Which myotome facilitates hip flexion?
Which myotome facilitates knee flexion?
Which movements does the L5 myotome facilitate?
Foot dorsiflexion and extensor hallicus longus
Which myotome facilitates plantarflexion?
What is sciatica?
Buttock and/or leg pain in a specific dermotomal distribution accompanied by neurological disturbance
What is shown on this MRI?
What is a slipped.herniated disc?
A tear in the annulus fibrosis of an intervertebral disc allows the nucleus pulposis to bulge out beyond the damaged outer rings
What are some of the causes of disc herniation?
What direction is spinal disc herniation usually in and why?
The presence of the posterior longitudinal ligament prevents the disc from herniating directly posteriorly
What is the presentation of an acute disc tear?
Typically occurs after lifting heavy object
Acute onset back pain
Worse on coughing
How does sciatica present?
Lower back pain
Buttock pain and numbness
Pain or weakness in various parts of the leg and foot
"pins and needles"
Tingling and difficulty moving or controlling the leg
What causes sciatica?
Compression or irritation of one of the five nerve roots of the sciatic nerve e.g. by a herniated disc causing compression
How is disc prolapse managed?
Consider surgery if not resolving after 3 months
Surgery is to treat leg pain
How is backache managed conservatively?
Anti-inflammatory and/or muscle relaxant
Return to normal activity
What are the red flag symptoms with back pain?
First back pain age <20 or >50
Non-mechanical, constant pain
History of cancer
History of steroids
Systemic upset/weight loss
Saddle anaesthesia/paraesthesia and loss of bowel and bladder control
Severe pain longer than 6 weeks
What is cauda equina syndrome?
A serious neurologic condition in which damage to the cauda equina causes acute loss of function of the lumbar plexus
How does mechanical back pain present?
Recurrent relapsing and remitting back pain with no neurological symptoms
Worse on movement, relieved by rest
Aged between 20-60 and have had previous 'flare ups'
What are some of the causes of mechanical back pain?
Poor lifting technique
Lack of physical activity
Degenerative disc prolapse
Facet joint OA
What is spondylolysis?
The intervertebral discs lose water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA
Why is bed rest not advised in mechanical back pain?
This will lead to stiffness and spasm of the back which may exacerbate disability
What are the symptoms of an L3/L4 prolapse and what nerve is compressed?
L4 root entrapped
Pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk
What are the symptoms of an L4/L5 disc prolapse and which nerve is compressed?
L5 nerve root entrapment
Pain down dorsum of foot
Reduced power Extensor Hallucis Longus and tibialis anterior
What are the symptoms of an L5/S1 prolapse and which nerve is compressed?
S1 nerve root entrapment
Pain to sole of foot, reduced power planarflexion, reduced ankle jerks
What is spinal stenosis?
When the cauda equina of the lumbar spine has less space due to a combination of bulging discs, bulging ligamentum flavum and osteophytosis
What is the primary symptom of spinal stenosis?
How does spinal claudication differ from vascular claudication?
The claudication distance is inconsistent
The pain is burning (rather than cramping)
Pain is less walking uphill (spine flexion creates more space for the cauda equina)
Pedal pulses are preserved
What are the symptoms of cauda equina syndrome?
Bilateral leg pain
Paraesthesiae or numbness and complain of “saddle anaesthesia”
What is the management of cauda equina syndrome?
How are osteoporotic fractures of the lumbar spine managed?
What cervical spine pathology are children with Down's syndrome at risk of developing?
Atlanto‐axial (C1/C2) instability with subluxation potentially causing spinal cord compression