W13 - Spine Degeneration

Question 1

Describe the pathophysiology of intervertebral disc degeneration

Answer 1

*ageing = dehydration = degeneration within the facet joints
+aggr. by smoking

=> tearing of annulus fibrosis and protrusion of nucleus

Question 2

Describe the common causes of low back pain

Answer 2

1. NERVE ROOT PAIN: common, limb pain worse than back pain; dermatome and myotome
   *MRI
   > physio and analgeisa
   => settle in 3mos

*T11/12 common discs affected
* L4/5
* L5/S1
L3/4 (least common)
- posterolateral commonly

2. CERVICAL and LUMBAR SPONDYLOSIS:
   common, degeneration at facet joints, discs, ligaments
   - can progress to myelopathy
3. SPINAL CLAUDICATION:
   bilateral, sensory dysaesthesiae, weakn.,
   - worse walking downhill

Question 3

Discuss suspicious features (‘red-flag symptoms’) of low back pain

Answer 3

*saddle anaesthesia, incontinence

Question 4

The pathology of intervertebral disc herniation

Answer 4

LATERAL DISC PROTRUSION = COMPRESSED ROOT

CENTRAL DISC PROTRUSION = COMPRESSED ROOTS WITHIN CAUDA EQUINA

Question 5

Clinical features of intervertebral disc herniation and nerve root impingement (e.g. sciatica)

Answer 5

a

Question 6

Describe the clinical presentation and management of Cauda Equina Syndrome

Answer 6

*commonly dt central lumbar disc prolapse; then tumour

• saddle anaesthesia, incontinence + leg pain
• loss of anal tone/reflex
• trauma / spinal post-op = high index suspicion (esp w/ urinary + leg pain)

> Sx emergency = decompression

Question 7

Pathophys of Lumbar Spondylosis

Answer 7

OArth of facet and disc joints

Question 8

Spinal Stenoses

Answer 8

1. LATERAL RECESS
   > non-sx: nerve root injection, epidural injection
   > sx
2. CENTRAL STENOSIS
   dt congenital abn canal shape
   > epidural steroid injection
   > sx: good outcomes
3. FORAMINA STENOSIS
   > nerve root/epidural injection
   > sx

Question 9

What type of joint is the costoverterbral joint

Answer 9

synovial plane

Question 10

Upper Limb Myotomes

Answer 10

C5 = SHOULDER ABDUCTION (deltoid)

C6 = ELBOW FLEX/WRIST EXT (biceps)

C7 = ELBOW EXT (triceps)

C8 = LONG FINGER FLEXOR (FDS/FDP)

T1 = Finger Abduction (interossei)

Question 11

Lower Limp Myotomes

Answer 11

L2 - Hip flexion (iliopsoas)

L3,4 - Knee extension (quadriceps)

L4 - Ankle dorsiflexion (tib ant)

L5 - Big toe extension (EHL)

S1 - Ankle plantar flexion (gastroc)

Question 12

Commonest cause of SC injury

Answer 12

• Falls
• RTC
• Sport

Question 13

What innervates diaphragm and its nerve roots

Answer 13

PHRENIC C3-5

Question 14

Partial Cord Syndromes

Answer 14

CENTRAL CORD SYNDROME

• older patients
• hyperext. injury
• upper limb weakn.

ANTERIOR CORD SYNDROME

• hyperflexion injury, ant. compression #
• dmg to anterior spinal artery
• preserved fine touch and proprioception
• profound weakn

BROWN-SEQUARD SYNDROME

• hemi-section of the cord
• penetrating injuries
• paralysis on affected side, loss of propriioception and fine discrimination (dorsal)
• pain and temp loss on opposite side below lesion

> ensure prevention of 2º insults
resus: ABCDE; consider neurogenic shock and spinal shock,
* assess PR and perianal sesn

Question 15

SC Injury Mgmt

Answer 15

> ensure prevention of 2º insults
resus: ABCDE; consider neurogenic shock and spinal shock,
* assess PR and perianal sesn

> Sx fixation

LT physio, counselling: uro/sexual, occupational rx