Spinal - Discs & Stenosis Flashcards

1
Q

What type of joint is an Intervertebral disc?

A

Secondary Cartilaginous

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2
Q

What attaches the discs to vertebral bodies?

A

ALL & PLL

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3
Q

What marks out pain as being from a nerve root?

A

Often ass with back pain but worse than it

Spread in a dermatomal/myotomal distribution

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4
Q

How do you treat nerve root pain?

A

Most go away on their own:

  • Physio
  • Analgesia
  • Referral after 12wks for MRI
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5
Q

Dsecribe the types of prolapsed disc:

A

Bulge - Most asymptomatic

Protrusion - Annulus weak but still intact

Extrusion – Annulus broken but nucleus still in continuity

Sequestration - Nucleus material free in spinal canal

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6
Q

Where do most disc prolapses occur?

A
Cervical = C5/6
Thoracic = T11/12 (but very rare)
Lumbar = L4/5 or L5/S1

Mostly posterolateral

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7
Q

What level disc has prolapsed:

  • Medial aspect of lower leg sensation lost
  • Weakness in quads
  • Knee jerk reflex lost
A

L3/4 (L4 nerve root)

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8
Q

Which level disc has prolapsed?

  • Sensation to little toe/sole
  • weakness on plantar flexion
  • Ankle jerk lost
A

L5/S1 (S1 nerve)

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9
Q

Which level disc has prolapsed?

  • Sensation to great toe & 1st webspace
  • EHL weakness
A

L4/5 (L5 nerve root)

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10
Q

What is Cauda Equina Syndrome?

A

Sacral nerve root compression due to

1) Centrally prolapsed lumbar disc
2) Tumour
3) Trauma or spinal stenosis
4) Infection (abscess)
5) Iatrogenic (surgery/epidural)

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11
Q

Why is Cauda Equina Such an emergency?

A

Can result in permanent bladder & bowel dysfunction/incontinence

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12
Q

How do you spot Cauda Equina?

A

1) Bilateral buttock/leg pain + varying dysaesthesia
2) Bladder/bowel dysfunction (urinary retention +/- overflow incontinence)
3) PR exam showing saddle anaesthesia, loss of anal tone & reflex

Look for a precipitating event e.g. injury, surgery etc.

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13
Q

How do you manage Cauda Equina?

A

Admit
MRI
Emergency Surgery within 48hrs

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14
Q

What do we call OA of the spine?

A

Cervical or Lumbar Spondylosis

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15
Q

What joints are there in the spine and what do they allow?

A

Facets - Synovial Plane - Flexion/extension

Discs - 2nd* Cartilaginous - Rotation

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16
Q

What are the major ligaments of the spine?

A
ALL (Front of bodies)
PLL (back of bodies)
Ligamentum Flavum (Laminae)
Interspinaous & Supraspinous
Intertransverse (between transverse processes)
17
Q

Spinal Claudication can occur due to Spinal Stenosis, how do we differentiate from PVD claudication?

A

Spinal is:

  • Usually bilateral
  • Comes with Dysaesthesia
  • ~Weakness e.g. foot drop
  • Takes longer to ease
  • Worse walking downhill rather than uphill (due to compression of spinal canal in extension)
18
Q

How can we manage Spinal stenosis?

A

Nerve root injection

Epidural Steroid Injection

Surgery