Spinal Cord Disease - Prolapsed Disc

Question 1

Anatomy of Vertebral Column (2).

Answer 1

1. 33 Bones separated by Intervertebral Discs.

2. 5 Regions : Cervical, Thoracic, Lumbar, Sacral, Coccyx.

Question 2

Key Features of Cervical Vertebrae (3).

Answer 2

7 Cervical Vertebrae :

1. Bifid Spinous Process (except C1 and C7).
2. Transverse Foramina (Vertebral Arteries).
3. Triangular Vertebral Foramen.

Question 3

Key Cervical Vertebrae (2).

Answer 3

1. C1 - Atlas.

2. C2 - Axis.

Question 4

Key Features of Thoracic Vertebrae (4).

Answer 4

12 Thoracic Vertebrae :

1. Demi-Facets : Superior and Inferior (Ribs).
2. Transverse Process has Costal Facet (Shaft of Rib).
3. Spinous Process - Oblique Inferoposterior.
4. Circular Vertebral Foramen.

Question 5

Key Features of Lumbar Vertebrae.

Answer 5

5 Lumbar Vertebrae :

1. Very Large Kidney-Shaped Vertebral Bodies.
2. Triangular Vertebral Foramen.
3. No Other Characteristic Features.

Question 6

Key Features of Sacral Vertebrae (2).

Answer 6

5 Sacral Vertebrae :

1. Fused.
2. Facets (Sacroiliac Joints).

Question 7

What is Kyphosis?

Answer 7

Excessive thoracic curvature - hunchback.

Question 8

What is Lordosis?

Answer 8

Excessive lumbar curvature - swayback.

Question 9

What is Scolisosis?

Answer 9

Lateral curvature of spine.

Question 10

Joints of the Spine (3).

Answer 10

1. Superior Articular Facet : Vertebra Above.
2. Inferior Articular Facet : Vertebra Below.
3. Intervertebral Discs.

Question 11

Ligaments of the Spine (2).

Answer 11

1. Anterior Longitudinal Ligament - Full Length - Prevent Hyperextension.
2. Posterior Longitudinal Ligament - All Length - Prevent Hyperflexion.

Question 12

What is the Intervertebral Disc?

Answer 12

Fibrocartilaginous cylinder between vertebra, permitting flexibility and acting as shock-absorbers.

Question 13

Anatomy of Intervertebral Disc (2).

Answer 13

1. Nucleus Pulposus (Jelly-Like).

2. Annulus Fibrosis (Tough and Collagenous).

Question 14

Pathophysiology of Prolapsed Intervertebral Disc (3).

Answer 14

1. Nucleus Pulposus Ruptures and Breaks Through Annulus Fibrosis.
2. Usually Posterolateral Direction.
3. Irritation of Nearby Spinal Nerves.

Question 15

Clinical Presentation of Prolapsed Disc (3).

Answer 15

1. Clear Dermatomal Leg Pain Associated with Neurological Deficit.
2. Leg Pain Worse than Back Pain.
3. Pain Worse When Sitting.

Question 16

L3 Nerve Root Compression (4).

Answer 16

1. Sensory Loss Over Anterior Thigh.
2. Weak Quadriceps.
3. Reduced Knee Reflex.
4. Posterior Femoral Stretch Test.

Question 17

L4 Nerve Root Compression (4).

Answer 17

1. Sensory Loss over Anterior Knee.
2. Weak Quadriceps.
3. Reduced Knee Reflex.
4. Positive Femoral Stretch Test.

Question 18

L5 Nerve Root Compression (4).

Answer 18

1. Sensory Loss over Dorsum of Foot.
2. Weakness in Foot and Hallux Dorsiflexion.
3. Reflexes Intact.
4. Positive Sciatic Nerve Stretch Test.

Question 19

S1 Nerve Root Compression (4).

Answer 19

1. Sensory Loss over Posterolateral Aspect of Leg and Lateral Foot.
2. Weakness in Plantar Flexion of Foot.
3. Reduced Ankle Reflex.
4. Positive Sciatic Nerve Stretch Test.

Question 20

Management of Prolapsed Disc (2).

Answer 20

1. Similar to MSK Lower Back Pain : Analgesia, Physiotherapy and Exercise.
2. Symptoms Persist for 4-6 Weeks : Referral for Consideration of MRI.