Intravertebral Disc Prolapse (2*)

Question 1

What occurs here?

What are its complications?

Answer 1

➊ • Age-related degeneration of Annulus Fibrosus, making it more likely to tear and lead to herniation of the softer, central portion of the disc
• Typically occurs after spinal trauma or excessive strain e.g. lifting/twisting

➋ • Nerve root compression
• Cauda equine syndrome (L4-S1) - bilateral sciatica, saddle anaesthesia (inability to feel toilet paper when wiping), urinary and bowel disturbance (constipation/retention or incontinence)

Question 2

How does it present?

What is the investigation to do?

How is it managed?

Answer 2

➊ Unilateral symptoms of:
• Pain that radiates in a dermatomal pattern
• Motor - Muscle weakness, Paralysis, Disrupted reflexes
• Sensory - Paraesthesia, Numbness, Tingling
• Sciatica if in lumbar region

➋ MRI

➌ Conservatively with pt staying active and analgesia