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MSK > Clinical Lumbar Spine > Flashcards

Clinical Lumbar Spine Flashcards

1
Q

Which part of the spine dehydrates with age which is why you get shorter with age?

A

Nucleus pulposus in the intervertebral discs

Causes loss in disc height

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2
Q

How does dehydration of the nucleus pulposus cause further degenerative changes of the spine?

A

Decreased height of discs , leads to bulging of discs and therefore alteration of the load stresses on the joints

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3
Q

What is marginal osteophytosis?

A

Osteophytes called syndesmophytes develop next to the end plates of the discs due to the altered load stresses on the vertebral joints

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4
Q

What is Facet Joint Osteoarthritis?

A

Increased stress being put on facet joints due to dehydrated nucleus pulposus of intervertebral disc

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5
Q

Why is arthritis in the facet joints so painful?

A

Joint supplied by meningeal branch of spinal nerve

Intervertebral foramina narrow which can compress spinal nerves = radicular or nerve pain

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6
Q

What is the definition of mechanical back pain?

A

Pain when the spine is loaded that is worsened by exercise but relieved by rest

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7
Q

What are the 3 main contributing lifestyle factors to getting mechanical back pain?

A

Weight
Posture
Exercise

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8
Q

Why does lack of exercise increase chances of mechanical back pain?

A

Muscles around spine deconditioned (core/paraspinal)

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9
Q

Why does poor posture lead to mechanical back pain?

A

Bulges of the intervertebral discs

When flexed, posters bulge
When extended, anterior bulge

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10
Q

Why does heavier weight increase chances of mechanical back pain?

A

More force on abdomen
Osteoarthritis more likely/easier to develop

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11
Q

How does a patient with mechanical back pain present?

A

Intermittent pain
Severity of pain doesn’t scale to the action
Usually triggered by a very minor incident like tying a shoe

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12
Q

What is a herniation?

A

When an organ/tissue protrudes out of the body cavity/place it normally lies in

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13
Q

What are the 4 stages to a prolapsed invertebrates disc/slipped disc/Herniated disc?

A

Degeneration (Disc bulges with age as nucleus pulposus dehydrates)

Prolapse

Extrusion

Sequestration

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14
Q

What happens at the prolapse stage of a slipped disc?

A

Protrusion of the nucleus pulposus occurs slightly impinging the spinal canal

Acidic nucleus pulposus still contained in annulus fibrosus

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15
Q

What happens at the extrusion stage of disc herniation/slipped disc?

A

Nucleus pulposus breaks through the annulus fibrosus but still stays in the disc space or doesn’t sink down

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16
Q

What happens at the sequestration stage of a slipped/prolapsed/herniated disc?

A

Nucleus pulposus breaks through annulus fibrosis and separates from main body of the disc in the spinal canal

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17
Q

Why does the nucleus pulposus normally herniate posterolaterally? (Paracentral prolapse)

A

Passes to the side of the posterior longitudinal ligament

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18
Q

In a paracentral herniation what nerve root is at risk of being irritated/compressed (lumbar spine)?

How does this compare to the cervical spine?

A

Traversing root
Almost always the nerve root associated with the lower vertebra affected
L4/L5 paracentral herniation = compressed L5 nerve root

Cervical spine = emerging root since cervical spinal nerves emerge above their associated vertebrae

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19
Q

What condition can central herniation/prolapse of an intervertebral disc cause?

A

Cauda equina syndrome

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20
Q

Prolapsed intervertebral discs usually heal, why is some of the nucleus pulposus permanently lost?

A

White cells in the CSF resorb the portion protruding into the spinal canal

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21
Q

Do paracentral herniation of an invertebral disc usually cause unilateral or bilateral effects?

A

Usually unilateral

Side effected which has the compressed root

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22
Q

What is Sciatica?

A

Pain cause by the irritation or compression of 1 or more of the nerve roots which contribute to the sciatic nerve (L4-S3)

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23
Q

What are the nerve roots of the sciatic nerve?

How to remember nerve roots of sciatic?

A

L4
L5
S1
S2
S3

Split scia_tic in half. 4 Letters = L4. 3 letters = S3
So sciatic = L4 - S3

24
Q

What can cause sciatica?

A

Marginal osteophytosis
Slipped disc

25
Q

How is pain experienced in sciatica?

A

Radiates from the lumbar spine to the Dermatome which the compressed spinal root supplies

26
Q

Where does the pain radiate if someone has L4 sciatica?

A

Anterior thigh
Anterior knee
Medial leg

Runs down front of leg

27
Q

Where does the pain radiate if someone has L5 sciatica?

A

Lateral thigh
Lateral leg
Dorsum of foot

28
Q

Where does the pain radiate if someone has S1 sciatica?

A

Posterior thigh
Posterior leg
Heel
Lateral border and sole of foot

29
Q

If the nerve compression in sciatica causes parasthesia, where is the parasthesia experienced?

A

Only the affected Dermatome

E.g If L4 spinal root compressed only L4 Dermatome (medial leg) affected

30
Q

What is Cauda Equina Syndrome?

A

Compression of lumbar and sacral nerve roots
Can be by a spinal canal filling prolapsed intervertebral disc/herniated disc

31
Q

What age do disc prolapses most commonly occur?

A

30-50yrs

32
Q

What are the 5 red flag symptoms of Cauda Equina Syndrome?

A

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

33
Q

When must Cauda equina syndrome be treated and how?

A

Surgical Decompression, within 48 hours of sphincter disturbance (urine/faecal incontinence)

If missed patient will need to forever self catheterise, empty bowels by looking at clock, chronic neuropathic pain and may need a wheelchair

34
Q

How can Cauda equina syndrome be diagnosed?

A

MRI
Check Perianal tone (insert finger and see if they can contract, called the anal wink)

35
Q

What are the complications of not treating Cauda equina syndrome in time?

A

Incontinence
Chronic neuropathic pain
Poor sexual experience
Impotence (infertility)

36
Q

What is Lumbar canal stenosis?

A

Narrowing of the spinal canal that compresses either the spinal cord or nerve roots

37
Q

What age group does lumbar canal stenosis tend to affect?

A

Elderly

38
Q

What usually leads to lumbar canal stenosis?

A

Disc bulge (ageing dehydration)
Facet joint osteoarthritis
Ligamentum flavum hypertrophy

39
Q

What is a common symptom of Lumbar canal stenosis?

A

Neurogenic claudication

40
Q

What is claudication?

A

Pain in legs whilst walking
(Heaviness, weakness, wobbliness and increasing pins + needles)

41
Q

How does Lumbar canal stenosis cause neurogenic claudication?

A

Compression of nerve roots leads to veins being engorged in exercise
Reduces arterial blood flow to the nerves
Leads to temporary ischaemia of affected nerves this causes the pain

42
Q

Why does a change in position by Flexion help relieve neurogenic claudication?

A

Leads to spinal canal enlarging so nerves not compressed

Ligamentum flavum tension widens canal
Posterior part of annulus fibrosis tightened reducing bulge
Full blood supply

43
Q

What other symptoms are there for lumbar canal stenosis?

A

Discomfort while standing
Discomfort or pain in lower limb’
Cervical stenosis = pain in shoulder, arm or hand
Bilateral symptoms
Numbness and weakness below level of stenosis

44
Q

How is lumbar canal stenosis treated?

A

Laminectomy

Surgical decompression to restore spinal canal dimensions

45
Q

What is a laminectomy?

A

Remove half of facet joint either side
Remove ligamentum flavum
Remove spinous process

46
Q

What is the meaning of Spondylolisthesis?

A

The forward shift/slip of one vertebra relative to the vertebra below

The top vertebra moves forward to the bottom one

47
Q

How do you spot spondylolisthesis?

A

Follow the posterior lines running up and down either side of the spine

If there is a step the, a vertebra has slipped and this is spondylolisthesis

48
Q

What is a lumbar puncture?

A

Needle is inserted into the subarachnoid space to withdraw Cerbrospinal fluid

49
Q

What position should a patient be in to take a lumbar puncture?

A

Lie on side
Back flexed and hips flexed (knees to chest position)

50
Q

At what vertebrae does the spinal cord end?
What is this point called?
What does the spinal cord become?

A

L1
Conus medullaris
Cauda equina

51
Q

What is the end of spinal cord called?

A

Conus medullaris

52
Q

How can you locate your L4-L5 gap?

A

Its at the midline if you draw a line joining your 2 iliac crests together

53
Q

At what spinal level would you perform a lumbar puncture?

A

Below L1 so:
L2/L3
L3/L4
L4/L5

54
Q

Why are lumbar punctures performed at L2/L3, L3/L4, or L4/L5?

A

Here the spinal cord is not present only the mobile spinal nerve roots of the Cauda equina

There is much less chance of neurological damage

55
Q

What are the 3 meninges that surround the spinal cord/Cauda equina?

A

Dura mater (Outer)
Arachnoid mater
Pia mater (Inner)

56
Q

With a lumbar puncture where must the needle travel through to reach the CSF?
At what point is the pop felt?

A

Skin
Subcutaneous fat
Supraspinous ligament
Interspinous ligament
Ligamentum flavum (Pops when pushed through)
Dura mater
Arachnoid mater
Subarachnoid space is where the CSF is located

MSK (36 decks)

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