Spine Flashcards
what normal aging changes occur in the spine?
> decrease in water conc. of the IV disc
disc space narrows
degenerative facet joint changes
what pathological changes can occur with aging?
> nerve root compression by osteophytes
spondylosis/spondylolisthesis
central spinal stenosis
tearing of annulus fibrosis and protrusion of nucleus
how does nerve root pain present?
> root tension signs
root compression sings
pain in nerve root distribution
what investigation would you carry out in nerve root pain?
MRI
what management would you carry out for nerve root pain?
> physiotherapy
analgesia
(most settle in 3 months)
describe the pathophysiology in cervical and lumbar spondylosis
degenerative changes in the discs, facet joints and ligaments
severe there is compression of the whole cord leading to myelopathy
how does spinal claudication present?
> bilateral > sensory dysesthesia > weakness (foot dropping) > takes minutes to cease after resting > worse downhill
what is spondylolysis?
bony defect between the transverse process and the lamina (due to stress fracture?)
what is spondylolisthesis?
forward shift of one vertebrae onto another
what management options are there for spondylolisthesis?
> conservative (lifestyle)
> surgery if there is persistent pain or nerve entrapment
what is the management of lateral recess stenosis?
> surgery
nerve root injection
epidural injection
what is the management of central stenosis?
> epidural steroid injection
> surgery
what is the management of foraminal stenosis?
> surgery
epidural injection
nerve root injection
what is the aetiology of cauda equina syndrome?
> central lumber disc prolapse > tumours > trauma > iatrogenic > spinal stenosis > infection (epidural abscess)
what are the clinical features of cauda equina syndrome?
> bladder/ bowel dysfunction > weakness > saddle anaesthesia > loss of anal tone and reflex > (increased suspicion in spinal post op patient with increasing leg pain and urinary retention)
what investigation would you carry out in suspected cauda equina syndrome?
urgent MRI
within what time frame should you operate in cauda equina syndrome?
48 hours
what is the outcome of cauda equina syndrome?
> 25% perianal anaesthesia > 33% sensory deficits > 25% motor deficits > 26% sexual dysfunction > 30% will not regain urinary function
what is disc sequestration?
desiccated disc material free in the canal
what is disc extrusion?
nucleus through the annulus but in continuity
what is disc protrusion?
annulus weakened but intact
what disc prolapse is the most common?
cervical C5-C6
at what level do most thoracic disc prolapses occur?
T8-12
