the spine

Question 1

what happens when disc material presses on an exiting nerve root

Answer 1

pain and altered sensation in. a dermatomal distribution as well as reduced power in a myotomal distribution

Question 2

where is the most common site for disc material to press on a root

Answer 2

lower lumbar spine, L4 L5 and S1

Question 3

what is the type of pain in sciatica

Answer 3

a neuralgic burning or severe tingling pain radiating down the back of the thigh to below the knee.

Question 4

what happens in L3/4 prolapse

Answer 4

• L4 root entrapment

- pain down to medial ankle, loss of quadriceps power, reduced knee jerk

Question 5

what happens in L4/5 prolapse

Answer 5

• L5 root entrapment

- pain down dorsum of foot, reduced power extensor hallicus longus and tibialis anterior

Question 6

what happens in L5/S1 prolapse

Answer 6

• S1 root entrapment

- pain to sole of foot, reduced power planarflexion, reduced ankle jerks

Question 7

first line treatment for sciatica

Answer 7

• analgesia
• maintaining mobility
• physiotherapy
• occasionally gabapentin

Question 8

when is surgery indicated for sciatica

Answer 8

when pain is not resolving despite physiotherapy and there are localising signs suggesting a specific nerve root involvement and positive MRI evidence of nerve root compression

Question 9

what can OA of the facet joints result in

Answer 9

osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica

Question 10

what is spinal stenosis

Answer 10

when with spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis, the cauda equina has less space

Question 11

give features of the pain in spinal stenosis

Answer 11

claudication

• the claudication is distance and inconsistent
• pain is burning
• pain is less walking uphill
• pedal pulses are preserved

Question 12

what is cauda equina syndrome

Answer 12

when a very large central disc prolapse can compres all the nerve roots of the cauda equina producing cauda equina syndrome

Question 13

why is cauda equina syndrome a surgical emergency

Answer 13

as affected nerve roots include the sacral nerves which control urination and defaecation

Question 14

symptoms of cauda equina syndrome

Answer 14

• bilateral leg pain
• paraesthesiae
• numbness
• saddle anaesthesia
• altered urinary function
• incontinence
• faecal incontinence and constipation

Question 15

investigations for cauda equina syndrome

Answer 15

• RECTAL EXAM

- urgent MRI

Question 16

what causes spontaneous osteoporotic crush fractures

Answer 16

severe osteoporosis

Question 17

what do crush fractures cause

Answer 17

acute pain and kyphosis

Question 18

symptoms of spondylosis in the cervical spine

Answer 18

• slow onset stiffness

- pain in neck which can radiate to shoulders and occiput

Question 19

treatment for spondylosis in cervical spine

Answer 19

analgesics and physio

Question 20

symptoms of nerve root compression

Answer 20

-shooting neuralgic pain down a dermatomal distribution with weakness and loss of relfexes

Question 21

what will acute and degenerative disc prolapse cause in the cervical spine

Answer 21

neck pain and potentially nerve root compression

Question 22

what can a large central prolapse of the cervical spine cause

Answer 22

can compress the cord leading to a myelopathy with upper motor neurone symptoms and signs.

Question 23

what conditions are associated with atraumatic cervical spine instability

Answer 23

• down syndrome

- rheumatoid arthritis

Question 24

what are children with down syndrome at risk of developing

Answer 24

atlanto‐axial (C1/C2) instability with subluxation potentially causing spinal cord compression

Question 25

how can rheumatoid arthritis cause atlanto-axial subluxation

Answer 25

due to destruction of the synovial joint between the atlas and the dens and rupture of the transverse ligament

Question 26

what can cause lower cervical subluxations

Answer 26

destruction of the synovialfacet joints and uncovertebral joints again with potential for cord compression (myelopathy) with upper motor neuron signs (

Question 27

what are some upper motor neuron signs

Answer 27

wide based gait, weakness, increased tone, upgoing plantar response

Question 28

which nerve passes through the carpal tunnel

Answer 28

the median nerve

Question 29

presentation of carpal tunnel syndrome

Answer 29

• parathesiae in median nerve
• worse at night
• loss of sensation and sometimes weakness in the thumb
• clumsiness in hand

Question 30

non-operative treatment of carpal tunnel syndrome

Answer 30

• wrist splints at night

- injection of corticosteroid

Question 31

surgical treatment of carpal tunnel syndrome

Answer 31

-division of the transverse carpal ligament under local anaesthetic

Question 32

what is cubital tunnel syndrome

Answer 32

compression of the ulnar nerve at the elbow behind the medial epicondyle

Question 33

symptoms of cubital tunnel syndrome

Answer 33

• paraesthesiae in the ulnar 1 1/2 fingers

- tinels test positive