Spine Pathologies Flashcards
True or false…
Lumbar spine problems can refer pain into the groin area.
True
How can L5 root compressions occur?
- degeneration of the spine
- decreased disc space
- growth of osteophytes on facet joints
- thickening of ligaments
What are (3) L5 root compression injuries?
- Disc prolapse (commonly a lifting injury)
- Fracture
- Spondylolisthesis (slip of one lumbar vertebra on another)
How does osteoporosis link to L5 root compression?
Links to degeneration + loss of space between discs, and lack of space for nerve roots
Describe spondylolisthesis.
A condition occurring when one vertebral body slips with respect to the adjacent vertebral body
What are modifiable risk factors of low back pain (LBP)?
- Physical activity level
- Cognition + emotions
- Environment
- Socioeconomic
- Cultural
- Work
- Home
- Stress
- Sleep
What are (3) non-modifiable factor of low back pain (LBP)?
- Genetics
- Gender
- Life stage
How does Cauda Equina Syndrome (CES) occur?
as a result of direct compression on the lumbosacral nerve roots distal to the conus medialis
What causes cauda equina syndrome (CES)?
- Large central disc prolapse at L4/5 or L5/S1
- Trauma
- Tumour
- Spinal canal stenosis
- Epidural haematoma
- Epidural abscess/post-op complications
What are the ‘red flag’ symptoms of Cauda Equina Syndrome (CES)?
- Severe low back pain (LBP)
- Sciatica: often bilateral but sometimes absent, (especially at L5/S1)
- Saddle and/or genital sensory disturbance
- Bladder, bowel and sexual dysfunction
- Disturbed/ataxic gait
- Objective findings (including sphincter tone on digital rectal examination)
What is Metastatic spinal cord compression (MSCC)?
Metastases = secondary malignant growths that develop at a different site to the primary cancer
Cancer cells from the primary site can travel through the blood or lymphatic system to form new tumours
What are the most common primary cancers to metastasise to the spine?
- Lung
- Breast
- Prostate
What are the symptoms of Metastatic spinal cord compression (MSCC)?
New + persistent localised back or neck pain
- Chest wall pain or other unexplained atypical pain
- Severe pain in lower back that gets worse or doesn’t go away
- Pain in the back that is worse when coughing, sneezing or straining
- Back pain that is worse at night
- Numbness, heaviness, weakness or difficulty using arms or legs
- A band of pain around the chest or abdomen or pain down an arm or leg
- Changes in sensation (e.g.: pins and needles or electric shock sensations)
- Numbness in the area around the saddle area
- Not being able to empty the bowel or bladder
- Problems controlling the bowel or bladder
What are the most common serious spinal diseases?
- Fracture
- Metastatic disease
- Spinal infection
- Cauda Equina Syndrome
- Axial Spondyloarthritis
What are some red flags/signs of cauda equina syndrome (CES)?
- Saddle anaesthesia
- Abnormal gait
- Changes / problems with bladder and/or bowel function
- Changes in sexual function
- Bilateral severe sciatica
- Severe low back pain (LBP)
- History of trauma
- History of cancer
- Severe, unremitting night pain
- Systemic upset or signs of infections
- Unexplained weight loss
What is axial spondyloarthritis an umbrella term for?
for a group of rheumatological conditions affecting predominantly the spine and pelvis
How does Axial spondyloarthritis
classically present?
Back pain and stiffness, worse in the morning, eases with exercise
(Chronic, progressive inflammatory disease resulting in skeletal changes
Pain is constant with intermittent, severe flare ups)
What can Axial spondyloarthritis be commonly associated with?
non-MSK symptoms like fatigue, IBS, eye symptoms
What does spinal infection include?
- Discitis
- Epidural abscess
- Septic facet joints
- Spondylitis
- TB
How do patients with spinal infection usually present?
- Severe, unremitting, non-mechanical spinal pain (but symptoms can take several weeks or months to become severe)
- Fever is common but not always present
What are some risk factors for spinal infection?
- HIV
- Recent surgery
- Malignancy
- Diabetes
Where is spinal metastasis most commonly found?
Thoracic Vertebrae
(but can be present in other areas of the spine + the local cord & soft tissues)
What is radiculopathy?
Neuropathic pain
- derived from the nerve itself or its connective tissue by mechanical or chemical stimulation
(5-10% LBP patients)
What can be the mechanical stimulation of radiculopathy?
Compression from a disc, osteophyte or stenosis
What can be the chemical stimulation of radiculopathy?
- Inflammatory chemicals
- Infection
What can radiculopathy be characterised by?
- Severe, referred pain (often burning, sharp or shooting in nature with more pain distally a common feature, (and minimal LBP not uncommon))
- Pain can refer along a dermatomal pattern, or along a specific nerve (e.g.: sciatic or femoral nerve)
- Often accompanied with neurological symptoms (P&N/numbness), and/or neuro integrity deficits (D, M and R changes).
What are the aggs of Stenotic/Neurogenic Claudication?
- Standing
- Walking
- Extension
What are the eases of Stenotic/Neurogenic Claudication?
- Sitting
- Flexion
What are the aggs of Discogenic?
- Bending
- Flexion
- Cough/sneeze
What are the eases of Discogenic?
- Prone
- Extension
What are some anatomical factors that can contribute to non-specific lower back pain (LBP)?
from the tissues as in more nociceptive/radicular pain patterns
What are some processing factors that can contribute to non-specific lower back pain (LBP)?
from the brain as in centrally driven pain patterns
What is spondylolisthesis graded based on?
the degree of slippage of one vertebral body on the adjacent vertebral body
What does spondylolisthesis cause (pain wise)?
radicular or mechanical symptoms or pain
What are non-spinal causes of low-back pain (LBP)?
- Hip disease
- Visceral causes (e.g.: pancreatis, endometriosis, kidney stones)
- Vascular causes (e.g.: abdominal aortic aneurysm, claudication)
- Systemic causes (e.g.: endocarditis)
- Viral syndromes
What are some examples of serious spinal diseases?
- Vertebral fracture
- Metastatic disease
- Spinal infection
- Axial spondyloarthritis
- Cauda equina syndrome
What are some examples of radicular pain or neurogenic claudication?
- Radicular pain
- Radiculopathy
- Spinal stenosis
What are some examples of nonspecific low-back pain (LBP)?
- Acute non-specific LBP
- Persistent non-specific LBP
How is Persistent non-specific low-back pain (LBP) usually treated?
- Pain and movement education
- General movement, activity and fitness advice
- Generalise exercise programme
- Healthy lifestyle advice
What are the signs & symptoms (S&S) of spinal fractures?
- Severe localised pain
- Reduced ROM
- +/- neurological symptoms
What symptoms would make you think that a patient might be getting hip pain referred from their lumbar spine?
- Normal hip strength
- Full hip ROM with OP
- Lower back pain
