Flashcards in Clinical anatomy of the spine and some syndromes Deck (24):
Describe the composition of the intervertebral disc?
Outer annulos fibrosa. Made out of fibrous tissue in layers.
In nucleus pulposa- gelitanous substance.
Affect of ageing on the intervertebral discs
as you get older, the water content in the intervertebral discs decreases. This makes it saggier and therefore is not as good at supporting the spine.
How is movement of the spine brought about?
Each segment offers only a small amount of movement- but collectively they offer a great amount of movement.
Decrease in water content of the intervertebral disc which leads to overloading of the facet joints. Pain becomes worse with extension- therefore people tend to be hunched over.
Treatment of spondylosis
Facet joint injection- steroids and local anaesthetic under flouroscopy.
Osteoarthritis in the spine
If in only one or two segments can be treated with spinal fusion. However if multi-level- won't be effective.
Where is acute disc prolapse likely to occur?
L4/L5 and L5/S1
How do people cause prolapsed discs?
They lift heavy objects causing a sudden tear in the annulus fibrosa.
How do people with prolapsed discs characteristically present?
Pain on coughing- due to coughing squashing the spine.
What is the cauda equina?
Means the horses tail. The spinal cord is called this when it reaches L1.
Where does the spinal cord run?
Inside a thecal sac inside the vertebral foramen. The roots then exit via the intervertebral foramen.
The nerve root passes out of the thecal sac under the pedicle of that vertebrae and exits
Remains anterior in the thecal sac until at the vertebra below and then crosses the disc and exits through that vertebrae's exiting root.
Which nerve root is more likely to be damaged in a prolapsed disc?
The transverse nerve root is more likely to be damaged because it crosses over the disc to the vertebrae below. The exiting root would only be damaged if it were a far lateral prolapse.
What symptoms does compression of the lumbar nerve roots cause?
Radiculopathy- pain down the sensory distribution (dermatome) of the nerve roots
In the lower leg known as sciatica
L4, L5 and S1 nerve roots contribute to the sciatic nerve (along with S2 and S3). Radiation of pain down the sensory division of the sciatic nerve is sciatica.
Nerve root compression by hypertrophic ligaments and osteophytes.
Presentation of spinal stenosis
Burning leg pain on walking- neuropathic claudication. Differs to cardiogenic claudication because it occurs at variable distances and is better going uphill due to the spine not being compressed.
Treatment of spinal stenosis
Surgery to remove osteophytes.
Spinal cord compression
Myelopathy- weakness and hyperspasisity. Causes upper neuron signs. It could be due to tumours or disc prolapses.
How to test for myelopathy
Scratch the bottom of the foot- normally the big toe would move down, in this it moves up.
Cauda Equina Syndrome
Compression of all lumbar and sacral nerve roots affecting the bladder and bowel as well as the lower limb.
It is a medical emergency
Presentation of cauda equina syndrome
Could present differently- incontinence, urinary retention, numbness at the tail end (saddle anaesthesia), loss of anal tone.