis, slip disc
Pain- Back and buttock radiates to dermatome of Affected nerve root
L4 ant thigh and knee and med leg
L5 lat thigh and leg, dorsum foot
S1 post thigh and leg, sole of foot
If paraesthesia, only in affected dermatome, not full path from spine
Cauda equina syndrome
Slip disc into full canal compressing lumbar and sacral nerve roots within the spinal cord
OR tumour affecting meninges or vert column,
spinal abscess, infection, spinal stenosis secondary to arthritis, vert fracture, spinal haemorrhage, late stage ankylosing spondylitis
Red flag symptoms:
Bilateral sciatica, perianal numbness, painless retention of urine, incontinence, erectile dysfunction
Need to treat with surgical decompression within 48hrs of onset of sphincter symptoms or poor prognosis
Missed/late diagnosis-neuropathic pain, impotence, intermittent self categorisation, manual evacuation of feaces, loss of sensation and lower limb weakness-wheelchair
Spinal canal stenosis
Abnormal narrowing of spinal canal compressing cord and or roots
Usually elderly
Disc bulge, facet joint osteoarthritis, lig flavum hypertrophy
Also, compression fractures of vert body, spondylolisthesis, trauma
Lumbar most common then cervical
Discomfort on standing Discomfort or pain in arm or leg Usually bilat symptoms Numbness or and weakness at or below level of stenosis Neurogenic claudication
Usually symptoms don’t change
Neurogenic claudication
Pain/pins and needles on prolonged standing, and walking, radiating sciatica distribution
Limp
Caused by spinal canal stenosis, leading to genius’s engorgement of nerve roots during exercise-> less art flow and transient art ischaemia-> pain/parasthesia of affected nerve
Relieved by rest, change position and flexing spine (bend over forward)
Spondylolisthesis
Ant displacement of vert relative to vert below
Congenital or dysplastic:instable facet joints
Isthmic: defect in pars interarticularis eg stress fracture
Degen: due to facet joint arthritis an joint remodelling (elderly)
Traumatic: fractures anywhere else in neural arch
Pathological: infection of mailg
Iatrogenic: caused by surgery (too much taken out/removed)
Range of pain/discomfort-mild lower back pain to incapacitating
Sciatica and neurogenic claudication
Spondylolysis
Complete fracture of pars interarticularis withought displacement (as in spondylolisthesis)
Looks like a scotty dog on oblique vue, dogs head should still be in place, if neck broken and head moved away from body it’s spondylolisthesis
