Spine

Question 1

what normal aging changes occur in the spine?

Answer 1

> decrease in water conc. of the IV disc
disc space narrows
degenerative facet joint changes

Question 2

what pathological changes can occur with aging?

Answer 2

> nerve root compression by osteophytes
spondylosis/spondylolisthesis
central spinal stenosis
tearing of annulus fibrosis and protrusion of nucleus

Question 3

how does nerve root pain present?

Answer 3

> root tension signs
root compression sings
pain in nerve root distribution

Question 4

what investigation would you carry out in nerve root pain?

Answer 4

MRI

Question 5

what management would you carry out for nerve root pain?

Answer 5

> physiotherapy
analgesia
(most settle in 3 months)

Question 6

describe the pathophysiology in cervical and lumbar spondylosis

Answer 6

degenerative changes in the discs, facet joints and ligaments
severe there is compression of the whole cord leading to myelopathy

Question 7

how does spinal claudication present?

Answer 7

> bilateral
> sensory dysesthesia
> weakness (foot dropping)
> takes minutes to cease after resting
> worse downhill

Question 8

what is spondylolysis?

Answer 8

bony defect between the transverse process and the lamina (due to stress fracture?)

Question 9

what is spondylolisthesis?

Answer 9

forward shift of one vertebrae onto another

Question 10

what management options are there for spondylolisthesis?

Answer 10

> conservative (lifestyle)

> surgery if there is persistent pain or nerve entrapment

Question 11

what is the management of lateral recess stenosis?

Answer 11

> surgery
nerve root injection
epidural injection

Question 12

what is the management of central stenosis?

Answer 12

> epidural steroid injection

> surgery

Question 13

what is the management of foraminal stenosis?

Answer 13

> surgery
epidural injection
nerve root injection

Question 14

what is the aetiology of cauda equina syndrome?

Answer 14

> central lumber disc prolapse
> tumours
> trauma
> iatrogenic
> spinal stenosis
> infection (epidural abscess)

Question 15

what are the clinical features of cauda equina syndrome?

Answer 15

> 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)

Question 16

what investigation would you carry out in suspected cauda equina syndrome?

Answer 16

urgent MRI

Question 17

within what time frame should you operate in cauda equina syndrome?

Answer 17

48 hours

Question 18

what is the outcome of cauda equina syndrome?

Answer 18

> 25% perianal anaesthesia
> 33% sensory deficits
> 25% motor deficits
> 26% sexual dysfunction
> 30% will not regain urinary function

Question 19

what is disc sequestration?

Answer 19

desiccated disc material free in the canal

Question 20

what is disc extrusion?

Answer 20

nucleus through the annulus but in continuity

Question 21

what is disc protrusion?

Answer 21

annulus weakened but intact

Question 22

what disc prolapse is the most common?

Answer 22

cervical C5-C6

Question 23

at what level do most thoracic disc prolapses occur?

Answer 23

T8-12