Flashcards in PBL- Back Pain Leading To Chronic Incapacity Deck (75)
What are the red flags of lower back pain?
Previous history of malignancy
Younger than 16, older than 50 with new pain
Prolonged steroid use
Recent serious illness
Recent significant infection
List some mechanical causes of lower back pain below.
Muscular and ligament pain
Pustular back pain
Facts joint syndrome
Lumbar disk prolapse
Describe the anatomy of an intervertebral disk.
Soft gelatinous centre called nucleus pulposus, encircled by a strong, ring-like collar of fibrocartilage called the annulus fibrosis.
What is the main function of an intervertebral disk?
What happens in an intervertebral disk prolapse?
Nucleus pulposus is squeezed out of place and herniated through the annulus fibrosis
Name some reasons an IV disk would become damaged?
Effects of aging
Degenerative disorders of the spine
Briefly describe pathology involved once an IV disk herniation has occurred?
Posterior protrusion of the nucleus pulposus towards the intervertebral foramen and its contained spinal root.
Annulus fibrosis becomes thin and poorly supported by posterior or anterior ligaments at this point
Which regions of the spine are most commonly involved in disk herniations?
Cervical and lumbar
Where are the signs and symptoms of a disk herniations seen?
Localised to the area of the body innervated by the affected spinal nerve roots- includes motor and sensory
If the nerve roots L4, L5, S1, S2 and S3 are damaged, what condition arises?
Describe where the pain is felt in sciatica?
Spreads down the back of the leg and over the sole of the foot
What are the most common sensory effects from spinal root compression?
Paraesthesia and numbness
What are the most common motor effects from spinal root compression?
Knee and ankle reflexes may be absent or diminished
What are the symptoms of severe spinal disease?
Pain worse at rest
What signs and symptoms of cord compression occur in severe spinal disease?
What signs and symptoms of cauda equina compression occur in severe spinal disease?
Bilateral leg pain
Perinatal sensory loss
Reduced anal tone
What are the layers of protection for the spinal cord?
Fat and connective tissue in epidural space
At what point do the spinal nerves stop being covered in meninges?
Once they exit the spinal column through the intervertebral foramen
What is the epineurium?
The outer covering of spinal and cranial nerves
- continuous with dura mater
Describe the connective tissues of the dura mater.
Thick, strong, dense and irregular
Describe the connective tissues of the arachnoid mater.
Thin, avascular with loosely arranged collagen and elastic fibres
Describe the connective tissues of the pia mater.
Thin and transparent
Bundles of collagen fibres and some elastic fibres
- adheres to surface of spinal cord and brain
Which meningeal layer contain blood vessels? (At least in the spine :/)
Pia mater and dura mater
What are denticulate ligaments?
Triangular shaped membranous extensions of the pia mater than suspend the spinal cord in the middle of the rural sheath
Where does the spinal cord arise and terminate in adults and babies?
Arises in the medulla oblongata
- superior border of 2nd lumbar vertebrae in adults
- L3,4 in newborns
What is the superior enlargement of the spinal cord, and where does it span?
It's a cervical enlargement, that nerves to and from the upper limb arise from
Spans from C4 to T1
What is the inferior enlargement of the spinal cord, and where does it span?
It's a lumbar enlargement, that nerves to and from the lower limb arise from
Spans from T9 to T12
What is the conical structure that is the end of the spinal cord called?
Conus medullaris (between L1, 2)
What is the film terminale?
Extension of pia mater that extends from conus medullaris to the arachnoid and dura mater at the coccyx
- anchors spinal cord to coccyx