The Lumbar Spine

Question 1

What are risk factors of mechanical back pain

Answer 1

Obesity
Poor posture
Sedentary lifestyle;e
Conditioning f paraspinal muscles
Poor seating
Incorrect manual handling

Question 2

How is mechanical back pain characterised

Answer 2

Pain when the spine is loaded
Worsens with exercise
Relieved by rest

Question 3

What happens to the nucleus pulposus of intervertebral discs with age

Answer 3

Dehydrate

Question 4

What does dehydration of the of the intervertebral discs cause

Answer 4

Decrease in disk height
Bulging of the discs
Alteration of the load stresses on the joints

Question 5

Name two degenerative changes in the vertebral column

Answer 5

Disc degeneration and marginal osteophytosis

Question 6

What is marginal osteophytosis

Answer 6

When syndesmophytes (osteophytes) develop adjacent to the end plates of the discs

Question 7

The facet joints develop osteoarthritic changes. This is deemed as painful as they are inebriated by which nerve

Answer 7

Meningeal branch of the spinal nerve

Question 8

Compression of the spinal nerve can occur due to decreases in disc height and arthritis of the facet joints and vertebral bodies and the decrease in intervertebral foraminifera size. This is causes pain that is perceived as …..

Answer 8

Radicular or nerve pain

Question 9

90% of herniated disks resolve in what time frame

Answer 9

3 months

Question 10

What are the four stages of disc herniation?

Answer 10

1) disc degeneration - chemical changes associated with ageing causing discs to dehydrate and bulge
2) prolapse - protrusion of the nucleus pulposus occurs with slight impingement into the spinal canal. The nucleus pulposus is contained within a rim of annulus fibrosus
3) extrusion - nucleus pulposus breaks through the annulus fibrosus but is still contained within the disc space
4) sequestration - the nucleus pulposus separates from the main body of the disc and enters the spinal canal

Question 11

Which discs are the most common sites for a dick heriation

Answer 11

L4/5
L5/S1
Due to the mechanical loading at these joints

Question 12

With regard to disc herniation, the nerve roots are most vulnerable at what two sites?

Answer 12

1) where they cross the intervertebral disc (paracentrically)
2) where they exit the spinal canal into the neural foramen

Question 13

What direction does the nucleus pulposus most commonly herniate

Answer 13

Posterolaterally

Lateral to the posterior longitudinal ligament

Question 14

In a posterolateral disk herniation, where does the spinal nerve common get compressed?

And what is the name of this prolapse

Answer 14

Intervertebral foramen

This is a paracentral prolapse

Question 15

Wha part of the nerve root is most at risk in a far lateral prolapse

Answer 15

The exiting nerve route as it emerges at the same level as the intervertebral disc

Question 16

Which nerve root is at risk in a paracentral herniation

Answer 16

The traversing nerve root

Question 17

What nerve roots contribute to the sciatic nerve

Answer 17

L4
L5
S1
S2
S3

Question 18

Name some causes of sciatica

Answer 18

Marginal osteophytosis

Slipped disc

Question 19

What is the distribution of pain for L4 sciatica

Answer 19

Anterior thigh
Anterior knee
Medial leg

Question 20

In sciatica, where would paraesthesia occur

Answer 20

Only in the affected dermatome

Question 21

What is the typical distribution of pain for L5 sciatica

Answer 21

Lateral thigh
Lateral leg
Dorsum of the foot

Question 22

What is the typical distribution of pain in S1 sciatica

Answer 22

Posterior thigh
Posterior leg
Heel
Sole of foot

Question 23

Name some causes of cauda equina syndrome

Answer 23

Disc prolapse (5%)
Tumours
Spinal infection/abscess
Spinal stenosis secondary to arthritis
Vertebral fracture
Spinal haemorrhage

Late stage ankylosing spondylitis

Question 24

What are the red flag symptoms of cauda equina syndrome

Answer 24

Bilateral sciatica
Perianal numbness
Painless urine retention
Urinary/faecal incontinence
Erectile dysfunction

Question 25

To avoid a poor prognosis, how does cauda equina syndrome need to be treated

Answer 25

Surgical decompression within 48 hrs of the onset of sphincter symptoms

Question 26

What is spinal canal stenosis

Answer 26

An abnormal narrowing of the spinal canal that compressed either the spinal cord or the nerve roots

Question 27

Name some causes of spinal canal stenosis

Answer 27

``` Disc bulging Facet joint OA Ligamentum flavum hypertrophy Compression fractures of the vertebral bodies Spondylolisthesis Trauma ```

Question 28

The symptoms of spinal canal stenosis dependent he region of the cord or nerve roots that are affected, what are some symptoms?

Answer 28

``` Discomfort when standing Pain in shoulder, arm, hand (cervical) Pain in lower limb (lumbar) Numb at or below level of stenosis Weakness at or below level of stenosis Neurogenic claudication ```

Question 29

Is neurogenic claudication is a symptom or diagnosis?

Answer 29

Symptom

Question 30

How does neurogenic claudication arise

Answer 30

Compression of spinal nerves as they emerge from the lumbosacral spine. This leads to engorement of the nerve roots during exercise, leading to reduced arterial inflow and transient arterial ischaemia. Ischaemia of the affected nerves results in pain &/or paraesthesia.

Question 31

Describe how flexion and extension relieves the symptoms of neurogenic claudication

Answer 31

Flexion relieves as it enlarges the spinal canal Extension narrows the spinal canal

Question 32

What is spondylolisthesis

Answer 32

Anterior displacement of the vertebrae above on the vertebrae below

Question 33

What are some symptoms of spondylolisthesis

Answer 33

Occasional lower back pain Incapacitating mechanical pain Sciatica

Question 34

In a lumbar puncture, where does the fluid come from

Answer 34

The subarachnoid space

Question 35

In a lumbar puncture, where is the needle inserted

Answer 35

In the midline between the spinous processes of the L3 & L4 (or L4 & L5) vertebrae