spine Flashcards
back pain syndromes
mechanical
back pain with nerve root pain
serious pathology
some causes of low back pain
disc herniation, ankylosing spondylitis, inflammatory bowel disease.
causes of low back pain
spondylogenic neurogenic viscerogenic vascular psychogenic
mechnanical back pain
reassurance managed in primary care avoid bed rest keep active fails to settle-physiotherapy may consider alternative therapy facet join injection accupuncuture
prolapsed intervertebral disc
lateral disc protusion- nerve root compression
central disc protrusion-
compressed roots within cauda equina
intervertebral discs
secondary cartilaginous joint
largest a vasular structure
ALL and PLL
anterior posterior longitudinal ligament
fibres of the annulus fibrosis run obliquely and alternately between layers
discs fail with twisting movements
nucleus pulposus
collagen and proteoglycans (hydrophilic)
disc prolapse usually postero lateral
normal ageing
decreased water content
disc space narrowing
degenerative changes
aggravated by smoking
nerve root pain
limb pain worse than back pain pain in nerve root distribution (radicular) dermatomes physiotherapy strong analgesia MRI scans
disc problems
bulge
protrusion
herniation
sequestration
most common cervical site for disc prolapse
C5/C6
thoracic disc prolapse
very uncommon
mostly T/11/12
lumbar
L4/L5 most common followed by L5/S1
posterolateral (PLL weakest)
cauda equina syndrome
cauda equina compression
surgical emergency
usually due to central lumbar herniated disc
clinical feat:
precipitating event
location (bilat buttock and leg pain +dysasthesia weakness)
bowel or bladder dysfunction
saddle anaesthesia, loss of anal tone and anal reflex
HIGH SUSPICION IN SPINAL POST OP PATIENTS WITH INCREASING LEG PAIN IN URINARY RETENTION.
treatment operative
cervical and lumbar spondylosis
degenerative change
-Facet joints
discs
cervical spine
foramen transversarium- transmit vertebral artery, may get occluded in cervical spondylosis causing LOC
Bifid spinous process (excpt c1 & C7)
C7 vertebra prominens
cervical spondylosis
treatment non operative
facets joins (true synovial joints)
flexion and extension
ligaments
ALL, PLL, ligamentum flavum
interspinous and supraspinous ligaments
intertranverse ligament
distinguishing spinal from vascular claudication
usually bilateral
sensory dysaesthesiae
poss weakness takes several minutes to ease after stopping walking
worse walking down hill worse cause of extension
spinal stenosis
lateral recess
central
foraminal
treatment
non operative
nerve root injection
epidural injection surgery
(central no nerve root injection)
spondylolysis
defect of pars interarticularis
spondylolisthesis
anterior vetebral translation of above vertebra on below vertebra
spondylolysis symptoms
low back pain
occasional radicular symptoms
oblique radiograph indicating spondylolysis
scotty dog (wearing a collar at L4)
spondylolisthesis
classification
radiographic (meyerding
aetiologic (wiltse)
