Spine

Question 1

IV disc features

Answer 1

Annulus fibrosis (tear)
Nucleus pulposus (prolapse)
Discs fail with twisting movements
Disc prolapses usually poserolateral
Disc space narrowing in old age

Question 2

Nerve root pain

Answer 2

Limb pain worse than back pain
Pain is radicular
Root tension and compression signs
Dermatomes and myotomes affected

Question 3

Management nerve root pain

Answer 3

MRI
Phsyio
Strong analgesia
Referral after 12 weeks

Question 4

Cauda equina syndrome

Answer 4

Compression of caudal equina

Surgical emergency

Question 5

Management of caudal equina

Answer 5

Admission, urgent MRI scan, emergency operation within 48 hours of onset, delay results in permanent dysfunction

Question 6

Features of cauda equina

Answer 6

Sacral roots compressed
Bladder and anal sphincter dysfunction
Decreased ankle reflex,
Bilateral buttock and leg pain

Question 7

Aetiology of caudal equina

Answer 7

Central lumbar disc prolapse
Tumours, trauma
Infection
Iatrogenic

Question 8

Cervical and lumbar spondylosis

Answer 8

Degenerative change at facet joints, discs, ligaments

If severe can compress whole cord causing myelopathy (UMN signs in limbs)

Question 9

Spinal claudication (distinguish from vascular)

Answer 9

Bilateral
Sensory dysaesthesiae
Possible weakness (foot drop)
Several minutes to ease after stopping walking
Worse walking down hills (extension –> smaller canal)

Question 10

Lateral and foramina stenosis treatment

Answer 10

Non operative - nerve root injection, epidural injection

Surgery

Question 11

Central stenosis and treatment

Answer 11

canal shape - trefoil

Treatment non operative or surgical

Question 12

Spondylolisthesis

Answer 12

Bone slides over bone below (lumbrosacral most common) leads to compression
Symptoms vary with type
Lower back pain, pain and numbness, tight hamstring, kyphosis

Question 13

Spondylolisthesis treatment

Answer 13

Dependent on symptoms
Conservative with lifestle changes
Surgery for persistent pain +/- nerve root entrapment