Spinal problems Flashcards
Give five causes of spinal cord compression
Tumour (primary/local or metastatic) Abscess Trauma Central disc prolapse Tuberculosis
What are the major causes of lumbar back pain?
EMERGENCIES:
- spinal cord compression
- cauda equina syndrome
- osteomyelitis
- malignancy
- multiple myeloma
Mechanical problems
Inflammatory conditions
What are the mechanical causes of lumbar back pain?
MECHANICAL:
- poor posture
- prolapsed disc
- fracture
- OA
- spondylolisthesis
- spinal stenosis
What are the inflammatory causes of lumbar back pain?
INFLAMMATORY
- ankylosing spondylitis
- discitis
- Paget’s disease
Describe the clinical presentation of spinal cord compression
Bilateral leg pain
Radicular (nerve root) pain
Paraesthesia below compression level
Upper/Lower motor neurone signs depending on location
Sphincter disturbance
Cauda equina syndrome (if lumbar region is compressed)
Describe the pathology of intervertebral disc prolapse
Herniation of the nucleus pulposus through the annulus fibrosus, due to tearing of the AF.
Can be central (compresses spinal cord) and/or lateral (most commonly posterolateral, causes nerve root pain)
Which region of the spine is most likely to suffer from a disc prolapse?
L4 / L5 / S1
Describe the clinical presentation of a disc prolapse
Back pain (often lumbar)
Referred leg pain
Sciatica
Motor and sensory symptoms over the distribution of the affected nerve root
How is a disc prolapse diagnosed?
Positive straight leg raise test (demonstrates nerve root irritation)
Confirmed on MRI
Describe the treatment options for disc prolapse
Initial rest
Analgesia
Physiotherapy
Surgery (spinal discectomy)
Give four types of intervertebral disc problem
Bulge
Protrusion
Extrusion
Sequestration
What is cauda equina syndrome?
Compression of the cauda equina
- this is a surgical emergency
List the possible causes of cauda equina syndrome
Central lumbar disc prolapse (most common)
Tumours
Trauma
Spinal stenosis
Chronic inflammation e.g. ankylosing spondylitis
Infection (epidural abscess)
Iatrogenic e.g. haematoma following spinal anaesthetic
Describe the protocol for suspected cauda equina syndrome
Admission
Urgent MRI scan
High-dose dexamethasone (reduces oedema)
Emergency surgical decompression within 48 hours of onset
Describe the presentation / red flags for cauda equina syndrome
Characteristic LMN symptoms:
- micturition disturbance: hesitancy and urgency
- faecal incontinence (sphincter dysfunction)
- increasing motor weakness + gait disorder
- saddle (perianal) anaesthesia
Note: symptoms can be variable/non-specific, so high index of suspicion is needed
Presence of UMN symptoms suggests cord compression rather than cauda equina
What is spondylosis?
: spinal degeneration accompanied by pain. Is often used as a synonym for spinal arthritis.
Describe the pathophysiology of spondylosis
Chronic disc degeneration with herniation of disc material, calcification and osteophytes (bony outgrowths forming along joint margins).
How/why does spondylosis cause pain?
- Radiculopathy due to compression, stretching or angulation of the cervical nerve roots.
- Myelopathy due to compression, compromised blood supply or recurring minor trauma to the cord.
What is spinal stenosis?
Narrowing of the spinal canal
What causes spinal stenosis?
Degenerative changes
Rarely due to prolapse, malignancy or congenital narrowing
What is the main symptom of spinal stenosis?
Spinal (neurogenic) claudication; painful cramping and weakness in the legs, usually bilateral
When is neurogenic claudication most severe?
Exercise
Spinal extension
- walking down hills
Describe the treatment options for spinal stenosis
Lifestyle changes, particularly weight loss
Analgesia
Physiotherapy
Surgery - spinal decompression
What is spondylolisthesis?
Displacement of a vertebra, either forwards or backwards, usually in the L4/L5/S1 region
What causes spondylolisthesis?
Ossification defect of the pars interarticularis; can be congenital or trauma-induced
Exacerbated by spinal hyperextension
Describe the clinical features of spondylolisthesis
Chronic back pain on standing and exercise
Sciatica and radiculopathy can occur
ROM and exercise may be restricted
What is spondylolysis?
A defect or stress fracture in the pars interarticularis of the vertebral arch.
