spine

Question 1

lumbar disc prolapse

Answer 1

most common
usually L4/5 or L5/S1
L1 is end of spinal cord so affects that
can happen with twisting movements
most posterolateral
central may give pain in both legs or may be back pain only

Question 2

radicular pain

Answer 2

pain in a nerve root distribution
limp pain worse than back
fairly common
most will settle within 3 months
referral after 12 weeks
MRI imaging
strong analgesia- gabapentin and amitryptyline

Question 3

types of disc prolapse

Answer 3

bulge (generalised)
protrusion (annulus weakened but still intact)
extrusion (through annulus but in continuity)
sequestration (dessicated disc material free in canal)

Question 4

cervical disc prolapse

Answer 4

2nd most common
usually C5/6

Question 5

L5/S1 disc prolapse affects

Answer 5

S1 nerve root
little toe and sole of foot sensation loss
plantarflexion weakness
ankle jerk loss

Question 6

L4/5 disc prolapse affects

Answer 6

L5 nerve root
big toe and 1st webspace sensory loss
EHL weakness
no reflex lost

Question 7

L3/4 disc prolapse affects

Answer 7

L4 nerve root
medial aspect of lower leg sensory loss
quads weakness
knee jerk loss

Question 8

cauda equina syndrome

Answer 8

due to lumbar disc prolapse (commonest), tumours, trauma, infection, iatrogenic
compression of cauda equina
surgical emergency
MRI scan, operation within 48 hours of onset
bladder and anal sphincter dysfunction and incontinence
poor prognosis for full recovery
high index of suspicion in spinal post op, increasing leg pain in prescnse of urinary retention

Question 9

cervical and lumbar spondylosis (OA)

Answer 9

common
OA of facet and disc joints and degeneration of ligaments
degenerative change
if severe can compress whole cord causing myelopathy- UMN signs

Question 10

spinal claudication

Answer 10

narrowing of arteries in lower limb
pain on walking
usually bilateral
sensory dysaesthesiae
poss weakness
several minutes to ease after stopping walking- vascular stops immediately
worse walking down hills

Question 11

types of spinal stenosis

Answer 11

lateral recess stenosis - unilateral pain
central stenosis- bilateral pain
foraminal stenosis - unilateral pain

Question 12

lateral recess stenosis treatment

Answer 12

non operative, nerve root injection, epidural injection
surgery if symptoms persist. decompress

Question 13

central stenosis treatment

Answer 13

exercises
epidural steroid injection
surgery if doesnt improve

Question 14

foraminal stenosis treatment

Answer 14

nerve root injection
epidural injection not as effective
surgery- 70% respond
settle within 3 months

Question 15

spondylolisthesis

Answer 15

one vertebrae is translated/ slips on another
symptoms vary depending on type
treatment depends on symptoms
surgery for persistent pain and nerve root entrapment

Question 16

spondololysis

Answer 16

defect in transverse process. posterior and anterior aspects separated