Lumbar Prolapsed Disc Flashcards

1
Q

Findings on examination for LPD

A
  • passive SLR +ve - 30-70 degrees usually
  • Reduce ROM lumbar spine due to paraspinal spasm
  • Myotome weakness -if neurological component
  • Dermatome parasthesia - if neurological component
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2
Q

Mytomes and actions which will be affected

A

L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - toe extension
S1 - ankle plantarflexion

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3
Q

Cause of prolapse disc

A
  • Same as degenerative disc disease card
  • Disc dehydration
  • = tears in annulus fibrosus
  • = herniation of nucleus pulposus
  • = compression of spinal nerve (traversing in lumbar, exiting in cervical but both will be second disc mentioned eg C5-C6 disc compresses C6 and L5-S1 disc compresses S1)
  • Then fibrosis and ostephyte formation
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4
Q

Progression of LPD

A
  • Initially localised back pain
  • Then radicular pain and parasthesia
  • Stiffness, worsening muscle tenderness
  • Reduced ROM
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5
Q

When to investigate prolapsed disc?

A

Same as degen disc disease:
* Any red flags
* Radiculopathy >6 weeks
* SCC evidence
* Imaging will significantly alter management

Most patients with mild do not need imaging

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6
Q

Management of prolapsed disc

A

As long as no red flags present:
* Simple analgesics and then neuropathic analgesics if needed (eg gabapentin, amytriptyline)
* Encourage mobility
* Physio
* If pain >3 months refer to pain clinic

If all this fails:
* Surgery decompression - laminectomy + microdiscectomy
* Spinal fusion if spinal instability

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7
Q

Imaging for spine

A
  • MRI gold standard for soft tissue things
  • CT used to assess bone +/- osteoporosis
  • X-ray only if recent significant trauma, known OP or older than 70
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8
Q
A
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