Flashcards in Lumbar Spine Deck (23):
What is mechanical back pain?
Recurrent or relapsing and remitting back pain with no neurological symptoms. Pain worse with movement, relieved by rest
What patients commonly present with mechanical back pain?
Between 20-60, had several previous flare ups, no red flags
What are some caused of mechanical back pain?
Obesity, poor posture, poor lifting technique, lack of physical activity, depression, degenerative disc prolapse, facet joint OA, spondylosis
What is Spondylosis?
Where IV discs lose water content with age, resulting in less cushioning and increased pressure on face joints leading to 2' OA
What is the treatment of mechanical back pain?
Analgesia and physio if necessary. Back to work early, not bed rest
In what cases of mechanical back pain may some patients benefit from spinal stabilisation surgery?
If single level (2 adjacent vertebrae) is affected by OA or instability, and if no improvement despite physio and conservative management, and no other adverse 2' gain or behavioral issues affecting surgery outcome
Where does an acute disc tear occur?
In the outer annulus fibrosis of an IVD
After what does an acute disc tear classically happen?
Lifting a heavy object
What makes pain characteristically worse in an acute disc tear?
Coughing (increases disk pressure)
What is the treatment for an acute disk tear?
Usually resolves, takes 2-3 months. Analgesia + physio
What can happen if a disk tear occurs to the gelatinous nucleus pulposis?
It can herniate or prolapse through the tear. It can impinge on an exiting nerve root resulting in pain and altered sensation in a dermatomal distribution as well as reduced power in a myotomal distribution
Where is the commonest site for a PIVD?
Lower lumbar spine
How does Sciatica occur?
PIVD in lower lumbar spine. L4/5/S1 nerve roots contributing to sciatic nerve and pain radiating to part of sensory distribution of sciatic nerve.
How is the radicular pain in sciatica felt?
Neuralgic burning or severe tingling, often like severe toothache radiating down the back of the thigh to below the knee.
In the lumbar spine which nerve root will be commonly compressed in relation to the vertebrae in the affected segment?
The nerve root corresponding to the lower of the two vertebrae (e.g. L3/4 prolapse > L4 entrapment>pin down medial ankle (L4), loss of quads power, reduced knee jerk
What can occur in a very lateral disk prolapse?
Impingement of the nerve root corresponding to the vertebra above (L4/5 impingement presenting with an L4 nerve radiculopathy)
What is the first line treatment of PIVD?
Analgesia, maintaining mobility and physio. Drugs for neuro pain can be used if leg pain severe
What further treatment in secondary care may be needed for PIVD?
Surgery (discectomy) indicated when pain is not resolving despite treatment and signs suggesting specific nerve root involvement and +ve MRI evidence of compression.
What can OA of the facet joints result in?
Osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica. Surgical depression, with osteophyte trimming, may be performed
What is spinal stenosis?
Narrowing of the spinal canal. In lumbar spine with spondylosis, bulging discs and ligamentum flavum, osteophytosis caude equina has less space- multiple nerve roots are compressed/irritated
Who will present with spinal stenosis?
Over 60yo, claudication in legs
What is different about neurogenic claudication compared to vascular claudication?
Claudication distance is inconsistent, pain is burning, pain is less uphill (due to spinal flexion), pedal pulses preserved