Spinal Flashcards
what layers are the intervertebral discs made up of
annulus fibrosis - fibrocartilage
nucleus pulposus - mostly water, collagen, proteoglycans
most common causes low back pain
obesity
lack exercise
facet joint OA
back pain red flags
age >55/<20 night pain pain without improvement on rest trauma systemic upset weight loss urine retention or incontinence faecal incontinence saddle anaesthesia hx malignancy
pathophysiology of lumbar disc herniation?
nucleus herniates through tear in annulus ring and compresses adjacent nerve roots
most common spinal levels affected by lumbar disc herniation
L4/5
L5/S1
what can a central disc herniation cause
spinal stenosis or cauda equina
what can a paramedian disc herniation cause
compresses traversing nerve so if L4/5 it would affect L5
what can a lateral disc herniation cause
affects the one exiting that level so if L4/5 it would affect L4
general clinical features of disc prolapse
sciatic pain exacerbated by cough/sneeze
paraesthesia
weakness
SLR+ve - if leg <45 degree before eliciting sciatica
S1 specific features of disc prolapse
pain on post thigh and radiates to heel
sensory loss lateral foot
reduced/absent ankle jerk
weak plantarflexion
L5 specific features of disc prolapse
pain on posterior/posterolateral thigh, radiation to dorsal foot and great toe
weak dorsiflexion of toe or foot
paraesthesia and numbness of foot and great toe
L4 specific features of sic prolapse
pain in ant thigh
wasting of quads
weak quads function and foot dorsiflexion
diminished ant thigh sensation, medial lower leg
reduced knee jerk
indication for operative management of disc prolapse
failing conservative pain central prolapse tumour neuro deficit
what is cauda equina syndrome and what are the causes
compression of cauda equina tumour infection haematoma trauma disc prolapse - central L4/5
clinical features cauda equina
urinary retention saddle paraesthesia incontinence low back pain bilateral sciatic back pain - radicular and partial/complete loss sensation/motor function
investigation for CES
DRE
MRI
what is spinal stenosis and what levels does it commonly occur at
narrowing of spinal canal compressing lower cord, neurogenic claudication
L3/4, L4/5
cause of spinal stenosis
hypertrophy of facet joints and ligamentum flavum
protrusing intervertebral discs
spondylolisthesis
features of spinal stenosis
progressive months/years
unilaterla/bilateral hip, buttock, lower extremity pain or burning
precipitated by back extension/standing and relief by sitting, lumbar flexion and walking uphill
preserved pulses
diagnosis of spinal stenosis
clinical but can get MRI
treatment of spinal stenosis
conservative with physio and painkillers
surgery if intolerable
what is cervical spondylosis and pathophysiology
degenerative arthritis of c spine and intervertebral discs and zygapophyseal joints
cervical disc degeneration, stress on cartilage and osteophytic spurs on margins of end plates to grow posterior into spinal canal
radiographic findings of cervical spondylosis
narrowing of disc space
osteophytes
clinical features of cervical spondylosis
myelopathy
radiculopathy
