Spinal Pathology Flashcards
Most common cause of back pain?
Mechanical.
Give an example of a factor that contributes to mechanical back pain?
- Obesity.
- Lack of exercise.
- Strain on paraspinal muscles.
- Facet joint osteoarthritis.
Mechanical back pain is most common in patients between which ages?
20 and 55 y/o.
Symptoms of mechanical back pain?
- Morning stiffness that resolves with movement.
- Pain worse on prolonged sitting or when rising from seated position.
Hypertrophied facet joints may cause referred pain mimicking what condition?
Sciatica - except that pain will not radiate below the knee.
Red flags for low back pain?
- > 60 or <20 y/o.
- Pain not improved by rest.
- Pain that WAKES the patient at night.
- Urinary retention/incontinence and faecal incontinence.
- Saddle anaesthesia.
- History of malignancy.
- Unexplained weight loss.
- Fever, immunosuppression or IV drug abuse.
Most common locations for lumbar disc herniation?
L4/5 and L5/S1.
What happens in a disc herniation?
Nucleus herniates through tear in annulus ring and compresses adjacent nerve roots.
Herniated discs are more common in whom and why?
- “Young” patients due to carrying heavy loads.
- Older patients due to vertebrae degeneration or spondylosis.
Most common direction of disc prolapse?
Paramedian/posterolateral herniated disc.
Describe a paramedian/posterolateral disc herniation.
Typically compresses traversing nerve i.e. nerve root that exits below the level of prolapsed disc.
A paramedian/posterolateral herniated disc at L4/L5 will compress which nerve?
L5.
A far lateral (extraforaminal) herniated disc typically does what?
Compresses exiting nerve i.e. nerve that exits at level of disc prolapse.
A far lateral (extraforaminal) herniated disc at L4/5 damages which nerve?
L4.
A central/medial herniation may cause what?
- Lumbar stenosis.
- If large enough, Cauda Equina.
What is radiculopathy?
Nerve root dysfunction causing dermatomal sensory deficit + weakness of muscle groups supplied by that nerve.
What is sciatica?
Pain along sciatic nerve usually due to nerve root compression (L4-S3).
Symptoms of sciatica?
- Sciatica pain pattern.
- Numbness/tingling along affected nerve distribution.
- Weakness.
- Positive straight leg raise test.
Describe a positive straight leg raise test.
Patient lies on back, lift leg with knee straight. If sciatic pain is elicited at <45o then test is positive.
Describe the sciatic pain pattern.
Shooting pain radiating from buttocks down to posterior knee/leg. May be exaggerated by coughing or sneezing.
