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Clinical conditions for MSK > Session 2 - The lumbar spine and Associated Disorders > Flashcards

Session 2 - The lumbar spine and Associated Disorders Flashcards

1
Q

Mechanical back pain

What is this characterised as?

A

Pain when the spine is loaded and this worsens with exercise and is relieved by rest

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2
Q

Mechanical back pain

How will the pain be described and what triggers it?

A
  • Described as intermittent

- triggered by innocuous activity such as bad posture and exercise

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3
Q

Mechanical back pain

What are the risk factors?

A
  • obesity
  • poor posture
  • a sedentary lifestyle
  • incorrect manual handling techniques
  • deconditioned core muscles
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4
Q

Degenerative changes in the vertebral column

What is disc degeneration?

A

When the nucleus pulposus of the intervertebral discs dehydrates with age leading to a loss of disc height, disc bulge and alteration of the load stresses on the joints.

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5
Q

Degenerative changes in the vertebral column

What is marginal osteophytosis?

A

Formation of osteophytes(bony spurs) called syndesmophytes adjacent to endplates of the discs.

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6
Q

Degenerative changes in the vertebral column

Why may osteoarthritic changes be seen?

A

Increased stress placed on facet joints due to the disc degeneration and marginal osteophytosis

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7
Q

Degenerative changes in the vertebral column

Why may facet joint osteoarthritis be perceived as painful?

A

The facet joints are innervated by the meningeal branch of the spinal nerve.

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8
Q

Degenerative changes in the vertebral column

Why may radicular or nerve pain occur?

A

Compression of spinal nerves due to the decrease in size of the intervertebral foramina because of the disc height decrease and arthritic changes in the facet joints and vertebral bodies.

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9
Q

Herniation of an intervertebral disc (slipped disc)

Why do patients feel pain with this?

A

Pain occurs due to herniated disc material pressing on a spinal nerve.

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10
Q

Herniation of an intervertebral disc (slipped disc)

What is the most common age group for this condition?

A

30-50 years

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11
Q

Herniation of an intervertebral disc (slipped disc)

Name the 4 stages of disc herniation

A
  • Disc degeneration
  • Prolapse
  • Extrusion
  • Sequestration
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12
Q

Herniation of an intervertebral disc (slipped disc)

Disc degeneration is one of the stages of disc herniation. What occurs in this stage?

A

Discs dehydrate and bulge due to chemical changes associated with ageing.

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13
Q

Herniation of an intervertebral disc (slipped disc)

Prolapse is one of the stages of disc herniation. What occurs in this stage?

A

The nucleus pulposus is usually contained within a rim of annulus fibrosus. Protrusion of the nucleus pulposus will occur with slight impingement into the spinal canal during this stage.

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14
Q

Herniation of an intervertebral disc (slipped disc)

Extrusion is one of the stages of disc herniation. What occurs in this stage?

A

The nucleus pulposus breaks through the annulus fibrosus but is still contained within the disc space.

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15
Q

Herniation of an intervertebral disc (slipped disc)

Sequestration is one of the stages of disc herniation. What occurs in this stage?

A

The nucleus pulposus separates from the main body of the disc and enters the spinal canal

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16
Q

Herniation of an intervertebral disc (slipped disc)

Name the 2 most common sites for ‘Slipped discs’

A
  • L4/5 discs
  • L5/S1 discs
  • due to mechanical loading at these joints
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17
Q

Herniation of an intervertebral disc (slipped disc)

Name the 3 ways in which the nucleus pulposus can herniate

A
  • paracentral prolapse
  • far lateral prolapse
  • central prolapse
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18
Q

Herniation of an intervertebral disc (slipped disc)

Out of the 3 ways the nucleus pulpous herniates, what is the most common way?

A
  • Paracentral prolapse (posterolaterally - lateral to the posterior longitudinal ligament)
    occurs in 96% of the cases
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19
Q

Herniation of an intervertebral disc (slipped disc)

What is the term ‘exiting nerve root’ replying to?

A

The nerve root that emerges from the spinal canal at the same level as the intervertebral disc

20
Q

Herniation of an intervertebral disc (slipped disc)

What is the term ‘traversing nerve root’ replying to?

A

The nerve root that emerges at the level below the intervertebral disc

21
Q

Herniation of an intervertebral disc (slipped disc)

Which nerve root is at risk in a far lateral herniation?

A

Exiting nerve root

22
Q

Herniation of an intervertebral disc (slipped disc)

Which nerve root is at risk in a paracentral herniation?

A

Traversing nerve root

23
Q

Herniation of an intervertebral disc (slipped disc)

Out of the 3 ways the intervertebral disc can prolapse, which way carries a risk of causing cauda equina syndrome?

A

Central herniation

24
Q

Radicular leg pain (Sciatica)

What is Sciatica?

A

Sciatica is the name given to a pain caused by irritation or compression of one or more of the nerve roots that contribute to the sciatic nerve (L4-S3)

25
Q

Radicular leg pain (Sciatica)

What are the causes of sciatica?

A
  • marginal osteophytosis

- slipped disc

26
Q

Radicular leg pain (Sciatica)

Why is the pain experienced described as following a path from ‘from the back to the dermatome’?

A

Typically experienced in the back and buttock and

radiates to the dermatome supplied by the affected nerve root.

27
Q

Radicular leg pain (Sciatica)

Describe the typical distribution of pain with L4 sciatica?

A
  • anterior thigh
  • anterior knee
  • medial leg
28
Q

Radicular leg pain (Sciatica)

Describe the typical distribution of pain with L5 sciatica?

A
  • lateral thigh
  • lateral leg
  • dorsum of foot
29
Q

Radicular leg pain (Sciatica)

Describe the typical distribution of pain with S1 sciatica?

A
  • posterior thigh
  • posterior leg
  • heel
  • lateral border and sole of the foot
30
Q

Radicular leg pain (Sciatica)

If paraesthesia occurred, where will this be felt?

A

In the affected dermatome rather than the full path from the lumbar spine to the dermatome

31
Q

Cauda Equina Syndrome

What is the most common cause of this?

A
  • Due to a central disc prolapse

- Canal filling disc compressing the lumbar and sacral nerve roots in the spinal canal

32
Q

Cauda Equina Syndrome

What is the age group this occurs in the most?

A

30 - 50 years

33
Q

Cauda Equina Syndrome

Name 3 other causes of this

A
  • late-stage ankylosing spondylitis
  • vertebral fracture
  • spinal stenosis secondary to arthritis
34
Q

Cauda Equina Syndrome

Name the red flag symptoms for this (BUPPE)

A
  • Bilateral sciatica (L5)
  • Urinary/faecal incontinence
  • Painless retention of urine
  • Perianal numbness (saddle anaesthesia)
  • Erectile dysfunction
35
Q

Cauda Equina Syndrome

How is this treated?

A

By surgical decompression within 48 hours of the onset of sphincter symptoms, otherwise, the prognosis is poor

36
Q

Cauda Equina Syndrome

Give 3 consequences of missing this diagnosis?

A
  • Chronic neuropathic pain
  • loss of sensation and lower limb weakness requiring a wheelchair
  • Impotence
37
Q

Spinal Canal Stenosis

What is this?

A

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

38
Q

Spinal Canal Stenosis

Often affect the elderly, what are some of the causes of this?

A
  • Disc bulging
  • Facet joint osteoarthritis
  • Ligamentum flavum hypertrophy
  • Spondylolisthesis
  • Trauma
39
Q

Spinal Canal Stenosis

What type of stenosis is most common?

A

Lumbar stenosis

40
Q

Spinal Canal Stenosis

What are the symptoms? (depend on the region of the cord or nerve roots that are affected)

A
  • Discomfort whilst standing (95% of patients)
  • Discomfort or pain in the shoulder, arm or hand (for cervical stenosis) or in the lower limb (for lumbar stenosis)
  • Bilateral symptoms in approximately 70% of patients
  • Numbness at or below the level of the stenosis
  • Weakness at or below the level of the stenosis
  • Neurogenic claudication
41
Q

Neurogenic claudication

What is this?

A
  • a symptom rather than a diagnosis.

- pins and needles in the legs on prolonged standing and on walking, radiating in a sciatica distribution.

42
Q

Neurogenic claudication

Explain the pathway in which this occurs

A
  • compression of nerve roots
  • venous engorgement of nerve roots during exercise
  • reduced arterial inflow (ischaemia)
  • pain and paraesthesia
43
Q

Neurogenic claudication

How is pain relieved?

A
  • rest

- flexion of the spine

44
Q

Spondylolisthesis

What is this?

A

Anterior(forward) displacement of the vertebra above relative to the vertebra below.

45
Q

Spondylolisthesis

What is it caused by?

A

Disconnection of the vertebral body from the vertebral arch

46
Q

Spondylolisthesis

What is the treatment for this?

A

Surgical using screws and rods to stabilise the spine

47
Q

Lumbar puncture (knee-chest position)

At which vertebral level is the needle inserted?

A
  • L3/L4

- L4/L5

Clinical conditions for MSK (6 decks)

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