Spine Flashcards
Percentage of people that suffer back pain
80%
Mechanical back pain
this is by far the most common condition and tends to be positional. Certain activities may help and they may have associated thigh pain. It tends to be managed in primary care with simple analgesia and reassurance. KEEP ACTIVE. Should return to work early. 90% of them will settle in six weeks but 60% recur. However, if it fails to settle organise physiotherapy. Alternative therapy, facet joint injections and acupuncture can
Causes of back pain
- Spindylogenic
- Neurogenic
- Viscerogenic
- Vascular and
- Psychogenic
The Intervertebral Disc
A secondary cartilaginous joint
Avascular
Resist rotational movements
Fail with twisting movements
Annulus Fibrosis
Tough outer layer
Nucleus Pulposus
Gelatinous Core
Ageing process of Intervertbral Disc Pathology
- Decreased water content of discs
- Disc space narrowing
- Degenerative changes on X-rays
- Degenerative changes in the facet joints
- Aggravated by smoking
Pathological Processes Intervertebral Disc
- Tearing of the annulus fibrosis and protrusion of the nucleus
- Nerve root compression by osteophytes
- Central spinal stenosis
Nerve root pain resulting from compression by intervertebral disc
Radicular pain. There may be signs of root tension and compresion in the spread of myotomes and dermatomes.
Treatment of nerve root pain
, it will usually settle within three months. If it doesn’t treat with physiotherapy and strong analgesia and refer after 12 weeks. Occasionally MRI can be conducted.
Disc Protrusion
Annulus is weakened but still intact
Disc herniation
Protrusion of the nucleus pulposis through the annulus but in continuity
Disc Sequestration
Dessicated disc material free in the spinal canal
Cervical disc problems occur
C5/6
Thoracic disc problems occur
mid to lower levels (T8-12) and can cause central, posterolateral and lateral herniations.
Lumbar disc problems
Lumbar usually occur L4/5 (45%), followed by L5/S1 (40%) then L3/4 (10%). Most of these are posterolateral. The central disc may give pain in both legs, or may be back pain only.
Cauda Equina Syndrome
This is compression of the cauda equina due to central lumbar herniated disc, tumours, trauma, spinal stenosis, epidural abscess
Clinical features of cauda equina syndrome
bilateral buttock an leg pain and varying dysaethesia and weakness), bowel or bladder dysfunction (urinary retention and incontinence overflow). There can also be saddle anaesthesia, loss of anal tone and anal reflex. There is a high index of suspicion in spinal post-operative patients with increasing leg pain in the presence of urinary retention.
Radiological investigation of cauda equina
MRI or lumbar CT or myelogram
Treatment of cauda equina syndrome
Operative treatment within 48 hours
Outcome of Cauda Equina Syndrome
- 30% undergoing discectomy for cauda equina syndrome do not regain normal urinary function
- 25% with motor deficits never regain full power
- 33% with sensory deficit never regained normal sensation
- 25% with perianal paraesthesiae did not return to normal
- 26% had persistent sexual dysfunction
Cervical and Lumbar Spondylosis
Defect in the isthmus of the vertebra, the part between the superior and inferior facets.
Spinal Ligaments
- The anterior longitudinal ligament (ALL – along the front of the vertebral bodies is broad and strong)
- The posterior longitudinal ligament (along the back of the vertebral bodies)
- Ligamentum flavum – between the laminae
- The interspinous and supraspinous ligaments – between the spinous processes
- Intratransverse ligament – between the transverse processes
Spinal claudication
- Usually bilateral
- Sensory dysaesthesia
- Poss weakness
- Takes several minutes to ease after stopping walking
- Worse when walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding a bicycle.
Lateral recess stenosis
Nerves become compressed by the overhanging facet joints so the patient present with sciatica which is worse with standing and walking but releaved by sitting.
Treatment is nerve root injection, epidural or decompression
Central stenosis
Epidural steroid injection or surgery
Foraminal stenosis
nerve root injection
Spondylolisthesis
this is the anterior vertebral translation (slippage) of the cephalad vertebra (above) or caudad vertebra (below). It can be split into two separate things – radiographic (meyerding) and aetiologic (Wiltse
Symptoms of spondylosis
Lower back pain and occasional radicular symptoms
Investigation of spondylosis
X-ray, CT, MRI, radio-isotope bone scan
Treatment of spondylosis
injection therapy and surgery.
