Lumbar spine clinical conditions

Question 1

What is the centre of gravity?

Answer 1

Weight of body projected into lower limbs

about a line that passes centrally through natural curvatures of spine

Question 2

What is the centre of gravity in the vertebral column?

Answer 2

C1, C2
C7, T1
T12, L1
L5, S1

Question 3

What is senile kyphosis?

Answer 3

Refers to secondary curvatures disappearing
primary curvature re-appearing
with old age

Question 4

What is an example of an abnormal curvature that is physiological?

Answer 4

Exaggeration of lordosis
of lumber spine
during pregnancy

Question 5

What is a suitable vertebral level for a lumbar puncture? Why?

Answer 5

L2/L3
L3/L4
L4/L5

After conus medullaris
only have spinal roots, not cord, least chance of neurological damage

Question 6

What structures does the needle pass through in a lumbar puncture in order to reach the CSF?

Answer 6

Skin
Subcutaneous tissue
Supraspinous ligament
Interpsinous ligament
Ligamentum flavum
Epideral fat and veins 
Dura matter
Arachnoid matter
Subarachnoid space

Question 7

Not having lower back pain - is it normal or abnormal?

Answer 7

Abnormal

Question 8

What are the exacerbating factors of mechanical back pain?

Answer 8

When spine is bearing weight e.g. standing, sitting

Exercising

Question 9

What are the relieving factors of mechanical back pain?

Answer 9

Lying down

Rest

Question 10

How long does mechanical back pain last?

Answer 10

Intermittent - comes and goes

Question 11

What triggers mechanical back pain?

Answer 11

Normal activity

e.g. bending down to pick something up

Question 12

What predisposes to mechanical back pain?

Answer 12

Obesity

Deconditioned core muscles - muscles have to work harder to maintian posture

Question 13

What is disc degeneration?

Answer 13

Nucleus polposus dehydrates with age

Question 14

How does disc degeneration affect height?

Answer 14

Height of disc decreases

Question 15

What are the results of a decrease in disc height?

Answer 15

Reactive marginal osteophytosis

Increased stress placed on facet joints
Leads to osteoarthritis
Pain via meningeal nerve

Decreased size of intervertebral foramen
Compression of spinal nerves

Question 16

What does spondylosis deformans mean?

Answer 16

Spondylosis = degeneration of vertebral column
Deformans = deform

Question 17

What does senile ankylosis mean?

Answer 17

Senile = old age
Ankylosis = abnormal fusion of bones of a joint, giving stiffness

Question 18

What do young discs look like on an MRI scan?

Answer 18

Appear white

Question 19

What do degerated discs look like on an MRI scan?

Answer 19

Appear grey/black

Question 20

What are the four stages of a slipped disc?

Answer 20

Disc degeneration
Prolapse
Extrusion
Sequestration

Question 21

What happens in disc degeneration?

Answer 21

Dehydration of discs with age

Causes them to bulge

Question 22

What happens in disc prolapse?

Answer 22

Protrusion of nucleus polposus

Slight impingement into vertebral canal

Question 23

What happens in disc extrusion?

Answer 23

Nucleus polposus breaks through annulus fibrosus

But still within disc space

Question 24

What happens in sequestration?

Answer 24

Nucleus polposus breaks through annulus fibrosus

Separates from main body of disc
Enters vertebral canal

Question 25

Which disc does slippage most commonly occur in?

Answer 25

L4/L5 disc L5/S1 disc

Question 26

What are the different types of disc herniation? What is the relative prevalence of each?

Answer 26

Paracentral - most common Far lateral - rare Canal filling - rare

Question 27

What is a paracentral disc herniation?

Answer 27

Disc herniates into spinal canal | next to the spinal cord

Question 28

What is a far lateral disc herniation?

Answer 28

Disc herniates laterally where nerve root is exiting | not in spinal canal

Question 29

What is a canal filling disc herniation?

Answer 29

Large disc herniation | Fills spinal canal

Question 30

What does a canal filling disc herniation result in?

Answer 30

Cauda equina syndrome

Question 31

What is sciatica?

Answer 31

Compression of nerve roots which contribute to the sciatic nerve L4-S3 NOT compression of the sciatic nerve!

Question 32

What is the most common cause of sciatica?

Answer 32

Disc prolapse

Question 33

Which nerve roots are most commonly compressed in sciatica?

Answer 33

L4, L5, S1

Question 34

Why is sciatica of S2, S3 rare?

Answer 34

Because they exit from the sacrum | which doesn't have any discs in it

Question 35

What are the symptoms of sciatica?

Answer 35

Pain - along whole course of nerve Paraesthesia - only end point that nerve supplies

Question 36

Where does pain occur with L4 sciatica?

Answer 36

Anterior thigh Anterior knee Medial shin

Question 37

Where does paraesthesia occur with L4 sciatica?

Answer 37

Medial shin

Question 38

Where does pain occur with L5 sciatica?

Answer 38

Lateral thigh Lateral calf Dorsum of foot

Question 39

Where does paraesthesia occur with L5 sciatica?

Answer 39

Lateral calf | Dorsum of foot

Question 40

Where does pain occur with S1 sciatica?

Answer 40

Posterior thigh Posterior calf Heel Sole of foot

Question 41

Where does paraesthesia occur with S1 sciatica?

Answer 41

Heel | Sole of foot

Question 42

Which nerve root is compressed by a paracentral disc prolapse?

Answer 42

The lower nerve root Because upper nerve root has already left Lower nerve root is starting to leave spinal cord gets compressed

Question 43

What nerve root would be compressed by an L5/S1 disc prolapse?

Answer 43

S1

Question 44

Which nerve root is affected by a far lateral disc prolapse?

Answer 44

The upper nerve root Because the upper nerve root is leaving laterally gets compressed

Question 45

What age group do slipped discs mostly occur in?

Answer 45

30-50 year olds

Question 46

Are slipped discs usually resolved?

Answer 46

Yes

Question 47

What is cauda equina syndrome caused by?

Answer 47

Canal filling disc prolapse

Question 48

What is compressed in cauda equina syndrome?

Answer 48

Cauda equina - lumbar and sacral nerve roots

Question 49

What age group does cauda equina mostly occur in?

Answer 49

30-50 year olds | same as slipped discs, since it's the cause

Question 50

What are the symptoms and signs of cauda equina syndrome?

Answer 50

Bilateral sciatica - both nerve roots compressed Perianal numbness - loss of S3, S4 supply Painless retention of urine Urinary and faecal incontinence - loss of sphincter control

Question 51

What does CSF normally look like on an MRI?

Answer 51

Appears white

Question 52

What does cauda equina syndrome look like on an MRI?

Answer 52

Disc prolapse appears dark - grey/black | where CSF should be

Question 53

How quikcly should cauda equina syndrome be treated?

Answer 53

Within 48 hours of sphincter symptoms

Question 54

What are the consequences of cauda equina syndrome that's untreated or treated too late?

Answer 54

Intermittent self catheterisation Digital rectal examinations Sexual dysfunction

Question 55

What is lumbar canal stenosis?

Answer 55

Narrowing of spinal canal in lumbar region

Question 56

What are the causes of lumbar canal stenosis?

Answer 56

Disc bulge Facet joint osteoarthritis Ligamentum flavum hypertrophy

Question 57

What age group does lumbar canal stenosis mostly occur in?

Answer 57

Elderly

Question 58

What does lumbar canal stenosis look like on an MRI scan?

Answer 58

Little CSF, white Appears darker - grey black

Question 59

What is claudication?

Answer 59

Pain in legs when walking

Question 60

What are the causes of claudication?

Answer 60

Neurogenic - lumbar canal stenosis Vascular - problems with perfusion of legs

Question 61

Does lumbar canal stenosis improve?

Answer 61

No | most people stay the same

Question 62

Which group of people should be treated for lumbar canal stenosis?

Answer 62

Restricted walking distance affects their quality of life

Question 63

What is spondylolisthesis?

Answer 63

Slip forwards of vertebra above | on vertebra below

Question 64

What are the types of spondylolisthesis?

Answer 64

``` Dysplasic Isthmic Degenerative Iatrogenic Pathological ```

Question 65

What is dysplastic spondylolisthesis?

Answer 65

Abnormality in shape of facet joints is the cause

Question 66

What is isthmic spondylolisthesis?

Answer 66

Defect in pars interarticularis is the cause

Question 67

What is pars interarticularis?

Answer 67

Bone that joins facet joints to vertebral body

Question 68

What is degenerative spondylolisthesis?

Answer 68

Arthritis is the cause

Question 69

What is iatrogenic spondylolisthesis?

Answer 69

Caused by medical process e.g. surgery

Question 70

What is pathological spondylolisthesis?

Answer 70

Caused by disease e.g. tumour

Question 71

What are the causes of a defective pars interarticularis?

Answer 71

Abnormality in development Fractures

Question 72

What happens with a fractured pars interarticularis?

Answer 72

Vertebral body detached from vertebral arch Vertebral body moves forwards no compression of spinal cord

Question 73

How does isthmic spondylolisthesis present?

Answer 73

Back pain L5 sciatica arch not intact so no spinal canal stenosis

Question 74

What does disc prolapse look like on an MRI?

Answer 74

Dark grey area in white CSF

Question 75

What happens to the prolapsed disc material?

Answer 75

Triggers inflammatory reactions | broken down by it

Question 76

Where does isthmic spondylolisthesis commonly occur?

Answer 76

L5 vertebrae

Question 77

In what age groups does isthmic spondylolisthesis present? Why?

Answer 77

Adolescence Adulthood Disc has started to age

Question 78

How does degenerative spondylolisthesis present?

Answer 78

Presents with claudication

Question 79

Why does degenerative spondylolisthesis present with claudication?

Answer 79

Posterior arch intact as vertebrae moves forward it compresses the spinal cord within the canal Facet joint osteoarthritis gives stenosis of canal

Question 80

How is spondylolisthesis treated?

Answer 80

Put vertebrae back into place | Screws and rods hold it in place