Classification of vertebral conditions

Question 1

What are the two main classes of vertebral conditions?

Answer 1

Related to spondylitides

Related to the nervous tissue

Question 2

What are the 3 diseases studied that relate to the spondylitides?

Answer 2

Aches and sprains
Mechanical back pain
Spondylolisthesis

Question 3

What are the 2 diseases studied that relate to the nervous tissue?

Answer 3

Disc prolapse

Bony root entrapment

Question 4

What causes the majority of back pain?

Answer 4

Awkward twisting or poor lifting - muscle/ligament injuries

Question 5

When you lift a heavy object you should decrease the distance between the object and the back, why is this?

Answer 5

Decreases the leverage and the spinal loading

Question 6

What is the management of back sprains?

Answer 6

Simple analgesia or NSAIDs

Question 7

What are the two main possible causes of mechanical back pain?

Answer 7

Spondylosis

Primary OA

Question 8

Define spondylosis

Answer 8

Degeneration of the intervertebral disc

Question 9

How do people develop secondary OA with spondylosis?

Answer 9

The degeneration of the intervertebrail disc causes increased loading of the facet joints

Question 10

What are the signs and symptoms of mechanical back pain?

Answer 10

Tends to recur - this doesnt mean the condition is deteriorating
No neurological signs

Question 11

What is the management of mechanical back pain?

Answer 11

Physio

NSAIDs and simple analgesics

Question 12

Why may an osteopath or chiropracter be useful in mechanical back pain?

Answer 12

May be able to ease to condition using manipulation

Question 13

Define spondylolithesis

Answer 13

Slippage of one vertebra relative to the one below

Question 14

Where is spondylolithesis commonly seen?

Answer 14

Lumbar spine

Question 15

The two types of spondylolithesis are congenital and acquired. How does acquired commonly occur?

Answer 15

Follows an acture or more likely a fatigue fracture of the pars interarticularis

Question 16

Why does one vertebra slip over the other in spondylolithesis?

Answer 16

Due to a bony abnormality which interferes with the stability of the facet joints and associated bony and ligamentous elements

Question 17

How does sponylolithesis present?

Answer 17

Almost identically to mechanical back pain

Question 18

How may the presentation of congenital spondylolithesis differ from acquired?

Answer 18

Congenital may have neurological signs

This is uncommon in acquired even if major/severe

Question 19

How do you diagnose spondylolithesis?

Answer 19

x-ray

Question 20

What is the management of spondylolithesis?

Answer 20

Spinal corset
NSAIDs and simple analgesia
Surgery

Question 21

What is the surgery for spondylolithesis?

Answer 21

Fusion of the two affected vertebrae

Question 22

When may surgery be used as a treatment of spondylolithesis?

Answer 22

Severe pain - it is a rare management

Question 23

Define spondylolysis

Answer 23

A pars interarticularis defect such as a fracture that may be seen on x-ray without forward slipping of the vertebrae

Question 24

What are the management options for spondylolysis

Answer 24

Nothing if no pain
Painful - analgesia and conservative methods
Severe - surgical fusion

Question 25

What part of the spine do prolapsed intervertebral discs occur?

Answer 25

Lumbar or cervical

Question 26

Who is most commonly affected by a prolapsed intervertebral disc?

Answer 26

<40yrs, male

Question 27

What are the symptoms of a prolapsed intervertebral disc?

Answer 27

Acute backache and legache

Question 28

What is the characteristic symptom of a prolapsed intervertebral disc?

Answer 28

Leg ache passing down the back of the thigh and leg to the foot

Question 29

What event do patients often describe in regards to prolapsed intervertebral disc?

Answer 29

Single event of lifting or strain - this is not necessarily the reason, it may arise spontaneously

Question 30

Describe the mechanism of a prolapsed disc

Answer 30

An abnormality in the intervertebral disc leads to a prolapse of the nucleus pulposus through annulus fibrosis

Question 31

If the disc prolapses backwards and laterally, what may the patient present with?

Answer 31

Nerve root impingement

Question 32

If the disc prolapses posteriorly, what may the patient present with?

Answer 32

Spinal cord or cauda equina impingement

Question 33

What vertebrae does a prolapsed disc most commonly affect?

Answer 33

L5 S1 - commonly referred to as sciatica

Question 34

What is the main thing to rule out with any back pain?

Answer 34

Cauda equina syndrome

Question 35

What is the management of a prolapsed disc?

Answer 35

NSAIDs, simple analgesia, rest and gentle, progressive mobilisation

Question 36

Most prolapsed discs recover spontaneously. Why is this?

Answer 36

Disc material is absorbed by cells released fro the bloodstream

Question 37

What management should occur if there is persistent pain or an increasing severity of localising signs in relation to a prolapsed disc?

Answer 37

Surgical removal of disc material

Question 38

how do you find the site of a prolpased disc?

Answer 38

Inject a radio-opaque material into the spinal fluid. the fluid cannot flow where prolapsed disc pressed on the nerve

Question 39

What is the name of the technique used to find the site of a prolapse disc?

Answer 39

Myelography

Question 40

Who is most likely to get a bony root entrapment?

Answer 40

>40yrs with a history of mechanical back pain

Question 41

What exacerbates bony root entrapment?

Answer 41

exercise

Question 42

What are the symptoms of bony root entrapment?

Answer 42

leg pain radiating to the foot

Question 43

What is bony root entrapment commonly caused by?

Answer 43

Bony overgrowth around the vertebral foramina where the nerve roots emerge

Question 44

What is bony overgrowth secondary to?

Answer 44

Degenerative changes in adjacent facet joints | May degenerate from primary osteoarthritis or as a result of disc degeneration

Question 45

What management of bony root entrapment may make the condition worse?

Answer 45

Removal of disc

Question 46

What is needed to free trapped nerve? What is risk of this?

Answer 46

Removal of bone | Disturbs spinal stability and lead to need for fusion of the affected vertebrae