spinal degenerative conditions Flashcards
describe intervertebral discs
Secondary cartilaginous joint
Largest avascular structure in the body
Made of two parts:
Annulus fibrosus - tough outer layer
Nucleus pulposus - gelatinous core
They resist rotational movements
What connects the discs to the vertebral bodies
anterior and posterior longitduinal ligament
What is the common direction of disc prolapses
Postero-laterally because the posterior longitudinal ligament thins out laterally
What happens to the intervertebral discs due to ageing
decreased water content of the discs
Disc space narrowing
Degeneration seen on Xray
Aggravated by smoking
Describe features of nerve root pain
Limb pain is worse than back pain
Pain is in a nerve root distribution
most settle in 3 months
root tension signs - e.g sciatic pain
root compression signs - loss of flexor reflexes in certain areas
What is the management of nerve root pain
Physiotherapy
Strong analgesia e.g gabapentin
Refer after 3 months if no improvement for MRI scan
What is a disc bulge
Common and asymptomatic
What is a disc protrusion
Annulus is weakened but still intact
What is disc extrusion
nucleus pulposis broken through annulus and herniated through
What is disc sequestration
Desiccated disc material free in the spinal canal
What is the most common lumbar disc prolapses
L4/5 and L5/S1 - sciatica
L3/4 - femoral neuralgia
What happens when there is an L5-S1 disc prolapse
S1 nerve root
Sensory loss at the little toe and sole of the foot
Motor weakness at the plantar flexion of the foot
Absent ankle jerk
What happens when there is a L4/5 disc prolapse
L5 nerve root
Sensory loss at the great toe and 1st dorsal web space
Motor weakness in the extensor hallicus longus
No loss of reflex
What happens when there is a L3/4 disc prolapse
L4 nerve root
Sensory loss at the medial aspect of the lower leg
Motor weakness at the quads
Absent knee jerk
What is cauda equina syndrome
Compression of the cauda equina - sacral nerve roots are compressed - bladder and anal sphincter control is lost - surgical emergency
What is the management of cauda equina syndrome
admission
urgent MRI
emergency operation within 2 days of onset
What are the causes of cauda equina syndrome
central lumbar disc prolapse - most common
tumours
trauma
infection
spinal stenosis
What is the presentation of cauda equina syndrome
injury or a precipitating event
Location of symptoms bilaterally at the buttock and leg pain with varying dysaethesiae(numbness) and weakness
(Be aware of the weakness as the sensory nerve roots are more sensitive to compression than motor ones so if there is motor compression, the nerves are more severely compressed)
Bowel or bladder dysfunction
Perianal loss of sensation, loss of anal tone and anal reflex
What is there raised suspicion of in a post op spinal surgery patient with increasing bilateral leg pain and urinary retention
Cauda equina syndrome
What imaging is done for cauda equina syndrome suspicion
MRI
Lumbar CT myelogram if MRI is contraindicated - if any metal implants or metallic heart valves
What is the treatment of cauda equina syndrome
within 48 hours from the onset of symptoms
discectomy can be done
What is cervical and lumbar spondylosis
spondylosis - Another name for osteoarthritis
Degenerative changes at facet joints, discs, ligaments …
If it severe it can compress the whole cord causing myelopathy
with upper motor neuron signs
Upper motor neurons when the spondylosis is high up the spine
describe facet joints
true synovial joints which allow flexion and extension
They are between the pedicle and lamina of a vertebra
What is spinal claudication
Symptom - narrowing of the arteries of the lower limb which has pain when walking
Bilateral
sensory dysaesthesiae
Poss weakness e.g foot dropping
Takes several minutes to ease after walking
Worse when walking down hills because the spinal canal becomes smaller in extension
What is the treatment of lateral recess stenosis
Nerve root injection
epidural injection of steroid
surgery
What shape of spinal canal predisposes to central stenosis
trefoil canal
What is the treatment of central stenosis
epidural steroid injection
Surgery
What is foraminal stenosis
The nerve root is compressed as it emerges from the intervertebral foramen
What is the treatment of foraminal stenosis
nerve root injection
epidural injection of steroid
surgery
What is spondylolisthesis
One vertebrae has translated onto another
What is spondylolysis
defect in the pars interarticularis - the posterior elements of the vertebrae is separated from the anterior
What is the treatment of spondylolisthesis
lifestyle changes
Surgery if they have persistent pain with or without nerve root entrapment
