Spinal - Discs & Stenosis

Question 1

What type of joint is an Intervertebral disc?

Answer 1

Secondary Cartilaginous

Question 2

What attaches the discs to vertebral bodies?

Answer 2

ALL & PLL

Question 3

What marks out pain as being from a nerve root?

Answer 3

Often ass with back pain but worse than it

Spread in a dermatomal/myotomal distribution

Question 4

How do you treat nerve root pain?

Answer 4

Most go away on their own:

• Physio
• Analgesia
• Referral after 12wks for MRI

Question 5

Dsecribe the types of prolapsed disc:

Answer 5

Bulge - Most asymptomatic

Protrusion - Annulus weak but still intact

Extrusion – Annulus broken but nucleus still in continuity

Sequestration - Nucleus material free in spinal canal

Question 6

Where do most disc prolapses occur?

Answer 6

Cervical = C5/6
Thoracic = T11/12 (but very rare)
Lumbar = L4/5 or L5/S1

Mostly posterolateral

Question 7

What level disc has prolapsed:

• Medial aspect of lower leg sensation lost
• Weakness in quads
• Knee jerk reflex lost

Answer 7

L3/4 (L4 nerve root)

Question 8

Which level disc has prolapsed?

• Sensation to little toe/sole
• weakness on plantar flexion
• Ankle jerk lost

Answer 8

L5/S1 (S1 nerve)

Question 9

Which level disc has prolapsed?

• Sensation to great toe & 1st webspace
• EHL weakness

Answer 9

L4/5 (L5 nerve root)

Question 10

What is Cauda Equina Syndrome?

Answer 10

Sacral nerve root compression due to

1) Centrally prolapsed lumbar disc
2) Tumour
3) Trauma or spinal stenosis
4) Infection (abscess)
5) Iatrogenic (surgery/epidural)

Question 11

Why is Cauda Equina Such an emergency?

Answer 11

Can result in permanent bladder & bowel dysfunction/incontinence

Question 12

How do you spot Cauda Equina?

Answer 12

1) Bilateral buttock/leg pain + varying dysaesthesia
2) Bladder/bowel dysfunction (urinary retention +/- overflow incontinence)
3) PR exam showing saddle anaesthesia, loss of anal tone & reflex

Look for a precipitating event e.g. injury, surgery etc.

Question 13

How do you manage Cauda Equina?

Answer 13

Admit
MRI
Emergency Surgery within 48hrs

Question 14

What do we call OA of the spine?

Answer 14

Cervical or Lumbar Spondylosis

Question 15

What joints are there in the spine and what do they allow?

Answer 15

Facets - Synovial Plane - Flexion/extension

Discs - 2nd* Cartilaginous - Rotation

Question 16

What are the major ligaments of the spine?

Answer 16

ALL (Front of bodies)
PLL (back of bodies)
Ligamentum Flavum (Laminae)
Interspinaous & Supraspinous
Intertransverse (between transverse processes)

Question 17

Spinal Claudication can occur due to Spinal Stenosis, how do we differentiate from PVD claudication?

Answer 17

Spinal is:

• Usually bilateral
• Comes with Dysaesthesia
• ~Weakness e.g. foot drop
• Takes longer to ease
• Worse walking downhill rather than uphill (due to compression of spinal canal in extension)

Question 18

How can we manage Spinal stenosis?

Answer 18

Nerve root injection

Epidural Steroid Injection

Surgery