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MSK > Clincal Conditions Of The Lumbar Spine > Flashcards

Clincal Conditions Of The Lumbar Spine Flashcards

1
Q

What worsens and eases back pain?

A

Worsens- exercise
Eases - rest

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2
Q

Risk factors for back pain

A

Obesity
Poor posture
Poorly designed seating
Inactivity
Incorrect manual handling techniques

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3
Q

Outline disc degeneration and how to leads to marginal osteophytosis

A
  • nucleus pulposus of IV discs dehydrate with age&raquo_space; reduced height + bulging of discs
  • osteophytes called syndesmophytes develop adjacent to end plates of discs
  • this is called marginal osteophytosis
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4
Q

What is sciatica?

A

Pain caused by irritation or compression of 1+ nerve roots of sciatic nerve L4-S3

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5
Q

Causes of sciatica

A

Marginal osteophytosis
Slipped disc

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6
Q

Where does pain occur in sciatica?

A

Back + buttock + radiates to affected dermatome

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7
Q

Where does paraesthesia occur in sciatica?

A

Only in affected dermatome no radiation

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8
Q

Where is pain typically in L4 sciatica?

A

Anterior thigh
Anterior knee
Medial leg

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9
Q

Where is pain typically in L5 sciatica?

A

Lateral thigh
Lateral leg
Dorsum of foot

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10
Q

Where is pain typically in S1 sciatica?

A

Posterior thigh
Posterior leg
Heel
Sole of foot

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11
Q

Who is cauda equina syndrome typically seen in?

A

30-50 year olds

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12
Q

What is the most common cause of cauda equina syndrome?

A

Disc prolapse

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13
Q

Causes of cauda equina

A
  • Disc prolapse
  • Tumours affecting vertebral column or meninges
  • Spinal infection/abscess or haemorrhage
  • Spinal stenosis
  • Vertebral fracture
  • Late stage ankylosing spondylitis
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14
Q

Red flag symptoms of cauda equina syndrome

A
  • Urinary/faecal incontinence
  • Erectile dysfunction
  • Painless retention of urine
  • Perianal numbness (saddle anaesthesia)
  • Bilateral sciatica
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15
Q

Treatment of cauda equina syndrome

A

Surgical decompression within 48 hours of onset

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16
Q

Consequences of missing diagnosis of cauda equina syndome

A

Impotence - ED
Faecal incontinence
Loss of sensation + weakness to lower limbs
Self catheterisation to pass urine

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17
Q

What are the 4 stages of disc herniation?

A

1- disc degeneration - ageing causes disc to dehydrate + bulge
2- prolapse - protrusion of nucleus pulposus with slight impingement into spinal canal
3- extrusion - nucleus pulposus breaks through annulus fibrosus, contained within disc space
4- sequestration - nucleus pulposus separates from disc + enters spinal canal

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18
Q

What happens in disc degeneration?

A

Chemical changes due to ageing cause discs to dehydrate and bulge

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19
Q

What happens in disc prolapse?

A

Protrusion of nucleus pulposus with slight impingement into spinal canal

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20
Q

What happens in disc extrusion?

A

Nucleus pulposus breaks through annulus fibrosus
Still contained within disc space

21
Q

What happens in disc sequestration?

A

Nucleus pulposus separates from disc
Enters spinal canal

22
Q

Where is the most common site for a slipped disc and why?

A

L4/5
L5/S1

Due to mechanical loading on joints

23
Q

Where are nerve roots most vulnerable?

A
  • Where they cross the IV disc (paracentrally)
  • Where they exit the spinal canal in the IV foramen (far laterally)
24
Q

How does the nucleus pulposus most commonly herniate?
What does this cause?

A

Posteolaterally
Paracentral prolapse

Compression on spinal nerves within IV foramen

25
Q

What nerve root is most at risk in far lateral disc herniation?

A

Exiting nerve root - emerges at same level as IV disc

26
Q

What type of disc herniation is the exiting nerve root most likely to be impacted by?

A

Far lateral disc herniation

27
Q

What nerve root is most at risk in paracentral disc herniation?

A

Transversing nerve root - emerges at level below IV disc

28
Q

What type of disc herniation is the transversing nerve root most likely to be impacted by?

A

Paracentral

29
Q

What nerve root is most at risk in a Paracentral herniation of L4/L5 IV disc?

A

L5 - transversing root

30
Q

What nerve root is most at risk in a Paracentral herniation of L5/S1 IV disc?

A

S1 - transversing nevre root

31
Q

What does central herniation have a risk of?

A

Cauda equina syndrome

32
Q

What is spinal canal stenosis?

A

Abnormal narrowing of spinal canal
Compresses spinal cord or nerve roots

33
Q

Who is most commonly affected by spinal canal stenosis?

A

Elderly people

34
Q

Causes of spinal canal stenosis

A

Disc bulging
Facet joint OA
Ligamentum flavum hypertrophy
Compression fractures of vertebral bodies
Spondyolistheis
Trauma

35
Q

Where is spinal canal stenosis most common?

A

Lumbar spine
Then cervical

36
Q

Symptoms of spinal cord stenosis

A
  • Discomfort standing
  • Numbness + weakness at or below level of stenosis
  • Neurogenic claudications
    Lumbar - discomfort in lower limbs
    Cervical - discomfort in shoulder, arm or hand
37
Q

What is neurogenic claudication?

A

Limp due to nerve injury/compression

Pain +/- Paraesthesia in legs on prolonged standing or walking
Cramping pain or weakness in leg

38
Q

Cause of neurogenic claudications

A

1- Compression of spinal nerves
2- venous engorgement of nerve roots during exercise
3- decreased arterial flow
4- transient arterial ischaemia
5- pain +/- paraesthesia

39
Q

What is neurogenic claudication relieved by?

A

Rest - most effective
Change in position
Flexion of spine e.g. walking up stairs, pushing a trolley

40
Q

What is spondylolisthesis?

A

Anterior displacement of vertebra from vertebra below

41
Q

Types of spondylolisthesis?

A

Congential
Isthmic - defect in pars inter articularis
Degenerative
Traumatic
Pathological
Iatrogenic

42
Q

What is spondylolysis?

A

Complete fracture of pars interartuclauris

43
Q

What is typically seen on an x ray of a patient with sponylolisthesis?

A

Scottie dog shape
Visible anterior displacement of vertebra

44
Q

What is a lumbar puncture?

A

Withdrawal of fluid from subarachnoid space of lumbar cistern

45
Q

What is a lumbar puncture used for?

A

To test for CNS disorders
e.g. MS + meningitis

46
Q

Outline the process of a lumbar puncture

A

1- patient must be lying on side with back + hips flexed
2- skin is anaesthetised
3- lumbar puncture needle inserted between L3+L4
4- needle goes through supraspinous ligament, interspinous ligament, ligamentum flavum, dura + arachnoid, lumbar cistern
5- CSF is removed

47
Q

How must a patient be lying for a lumbar puncture and why?

A
  • Lying on side with back and hips flexed
  • Flexes vertebral column > spreads apart vertebral laminae + spinous processes
48
Q

What structures does the lumbar puncture needle go through in order?

A
  • skin
  • SC tissue
  • supraspinous ligament
  • interspinous ligament
  • Ligamentum flavum
  • Dura + arachnoid
  • Lumbar cistern
49
Q

What is cauda equina syndrome?

A

Condition which occurs when the cauda equina is compressed due to herniated disc, tumour, infection or trauma in lower spine

MSK (25 decks)

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