Spinal Symposium: Spine Degeneration, Low Back Pain, Disc Prolapse, Spinal Stenosis

Question 1

RECAP- which level does the spinal cord usually end at?

Answer 1

L1

Question 2

What is the most common type of disc prolapse direction?

Answer 2

Postero-lateral

Question 3

RECAP-Type of joint of IV discs?

Answer 3

Secondary cartilaginous joints

Question 4

RECAP- two parts of intervertebral discs?

Answer 4

Annulus fibrosis- tough outer layer
Nucleus pulposus- core

Question 5

RECAP- which ligaments connect the IV discs with the bodies?

Answer 5

Anterior and posterior longitudinal ligaments

Question 6

What happens to the IV discs with ageing?

Answer 6

Decreased water content so disc spaces narrow

Question 7

What aggravates the degeneration of IV discs?

Answer 7

Smoking

Question 8

Nerve root pain is fairly common. What can be done for it?

Answer 8

90% settles in three months
Physiotherpay
Strong analgesia

Question 9

When do you refer for nerve root pain?

Answer 9

Ongoing for > 12 weeks

Question 10

What imaging is done for nerve root pain?

Answer 10

MRI

Question 11

What is meant by radicular pain?

Answer 11

Pain in a nerve root distribution

Question 12

Four types of disc problem?

Answer 12

Bulge
Protrusion
Extrusion
Sequestration

Question 13

Protrusion?

Answer 13

Annulus weakened but still in tact
Nucleus is elongated

Question 14

Extrusion?

Answer 14

Through annulus but in continuity

Question 15

Sequestration?

Answer 15

Desiccated disc material free in canal

Question 16

Bulging?

Answer 16

Nucleus is contained, annulus bulging

Question 17

Which cervical vertebrae most commonly prolapse?

Answer 17

C5/6

Question 18

In which region of the spine are disc prolapses most common?

Answer 18

Lumbar region

Question 19

In which region of the spine are disc prolapses least common?

Answer 19

Thoracic

Question 20

Although thoracic prolapses are rarer, if they occur, which vertebrae are most commonly affected?

Answer 20

T11/12

Question 21

Why are most lumbar prolapses postero-lateral?

Answer 21

Posterior longitudinal ligament is the weakest

Question 22

Which lumbar vertebrae are most commonly affected by prolapse?

Answer 22

L4/5 or L5/S1

Question 23

What is usually the symptoms of a lumbar disc prolapse?

Answer 23

Pain which goes right down the leg into the foot

Question 24

If there is a prolapsed disc at L5/S1, which nerve root will be compressed?

Answer 24

S1

Question 25

Where is there sensory loss when there is a L5/S1 prolapse?

Answer 25

Little toe and sole of foot ->because nerve root compressed is S1

Question 26

When will there be motor weakness in an L5/S1 prolapse?

Answer 26

Plantarflexion of foot

Question 27

Which, if any, reflex change will be present in an L5/S1 prolapse?

Answer 27

Ankle jerk ->these questions he said we would be expected to know the details of

Question 28

So just to round up this L5/S1 prolapse- summarise the findings.

Answer 28

S1 nerve root compressed Sensory loss of little toe and sole of foot Weakness in plantarflexion Diminished ankle jerk

Question 29

And onto the next one :) If there is a prolapsed disc at L4/5, which nerve root will be compressed?

Answer 29

L5

Question 30

Where is there sensory loss when there is a L4/5 prolapse?

Answer 30

Great toe and 1st dorsal web space

Question 31

Where will there be motor weakness in an L4/5 prolapse?

Answer 31

Extensor hallicus longus

Question 32

Which, if any, reflex change will be present in an L4/5 prolapse?

Answer 32

No changes

Question 33

So just to round up this L4/5 prolapse- summarise the findings.

Answer 33

L5 nerve root compressed Sensory loss of great toe and 1st dorsal web space Motor weakness of EHL No reflex changes

Question 34

And onto the next one :) If there is a prolapsed disc at L3/4, which nerve root will be compressed?

Answer 34

L4

Question 35

Where is there sensory loss when there is a L3/4 prolapse?

Answer 35

Medial aspect of lower leg

Question 36

Where will there be motor weakness in an L3/4 prolapse?

Answer 36

Quadricep muscles

Question 37

Which, if any, reflex change will be present in an L3/4 prolapse?

Answer 37

Knee jerk

Question 38

So just to round up this L3/4 prolapse- summarise the findings.

Answer 38

L4 nerve root compressed Sensory loss in medial aspect of lower leg Motor weakness in quads Knee jerk reflex affected

Question 39

Which spinal cord compression condition is a surgical emergency?

Answer 39

Cauda Equina syndrome

Question 40

Cauda Equina syndrome?

Answer 40

Compression of the cauda equina

Question 41

If you suspect a patient has cauda equina syndrome, what is done?

Answer 41

Admission Urgent MRI Emergency operation within 48hrs of onset ->if operation is delayed, will result in permanent dysfunction

Question 42

In cauda equina syndrome, the sacral nerve roots are compressed. What can this result in?

Answer 42

Permanent bladder and anal sphincter dysfunction and incontinence

Question 43

Causes of Cauda Equina Syndrome?

Answer 43

Central lumbar disc prolapse- most common Tumours Trauma Infection- epidural abscess Iatrogenic- spinal surgery or manipulation, spinal epidural

Question 44

Clinical features of Cauda Equina syndrome?

Answer 44

Injury or precipitating event Bilateral buttock and leg pain, varying dysaethsiae and weakness Bowel or bladder dysfunction Upon PR exam- loss of anal tone and reflex, saddle anaethesia

Question 45

When would there be a high index of suspicion of Cauda Equina Syndrome?

Answer 45

In spinal post-op patients with increasing leg pain in presence of urinary retention

Question 46

Which investigation is used in the diagnosis of Cauda Equina syndrome?

Answer 46

MRI ->if contraindicated, then lumbar CT myelogram

Question 47

Treatment of Cauda Equina Syndrome?

Answer 47

Always surgery

Question 48

Cervical and lumbar spondylosis?

Answer 48

Common degenerative changes at the facet joints, ligaments, discs, etc.

Question 49

What happens in severe cases of cervical and lumbar spondylosis?

Answer 49

Can compress the whole cord, not just nerve roots, causing myelopathy

Question 50

Degenerative changes of the spine can cause what to form?

Answer 50

Osteophytes ->this can cause calcification of ligaments

Question 51

What type of joints are facet joints?

Answer 51

True synovial joints

Question 52

What type of joints are IV discs?

Answer 52

Secondary cartilaginous joints

Question 53

What movements do the facet joints allow?

Answer 53

Flexion and extension

Question 54

What movements do the IV discs allows for?

Answer 54

Movement between vertebrae

Question 55

In which type of claudication does pain tend to be bilateral?

Answer 55

Spinal claudication

Question 56

Main differences between spinal and vascular claudication?

Answer 56

Spinal- bilateral, symptoms last for a while after stopping, worst down hills Vascular- unilateral usually, symptoms stop pretty quickly with rest

Question 57

Three types of spinal stenosis?

Answer 57

Lateral recess stenosis Central stenosis Foraminal stenosis

Question 58

Which type of spinal stenosis does there tend to be bilateral symptoms?

Answer 58

Central stenosis

Question 59

Treatment of lateral recess stenosis?

Answer 59

Non-operative, nerve root injection or epidural injection Surgery if symptoms persist

Question 60

Treatment of central stenosis?

Answer 60

Non-operative- exercising, pain killers, epidural steroid injection Surgery if required but major surgery although 80% improve

Question 61

Treatment of foraminal stenosis?

Answer 61

Non-operative- nerve root injection or epidural injection Surgery if injections do not help

Question 62

Spondylolisthesis?

Answer 62

When one vertebrae is translated on another (slips onto it)

Question 63

Most common cause of Spondylolisthesis?

Answer 63

Degeneration most common Trauma Tumours Infection

Question 64

Spondylosis?

Answer 64

Defect in the transverse processes

Question 65

Treatment of spondylotisthesis?

Answer 65

Conservative with lifestyle changes Surgery for persistent pain +/- nerve root entrapment