Spinal - Discs & Stenosis Flashcards
What type of joint is an Intervertebral disc?
Secondary Cartilaginous
What attaches the discs to vertebral bodies?
ALL & PLL
What marks out pain as being from a nerve root?
Often ass with back pain but worse than it
Spread in a dermatomal/myotomal distribution
How do you treat nerve root pain?
Most go away on their own:
- Physio
- Analgesia
- Referral after 12wks for MRI
Dsecribe the types of prolapsed disc:
Bulge - Most asymptomatic
Protrusion - Annulus weak but still intact
Extrusion – Annulus broken but nucleus still in continuity
Sequestration - Nucleus material free in spinal canal
Where do most disc prolapses occur?
Cervical = C5/6 Thoracic = T11/12 (but very rare) Lumbar = L4/5 or L5/S1
Mostly posterolateral
What level disc has prolapsed:
- Medial aspect of lower leg sensation lost
- Weakness in quads
- Knee jerk reflex lost
L3/4 (L4 nerve root)
Which level disc has prolapsed?
- Sensation to little toe/sole
- weakness on plantar flexion
- Ankle jerk lost
L5/S1 (S1 nerve)
Which level disc has prolapsed?
- Sensation to great toe & 1st webspace
- EHL weakness
L4/5 (L5 nerve root)
What is Cauda Equina Syndrome?
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)
Why is Cauda Equina Such an emergency?
Can result in permanent bladder & bowel dysfunction/incontinence
How do you spot Cauda Equina?
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.
How do you manage Cauda Equina?
Admit
MRI
Emergency Surgery within 48hrs
What do we call OA of the spine?
Cervical or Lumbar Spondylosis
What joints are there in the spine and what do they allow?
Facets - Synovial Plane - Flexion/extension
Discs - 2nd* Cartilaginous - Rotation