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Year 2- MSK > Spinal Symposium: Spine Degeneration, Low Back Pain, Disc Prolapse, Spinal Stenosis > Flashcards

Spinal Symposium: Spine Degeneration, Low Back Pain, Disc Prolapse, Spinal Stenosis Flashcards

1
Q

RECAP- which level does the spinal cord usually end at?

A

L1

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2
Q

What is the most common type of disc prolapse direction?

A

Postero-lateral

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3
Q

RECAP-Type of joint of IV discs?

A

Secondary cartilaginous joints

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4
Q

RECAP- two parts of intervertebral discs?

A

Annulus fibrosis- tough outer layer
Nucleus pulposus- core

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5
Q

RECAP- which ligaments connect the IV discs with the bodies?

A

Anterior and posterior longitudinal ligaments

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6
Q

What happens to the IV discs with ageing?

A

Decreased water content so disc spaces narrow

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7
Q

What aggravates the degeneration of IV discs?

A

Smoking

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8
Q

Nerve root pain is fairly common. What can be done for it?

A

90% settles in three months
Physiotherpay
Strong analgesia

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9
Q

When do you refer for nerve root pain?

A

Ongoing for > 12 weeks

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10
Q

What imaging is done for nerve root pain?

A

MRI

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11
Q

What is meant by radicular pain?

A

Pain in a nerve root distribution

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12
Q

Four types of disc problem?

A

Bulge
Protrusion
Extrusion
Sequestration

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13
Q

Protrusion?

A

Annulus weakened but still in tact
Nucleus is elongated

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14
Q

Extrusion?

A

Through annulus but in continuity

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15
Q

Sequestration?

A

Desiccated disc material free in canal

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16
Q

Bulging?

A

Nucleus is contained, annulus bulging

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17
Q

Which cervical vertebrae most commonly prolapse?

A

C5/6

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18
Q

In which region of the spine are disc prolapses most common?

A

Lumbar region

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19
Q

In which region of the spine are disc prolapses least common?

A

Thoracic

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20
Q

Although thoracic prolapses are rarer, if they occur, which vertebrae are most commonly affected?

A

T11/12

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21
Q

Why are most lumbar prolapses postero-lateral?

A

Posterior longitudinal ligament is the weakest

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22
Q

Which lumbar vertebrae are most commonly affected by prolapse?

A

L4/5 or L5/S1

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23
Q

What is usually the symptoms of a lumbar disc prolapse?

A

Pain which goes right down the leg into the foot

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24
Q

If there is a prolapsed disc at L5/S1, which nerve root will be compressed?

A

S1

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25
Q

Where is there sensory loss when there is a L5/S1 prolapse?

A

Little toe and sole of foot

->because nerve root compressed is S1

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26
Q

When will there be motor weakness in an L5/S1 prolapse?

A

Plantarflexion of foot

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27
Q

Which, if any, reflex change will be present in an L5/S1 prolapse?

A

Ankle jerk

->these questions he said we would be expected to know the details of

28
Q

So just to round up this L5/S1 prolapse- summarise the findings.

A

S1 nerve root compressed
Sensory loss of little toe and sole of foot
Weakness in plantarflexion
Diminished ankle jerk

29
Q

And onto the next one :)

If there is a prolapsed disc at L4/5, which nerve root will be compressed?

A

L5

30
Q

Where is there sensory loss when there is a L4/5 prolapse?

A

Great toe and 1st dorsal web space

31
Q

Where will there be motor weakness in an L4/5 prolapse?

A

Extensor hallicus longus

32
Q

Which, if any, reflex change will be present in an L4/5 prolapse?

A

No changes

33
Q

So just to round up this L4/5 prolapse- summarise the findings.

A

L5 nerve root compressed
Sensory loss of great toe and 1st dorsal web space
Motor weakness of EHL
No reflex changes

34
Q

And onto the next one :)

If there is a prolapsed disc at L3/4, which nerve root will be compressed?

A

L4

35
Q

Where is there sensory loss when there is a L3/4 prolapse?

A

Medial aspect of lower leg

36
Q

Where will there be motor weakness in an L3/4 prolapse?

A

Quadricep muscles

37
Q

Which, if any, reflex change will be present in an L3/4 prolapse?

A

Knee jerk

38
Q

So just to round up this L3/4 prolapse- summarise the findings.

A

L4 nerve root compressed
Sensory loss in medial aspect of lower leg
Motor weakness in quads
Knee jerk reflex affected

39
Q

Which spinal cord compression condition is a surgical emergency?

A

Cauda Equina syndrome

40
Q

Cauda Equina syndrome?

A

Compression of the cauda equina

41
Q

If you suspect a patient has cauda equina syndrome, what is done?

A

Admission
Urgent MRI
Emergency operation within 48hrs of onset

->if operation is delayed, will result in permanent dysfunction

42
Q

In cauda equina syndrome, the sacral nerve roots are compressed. What can this result in?

A

Permanent bladder and anal sphincter dysfunction and incontinence

43
Q

Causes of Cauda Equina Syndrome?

A

Central lumbar disc prolapse- most common
Tumours
Trauma
Infection- epidural abscess
Iatrogenic- spinal surgery or manipulation, spinal epidural

44
Q

Clinical features of Cauda Equina syndrome?

A

Injury or precipitating event
Bilateral buttock and leg pain, varying dysaethsiae and weakness
Bowel or bladder dysfunction
Upon PR exam- loss of anal tone and reflex, saddle anaethesia

45
Q

When would there be a high index of suspicion of Cauda Equina Syndrome?

A

In spinal post-op patients with increasing leg pain in presence of urinary retention

46
Q

Which investigation is used in the diagnosis of Cauda Equina syndrome?

A

MRI

->if contraindicated, then lumbar CT myelogram

47
Q

Treatment of Cauda Equina Syndrome?

A

Always surgery

48
Q

Cervical and lumbar spondylosis?

A

Common degenerative changes at the facet joints, ligaments, discs, etc.

49
Q

What happens in severe cases of cervical and lumbar spondylosis?

A

Can compress the whole cord, not just nerve roots, causing myelopathy

50
Q

Degenerative changes of the spine can cause what to form?

A

Osteophytes

->this can cause calcification of ligaments

51
Q

What type of joints are facet joints?

A

True synovial joints

52
Q

What type of joints are IV discs?

A

Secondary cartilaginous joints

53
Q

What movements do the facet joints allow?

A

Flexion and extension

54
Q

What movements do the IV discs allows for?

A

Movement between vertebrae

55
Q

In which type of claudication does pain tend to be bilateral?

A

Spinal claudication

56
Q

Main differences between spinal and vascular claudication?

A

Spinal- bilateral, symptoms last for a while after stopping, worst down hills

Vascular- unilateral usually, symptoms stop pretty quickly with rest

57
Q

Three types of spinal stenosis?

A

Lateral recess stenosis
Central stenosis
Foraminal stenosis

58
Q

Which type of spinal stenosis does there tend to be bilateral symptoms?

A

Central stenosis

59
Q

Treatment of lateral recess stenosis?

A

Non-operative, nerve root injection or epidural injection

Surgery if symptoms persist

60
Q

Treatment of central stenosis?

A

Non-operative- exercising, pain killers, epidural steroid injection

Surgery if required but major surgery although 80% improve

61
Q

Treatment of foraminal stenosis?

A

Non-operative- nerve root injection or epidural injection

Surgery if injections do not help

62
Q

Spondylolisthesis?

A

When one vertebrae is translated on another (slips onto it)

63
Q

Most common cause of Spondylolisthesis?

A

Degeneration most common
Trauma
Tumours
Infection

64
Q

Spondylosis?

A

Defect in the transverse processes

65
Q

Treatment of spondylotisthesis?

A

Conservative with lifestyle changes
Surgery for persistent pain +/- nerve root entrapment

66
Q
A

Year 2- MSK (36 decks)

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