Flashcards in Lumbar spine Deck (18):
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