Lumbar spine Flashcards Preview

Musculoskeletal > Lumbar spine > Flashcards

Flashcards in Lumbar spine Deck (18):

Mechanical pain

Recurrent and remitting back pain with no neurological symptoms. Worse on exercise and relieved by rest.
No red flag symptoms


Causes of mechanical back pain

Obesity, poor posture, poor lifting technique, lack of physical activity, depression, osteoarthritis, spondylosis (loss of water content as age increases in intervertebral discs),


Treatment of mechanical spinal pain

Analgesia and physiotherapy.
Patients are encouraged to get back to work and maintain normal function asap.


When would spinal stabilisation surgery (fusion) be considered for mechanical back pain?

If the patient has OA on adjacent levels, not responded to physio or conservative management and have no behavioural issues that may affect the outcome of surgery


Acute disc tear /discogenic pain and its symptoms

An acute tear can occur in the annulus fibrosis. There are lots of sensory fibres here so it is very painful. Pain also worse on coughing


Treatment of an acute disc tear

Symptoms usually resolve in 2-3 months. Treatment in the mean time should be analgesia and physiotherapy.


In what situations do acute disc tears occur?

Lifting a heavy object.


What is sciatica

Neurological pain that travels down the buttock, thigh and past the knee. Pain is due to compression of the nerves that contribute to the sciatic nerve.


What can cause sciatica

In an acute disc prolapse- the herniated nucleus pulposa can compress on the nerve root.


If a prolapsed disc occurs- which nerve root is likely to be compressed?

The nerve root below. E.g. if L2/L3 disc prolapse occurs- L3 exiting root will be damaged.


Describe the pain in sciatica. What does it do to muscles.

Burning or tingling pain. Also causes weakness in a myotomal distribution.


Treatment of sciatica

First line- analgesia, physiotherapy and maintaining mobility.
Second line- drugs for neuropathic leg pain e.g. gabapentin
Third line- very rare but surgery called a discectomy.


Other (rarer) causes of sciatica

OA can cause osteophytes to form which compress nerve roots.


Treatment of bony causes of sciatica

Surgery to decompress the nerve by trimming osteophytes.


Spinal stenosis is

Compression or irritation of the cauda equina due to several conditions.


Which conditions cause spinal stenosis

Spondylosis- this doesn't necessarily cause spinal stenosis however will contribute to it.
Bulging discs, prolapsed discs, bulging ligamentum flavum and osteophytes.


Presentation of spinal stenosis



Treatment of spinal stenosis

Conservative- weight loss or physiotherapy
If these don't work discectomy to relieve pressure from the cauda equina.