2.2. Spine - Prolapsed Intervertebral Disk and Cauda Equina Syndrome Flashcards Preview

3rd Year - MSK Diseases > 2.2. Spine - Prolapsed Intervertebral Disk and Cauda Equina Syndrome > Flashcards

Flashcards in 2.2. Spine - Prolapsed Intervertebral Disk and Cauda Equina Syndrome Deck (27):
1

What are the 2 types of Disk Protrusion which occur in the Lumbar Region, causing pain?

1. Lateral Disk Protrusion
2. Central Disk Protrusion

2

What are the Features of the Intervertebral Disks?

1. They are Secondary Cartilaginous Joints
2. It is the largest Avascular Structure in the Body
3. It contains 2 Layers:
3. a) Annulus Fibrosus (Tough outer layer)
3. b) Nucleus Pulposus (Gelatinous Core)

3

What happens during a Prolapsed Disk?

The Annulus Fibrosus (Tough outer layer) tears and the Nucleus Pulposus prolapses - causing cord / nerve root compression

4

What are the 2 types of Disk Protrusion which occur in the Lumbar Region, causing pain?

1. Lateral Disk Protrusion (Compresses Nerve Roots)
2. Central Disk Protrusion (Compresses Roots within the Cauda Equina)

5

What does the Cartilaginous End-Plate of each Intervertebral Disk attach to?

The Bony End-Plate of the Vertebrae

6

What movements do the Intervertebral Disks resist?

Rotational Movement - The fibres of the Annulus Fibrosus run obliquely and alternately between layers
Note - Disks fail with twisting movements

7

What happens during the normal aging process?

1. The water contents of the Disk Decreases
2. The Disk space narrows causing "Degenerative changes" on X-Rays and in the Facet Joints

8

What are common pathological process of the Intervertebral Disk Protrusion?

1. Tearing of the Annulus Fibrosis and Protrusion of the Nucleus Pulposus
2. Nerve Root Compression by Osteophytes
3. Central Spinal Stenosis
4. Abnormal Movement:
4. a) Spondylolysis
4. b) Spondylolisthesis

9

What are the features of Nerve Root Pain?

1. Limb Pain is worse than Back Pain
2. Pain in a Nerve Root Distribution (Radicular)
3. Root Tension Signs
4. Root Compression Signs
5. Dermatomes and Myotomes affected

10

How is Nerve Root Pain managed?

1. About 90% settle in 3 months
2. Physiotherapy
3. Stong Analgesia
4. Referral after 12 weeks for MRI (imaging)

11

What are the 4 types of Disk Problems, which can cause Nerve Root Pain?

1. Disk Bulge
2. Disk Protrusion
3. Disk Herniation
4. Disk Sequestration

12

What is a Disk Bulge?

Generalized enlargement of the Disk
Note - this is common and the majority are asymptomatic

13

What is a Disk Protrusion?

The Annulus Fibrosus is weakened but still in tact

14

What is a Disk Herniation?

The Nucleus Fibrosus has run through the Annulus Fibrosus (it is no longer still in tact)

15

What is a Disk Sequestration?

Dessicated Disk Material is Free in the Canal

16

Where do Disk Problems most commonly occur, in the Thoracic Region?

Mid to Lower Levels (75% at T8-12), with Most occurring at T11/12
Note - This accounts for <1% of Intervertebral Disk Prolapses

17

Where do Disk Problems most commonly occur, in the Thoracic Region?

Mid to Lower Levels (75% at T8-12), with Most occurring at T11/12
Note - This accounts for <1% of Intervertebral Disk Prolapses

18

Where do Disk Problems most commonly occur, in the Lumbar Region?

1. L4/5 (45%)
2. L5/S1 (40%)
3. L3/4 (10%)

19

What type of Herniation commonly occurs at the Lumbar Region?

Posterolateral

20

How does Central Disk Protrusion, from the Lumbar Region, present?

1. Pain in both legs
2. Pain in the back only

21

What is the common name for a Central Disk Protrusion in the Lumbar Region?

Cauda Equina Syndrome

22

How serious is Cauda Equina Syndrome?

It is a Surgical Emergency

23

Other than a Central Lumbar Herniated Disk, what can cause Cauda Equina Syndrome?

1. Tumours
2. Trauma
3. Spinal Stenosis
4. Epidural Abscess
5. Iatrogenic:
5. a) Spinal Manipulation
5. b) Spinal Epidural
5. c) Surgery

24

What are the Clinical Features of Cauda Equina Syndrome?

1. Injury / Precipitating Event
2. Bilateral Buttock + Leg Pain
3. Varying Dysaethesia + Weaknes
4. Bowel / Bladder Dysfunction
5. Saddle Anaesthesia - Loss of Anal Tone & Reflex
6. High index of suspicion in Spinal Post-op patients

25

How is the severity of Cauda Equina Syndrome evaluated?

1. MRI
2. Lumbar CT or Myelogram (if MRI is contraindicated)

26

What are the potential outcomes of Cauda Equina Syndrome?

1. 30% undergoing discectomy did NOT regain normal Urinary Function
2. 25% with motor deficits never regained full power
3. 33% with sensory deficits never regained normal sensation
4. 25% with perianal paraesthesia did not return to norma
5. 26% had persistent Sexual Dysfunction

27

What are the potential outcomes of Cauda Equina Syndrome?

1. 30% undergoing discectomy did NOT regain normal Urinary Function
2. 25% with motor deficits never regained full power
3. 33% with sensory deficits never regained normal sensation
4. 25% with perianal paraesthesia did not return to norma
5. 26% had persistend Sexual Dysfunction

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