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Mariam MSK > Spine - Prolapsed Intervertebral Disc and Spinal Stenosis > Flashcards

Spine - Prolapsed Intervertebral Disc and Spinal Stenosis Flashcards

1
Q

What connects discs with vertebral bodies?

A
  • Anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL) connect discs with vertebral bodies
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2
Q

What are the layers of the intervertebral discs?

A
  • Annulus fibrosis
    • Tough outer layer, made of collagen
    • Fibres run obliquely and alternately between layers
      • Resist rotational movement
      • Discs fail with twisting movement
  • Nucleus pulposus
    • Gelatinous core
    • Made of mainly water (88%), with collagen and proteoglycans (very hydrophilic)
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3
Q

What is the function of the annulus fibrosis?

A
  • Fibres run obliquely and alternately between layers
    • Resist rotational movement
    • Discs fail with twisting movement
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4
Q

What is the nucleus pulposus made of?

A
  • Made of mainly water (88%), with collagen and proteoglycans (very hydrophilic)
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5
Q

What can happen if the annulus fibrosis tears?

A

Nucleus prolapse

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6
Q

What can nuclear prolapse cause?

A

Cord or spinal nerve compression

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7
Q

In what direction are nucleus prolapses normally?

A
  • Prolapses are usually posterio-lateral
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8
Q

How do intervertebral discs change with ageing?

A
  • Decreased water content of discs
  • Disc space narrowing
  • Degenerative changes on x-ray and in facet joints
    • Aggravated by smoking etc
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9
Q

What movement do the facet joints between vertebrae allow?

A
  • Allow mainly flexion and extension
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10
Q

What ligaments are present in the spine?

A
  • Anterior longitudinal ligament (ALL)
    • Along front of vertebral bodies
    • Broad, strong
  • Posterior longitudinal ligament (PLL)
    • Along back of vertebral bodies
    • Narrow, weaker
  • Ligamentum flavum
    • Between laminae
  • Interspinous and supraspinous ligaments
    • Between spinal processes
  • Intertransverse ligament
    • Between transverse processes
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11
Q

Is the ALL or PLL stronger?

A

ALL is broader and stronger than PLL

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12
Q

What are some pathological processes can occur in the spine?

A
  • Tearing of annulus fibrosis and protrusion of nucleus
  • Nerve root compression by osteophytes
  • Central spinal stenosis
  • Abnormal movement
    • Spondylolysis
    • Spondylolisthesis
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13
Q

Describe the presentation of nerve root pain?

A
  • Pain in nerve route distribution (radicular)
  • Limb pain worse than back pain
  • Root tension signs
  • Root compression signs
  • Dermatomes and myotomes
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14
Q

Describe the investigations for nerve root pain?

A
  • Referral after 12 weeks
  • Imaging
    • MRI
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15
Q

Describe the treatment for nerve root pain?

A
  • Physiotherapy
  • Strong analgesia
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16
Q

What are different kinds of disc problems?

A
  • Bulge
    • Generalised
    • Common, most asymptomatic
  • Protrusion
    • Nucleus elongated instead of round
    • Annulus weakened but still in tact
  • Extrusion
    • Through annulus but in continuity
  • Sequestration
    • Desiccated disc material free in canal
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17
Q

Where does cervical disc prolpase most commonly occur?

A
  • Most commonly C5/C6
18
Q

What parts of the spine are most affected by disc prolapse?

A

Lumbar -> cervical -> thoracic

19
Q

Where do most thoracic disc prolapses occur?

A
  • Most at T11/12
20
Q

What are the 2 kinds of lumbar disc prolapse?

A
  • Central protrusion
    • Compressed cauda equina
  • Lateral protrusion
    • Most common
    • Compressed spinal nerve root
21
Q

Are central or lateral lumbar disc prolapses most common?

A

Lateral protrusion

22
Q

What vertebrae are most commonly affected by lumbar disc prolapse?

A
  • Usually L4/L5, then L5/S1 then L3/4
23
Q

In what direction is what lumbar disc prolapse?

A
  • Most are posterolateral
    • Posterior longitudinal ligament weakest
24
Q

Describe the presentation of lumbar disc prolapse?

A
  • Central disc may give pain in both legs or may be back pain only
25
Q

Describe the: sensory loss, motor weakness and reflex change due to disc prolapse at,

L5/S1

L4/5

L3/4

A
26
Q

What is cauda equina syndrome?

A

Compression of cauda equina

MEDICAL EMERGENCY

27
Q

Describe the aetiology of cauda equina syndrome?

A
  • Lumbar disc prolapse
    • Commonest
  • Tumour
  • Trauma or spinal stenosis
  • Infection
    • Epidural abscess
  • Iatrogenic
    • Spinal surgery
28
Q

What is the commonest cause of cauda equina syndrome?

A

Lumbar disc prolapse

29
Q

Describe the clinical features of cauda equina syndrome?

A

Injury/pain

Pain in bum & leg

Bowel/bladder dysfunction

Loss of perianal sensation

Loss of anal tone/reflex

30
Q

Descrbe the investigations for cauda equina syndrome?

A
  • Radiographic evaluation
    • MRI
    • If contraindicated, lumbar CT myelogram
31
Q

Describe the prongnosis of cauda equina syndrome?

A
  • Sacral nerve roots compressed, can result in permanent bladder and anal dysfunction if not treated quick
32
Q

What is spondylosis?

A

OA of facet and disc joints with degeneration of ligaments

33
Q

Describe the pathophysiology of spondylosis?

A
  • Degenerative changes as facet joints, discs, ligaments etc
  • If severe, can compress whole cord (not just nerve roots) causing myelopathy
34
Q

Describe the clinical features of cervical and lumbar spondylosis?

A
  • UMN signs in limbs
    • Increased tone, brisk reflexes etc
35
Q

What is spinal claudication?

A

Is a symptom, often caused by spinal stenosis

36
Q

Distuinguish spinal claudication from vascular claudication?

A
  • Usually bilateral
  • Sensory dysesthesia
  • Possible weakness
    • Foot drop
  • Takes several minutes to east after stopping walking
  • Worse walking down hills because spinal canal becomes small in extension, better walking uphill
37
Q

What are the different kinds of spinal stenosis?

A
  • Lateral recess stenosis
    • Nerve emerging from spine compressed
    • Unilateral symptoms
    • Treatment
      • Non-operative
      • Nerve root injection
      • Epidural injection
      • Surgery
  • Central stenosis
    • Risk factor is trefoil canal (congenital, canal shape)
    • Bilateral symptoms
    • Treatment
      • Non-operative
      • Epidural steroid injection
      • Surgery
  • Foraminal stenosis
    • Nerve root compressed just as emerges from spine
    • Treatment
      • Non-operative
      • Nerve root injection
      • Epidural injection
      • Surgery
38
Q

What is spondylolisthesis?

A

Is where one vertebra is translated onto the other

39
Q

Describe the aetiology of spondylothesis?

A
  • Degenerative
  • Congenital
  • Tumours
  • Infection
  • Fractures
40
Q

Describe the treatment of spondylolisthesis?

A
  • Depends on symptoms
  • Conservative with lifestyle changes
  • Surgery for persistent pain +/- nerve root entrapement
41
Q

What is spondylolysis?

A

Defect in transverse process, posterior elements of vertebra separate from anterior elements

Mariam MSK (31 decks)

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