lumbar spine injuries Flashcards
what is mechanical back pain?
what are risk factors of mechanical back pain?
what is it?
– characterised by pain when the spine is loaded, that worsens with exercises and is relieved by rest
risk factors:
– obesity, poor posture, sedentary lifestyle with deconditioning of paraspinal muscles, incorrect manual handling
what is disc degeneration and marginal osteophytosis?
The nucleus pulposus of the intervertebral discs dehydrates with age. This leads to a decrease in the height of the discs, bulging of the discs and alteration of the load stresses on the joints.
Osteophytes (bony spurs) called syndesmophytes therefore develop adjacent to the end plates of the discs. This is known as marginal osteophytosis.
Increased stress is also placed on the facet joints, which also develop osteoarthritic changes
what are the symptoms associated with disc degeneration + marginal osteophytosis?
the intervertebral foramina decrease in size. this can lead to compression of the spinal nerves and is perceived as radicular or nerve pain.
what are herniations of intervertebral discs and who do they most commonly occur in?
‘slipped disk’
most commonly occur in patients aged 30-50 and 90% of cases resolve by 3 months
what are the 4 stages of disc herniation that you need to be aware of?
- Disc degeneration: chemical changes associated with ageing cause discs to dehydrate and bulge
- Prolapse: Protrusion of the nucleus pulposus occurs with slight impingement into the spinal canal. The nucleus pulposus is contained within a rim of annulus fibrosus
- Extrusion: The nucleus pulposus breaks through the annulus fibrosus but is still contained within the disc space
- Sequestration: The nucleus pulposus separates from the main body of the disc and enters the spinal canal.
where are the most common sites for a slipped disc??
the L4/5 and L5/S1 due to mechanical loading at these joints
what are the different types of herniations?
paracentral prolapse herniations (occurs in 96% of cases)
far lateral herniations (occurs in 2%)
central herniations (occurs in 2%)
what are the 2 nerve roots associated with an intervertebral discs?
1) exiting nerve root: nerve root that emerges from spinal canal at same level as intervertebral disc - most at risk in ‘far lateral’ herniation
2) transversing nerve root: nerve root that emerges at level below intervertebral disc - most at risk in paracentral herniation
what is radicular leg pain “sciatica”?
name given to pain caused by irritation or compression of one or more of the nerve roots that contribute to the sciatic nerve
what causes radicular leg pain “sciatica”?
marginal osteophytosis + slipped disc
what are the symptoms associated with sciatica?
pain radiates from the back and travels through all the dermatomes until it reaches the affected dermatome
paraesthesia only experienced in affected dermatome
what is cauda equina syndrome?
develops in prolapsed intervertebral disc when there is a ‘canal filling disc’ that compresses the lumbar and sacral nerve roots within the spinal canal
what causes cauda equina syndrome?
- 5% of cases of cauda equina syndrome are due to a disc prolapse (this most commonly occurs in people aged 30 – 50 years)
- spinal infection / abscess
- vertebral fracture
- spinal haemorrhage
what are the red flag symptoms of cauda equina syndrome?
- Bilateral sciatica
- Perianal numbness (saddle anaesthesia)
- Painless retention of urine
- Urinary / faecal incontinence
- Erectile dysfunction
how is cauda equina syndrome treated?
surgical decompression within 48 hours of the onset of sphincter symptoms, otherwise the prognosis is poor
- chronic neuropathic pain
- impotence
- having to perform intermittent self catheterisation to pass urine
- faecal incontinence or impaction requiring manual evacuation of faeces
- loss of sensation and lower limb weakness requiring a wheelchair
