Session 5 Clinical Conditions Flashcards
What is mechanical back pain characterised by
Pain when spine is loaded, that worsens with exercise and is relieved by rest . Intermittent.
Risk factors for mechanical back pain
Obesity, poor posture, Sedentary lifestyle, deconditioning of core muscles, poor seating and incorrect manual handling
2 main degenerative changes in vertebral column
Disc degeneration and marginal osteophytosis
Disc degeneration key points
- Nucleus pulposus of intervertebral discs dehydrates with age
- Decrease in height of discs, bulging and alteration of load stresses
- Osteophytes (bone spurs) called Syndesmophytes develop adjacent to end plate
What is marginal osteophytosis
Syndesmophytes developing adjacent to end plates of discs. Increased stress can cause osteoarthritis changes.
What are facet joints innervated by
Meningeal branch of spinal nerve, so arthritis in these joints is painful
As disc height decreases and arthritis develops in facet joints and vertebral bodies (due to disc generation and marginal osteophytosis), what happens
Intervertebral foramina decrease in size lading to compression of spinal nerves and radicular/nerve pain
Why does pain occur in herniated disc
Herniated disc material presses on spinal nerve
4 stages of disc herniation
- Disc degeneration
- Prolapse
- Extrusion
- Sequestration
What is disc degeneration
chemical changes associated with ageing cause discs to dehydrate and bulge
What is prolapse
Protrusion of nucleus pulposus occurs with slight impingement into the spinal canal
What is extrusion
Nucleus pulposus breaks through annulus fibrosis but is still contained within disc space
What is sequestration
Nucleus pulposus separates from main body of disc and enters spinal canal
Most common sites for slipped disc
L4/5 and L5/S1 due to mechanical loading
Nerve roots are most vulnerable at 2 sites:
- Where they cross the intervertebral disc
2. Where the exit the spinal canal in the intervertebral foramen
Nucleus pulposus most commonly herniates…
Posterolaterally (causing compression of a spinal nerve root within intertertebral foramen). Paracentral prolapse.
2% are far lateral and 2% are central
Nerve roots at risk in far lateral, paracentral and central herniation
Far lateral- exiting nerve root
Paracentral- transversing nerve root
Central- cauda equina syndrome
What is most frequently compressed in paracentral herniation of L4/5
L5 root (transversing root)
What is sciatica
Radicular leg pain caused by irritation or compression of the nerve roots contributing to sciatic nerve (L4, L5, S1, S2 and S3)
Sciatica pain
Back and buttock and radiates to dermatome supplied by affected nerve root.
Distribution of pain in sciatica L4 L5 and S1
L4- anterior thigh, anterior knee, medial leg
L5- lateral thigh, lateral leg, dorsum of foot
S1- posterior thigh, posterior leg, sole of foot
What is cauda equina syndrome
Can be Prolapsed intervertebral disc when there is a canal filling disc- compresses lumbar and sacral nerve roots within the spinal canal
Other causes- tumours, spinal infection, stenosis secondary to arthritis, fracture, haemorrhage and ankylosis spondylitis
Red flag symptoms of cauda equina syndrome
- Bilateral sciatica
- Parianal numbness
- Painless retention of urine
- Urinary/faecal incontinence
- Erectile dysfunction
Treatment of cauda equina syndrome
Surgical decompression within 48 hrs of onset for good prognosis
