Ch66 Low back pain and radiculopathy

Question 1

What proportion of people complaining of lower back pain will improve in 1 month?

Answer 1

90% (even without treatment)

Question 2

What is the embryological origin of the nucleus pulpous?

Answer 2

remnant of the notochord

Question 3

What is Schmorl’s node?

Answer 3

When disc herniates in the craniocaudal direction through the cartilaginous end plate into the vertebral body

Question 4

What is Modic’s classification?

Answer 4

Type 1 (acute/subacute)
Dark T1 Bright T2

Type 2 (replacement of bone marrow with fat)
Bright T1 Iso/bright T2

Type 3 (rare - subchondral osteosclerosis)
Dark T1 Dark T2

Question 5

What is Kambin’s triangle?

Answer 5

a right triangle bounded at the hypotenuse by the exiting nerve root, inferiorly by the superior endplate of the inferior vertebral body, and medially by the thecal sac.

Question 6

What is the largest risk factor for failed back surgery?

Answer 6

Pending legal or workers compensation claims!

Question 7

What are the 3 patterns on MRI of arachnoiditis?

Answer 7

Central adhesion of nerve roots into 1 or 2 “cords”

“empty thecal sac” pattern - roots adhere to meninges around periphery

Thecal sac filled with inflammatory tissue, no csf signal