What is the pathophysiology of intervertebral disc herniation?
1 - Annulus fibrosis is torn and the nucleus protrudes through posterior longitudinal ligament (PLL)
2- Nerve root becomes compressed by osteophytes
3 - Central spine becomes stenosed
4 - Disc herniation is usually postero-lateral
What are the common causes of lower back pain?
1 - Prolapsed disc
2 - Trauma
3 - Fractures
4 - Ankylosing Spondylitis
5 - Degenerative
6 - Osteoporotic vertebral prolapse
7 - Cauda Equina syndrome
What is the epidemiology of spinal cord injuries?
- Male > Female
- Peak 20-29 years
What are the most common causes of spinal cord injury?
1 - Falls
2 - RTA's
3 - Sport
What are the red-flag symptoms of lower back pain?
Age - <20 years or > 55 years
Acute onset in elderly people
Constant or progressive pain
Worse pain lying supine (face upwards)
Fever, night sweats, weight loss
History of malignancy
Bilateral or alternating leg pain
What is the pathology of intervertebral disc degeneration during the normal ageing processes?
1 - Decreased water content of discs
2 - Disc space narrowing
3 - Degenerative changes observed on x-rays
4 - Degenerastive changes in the facet joints
What are the clinical features of intervertebral disc herniation and sciatica?
- Limb pain > back pain
- Pain occurs in a nerve root distribution
- Root tension & compression signs
- Dermatomes & myotome involvement
What are the clinical features of cauda equina syndrome?
- Injury or precipitating event
- Location of symptoms: bilateral buttock + leg pain with weakness
- Bowel or bladder dysfunction (urinary retention +- incontinence overflow)
- PR exam: saddle anaesthesia, perianal loss of sensation, loss of anal tone
- High index of suspicion in spinal post-op patients
What are the classic symptoms that cauda equina patients complain of?
- Bilateral leg pain
- Numb bum
How is cauda equina syndrome managed?
- If MRI contraindicated, then lumbar CT myelogram
- Treatment = Operation within 48hrs