SPINAL SYMPOSIUM 2

Question 1

Briefly describe the function and anatomy of the intervertebral discs

Answer 1

Function: resist rotational movements

Anatomy

• tough outer- annulus fibrosis
• gelatinous centre- mainly water

Question 2

What pathology is common in intervertebral discs

Answer 2

Prolapsed disc

• annulus fibrosus tears
• nucleus collapses

Question 3

common disc problems

Answer 3

• Bulge – generally asymptomatic
• Protrusion – annulus weakend but still intact
• Extrusion – through annulus but in continuity
• Sequestration- dessicated disc material free in canal

Question 4

Symptoms of cauda equina

Answer 4

• bilateral buttocks and leg pain + variable dysaethesia + weakness ( flaccid and areflexic)
• Bowel and bladder dysfunction
• Saddle anestesia

Question 5

Aetiology of cauda equina

Answer 5

–central lumbar disc prolapse (commonest)
–tumours
–trauma (burst or Chance #, disc) or spinal stenosis
– infection (epidural abscess)
– iatrogenic (spinal surgery or manipulation, spinal epidural injection)

Question 6

Investigations for cauda equina

Answer 6

• DRE : loss of anal tone, loss of anal reflex
• MRI
• CT pyelogram if MRI contraindicated

Question 7

Treatment for cauda equina

Answer 7

Operative: within 48 hours

DISCECTOMY

Question 8

Difference between cauda equina and cord compression

Answer 8

• cauda equina : Spinal shock: flaccid and arefflexic

- cord compression: neurogenic shock: spastic and hyper-reflexic

Question 9

what is cervical/ lumbar spondylosis?

Answer 9

OA of facet and disc joints

Question 10

What is spinal claudication?

Answer 10

Narrowing of the spinal canal with resulting pressure on the cauda equina

Need to distinguish from vascular claudication

Question 11

Presentation of spinal claudication?

Answer 11

• Bilateral
• Sensory dysaestesia
• Possible weakness e.g. foot drop
• Takes a few minutes to ease after stop walking - worse on extension
• Worse walking down hill as spinal canal becomes smaller in extension

Question 12

Types of stenosis and treatments

Answer 12

Lateral recess:

• Non- operative
• Nerve root injection
• Epidural injection
• Surgery

Central
–Non-operative
–Epidural steroid injection
–Surgery (80% improve

Foraminal 
–Non-operative
–Nerve root injection
–Epidural injection
–Surgery

Question 13

presentation of lumbar disc prolapse

Answer 13

• Pain on sneezing/coughing
• Limited flexion/extension
• Cauda equina syndrome
• Either confined to leg or buttock (usually LIMBS)

Question 14

which is the most common lumbar disc prolapse and how does it present?

Answer 14

L4/L5

• Sensory: great toes, first webbed space in between toes
• motor: EHL

Question 15

Second most common lumbar disc prolapse and how does it present?

Answer 15

L5/S1

• sensory: sole of foot and little toe
• Motor: plantar flexion

Question 16

what does and L5/S1 prolapse present with?

Answer 16

• ankle jerk

Question 17

what does an L3/L4 present with?

Answer 17

• knee jerk