Spine

Question 1

Percentage of people that suffer back pain

Answer 1

80%

Question 2

Mechanical back pain

Answer 2

this is by far the most common condition and tends to be positional. Certain activities may help and they may have associated thigh pain. It tends to be managed in primary care with simple analgesia and reassurance. KEEP ACTIVE. Should return to work early. 90% of them will settle in six weeks but 60% recur. However, if it fails to settle organise physiotherapy. Alternative therapy, facet joint injections and acupuncture can

Question 3

Causes of back pain

Answer 3

• Spindylogenic
• Neurogenic
• Viscerogenic
• Vascular and
• Psychogenic

Question 4

The Intervertebral Disc

Answer 4

A secondary cartilaginous joint
Avascular
Resist rotational movements
Fail with twisting movements

Question 5

Annulus Fibrosis

Answer 5

Tough outer layer

Question 6

Nucleus Pulposus

Answer 6

Gelatinous Core

Question 7

Ageing process of Intervertbral Disc Pathology

Answer 7

• Decreased water content of discs
• Disc space narrowing
• Degenerative changes on X-rays
• Degenerative changes in the facet joints
• Aggravated by smoking

Question 8

Pathological Processes Intervertebral Disc

Answer 8

• Tearing of the annulus fibrosis and protrusion of the nucleus
• Nerve root compression by osteophytes
• Central spinal stenosis

Question 9

Nerve root pain resulting from compression by intervertebral disc

Answer 9

Radicular pain. There may be signs of root tension and compresion in the spread of myotomes and dermatomes.

Question 10

Treatment of nerve root pain

Answer 10

, it will usually settle within three months. If it doesn’t treat with physiotherapy and strong analgesia and refer after 12 weeks. Occasionally MRI can be conducted.

Question 11

Disc Protrusion

Answer 11

Annulus is weakened but still intact

Question 12

Disc herniation

Answer 12

Protrusion of the nucleus pulposis through the annulus but in continuity

Question 13

Disc Sequestration

Answer 13

Dessicated disc material free in the spinal canal

Question 14

Cervical disc problems occur

Answer 14

C5/6

Question 15

Thoracic disc problems occur

Answer 15

mid to lower levels (T8-12) and can cause central, posterolateral and lateral herniations.

Question 16

Lumbar disc problems

Answer 16

Lumbar usually occur L4/5 (45%), followed by L5/S1 (40%) then L3/4 (10%). Most of these are posterolateral. The central disc may give pain in both legs, or may be back pain only.

Question 17

Cauda Equina Syndrome

Answer 17

This is compression of the cauda equina due to central lumbar herniated disc, tumours, trauma, spinal stenosis, epidural abscess

Question 18

Clinical features of cauda equina syndrome

Answer 18

bilateral buttock an leg pain and varying dysaethesia and weakness), bowel or bladder dysfunction (urinary retention and incontinence overflow). There can also be saddle anaesthesia, loss of anal tone and anal reflex. There is a high index of suspicion in spinal post-operative patients with increasing leg pain in the presence of urinary retention.

Question 19

Radiological investigation of cauda equina

Answer 19

MRI or lumbar CT or myelogram

Question 20

Treatment of cauda equina syndrome

Answer 20

Operative treatment within 48 hours

Question 21

Outcome of Cauda Equina Syndrome

Answer 21

• 30% undergoing discectomy for cauda equina syndrome do not regain normal urinary function
• 25% with motor deficits never regain full power
• 33% with sensory deficit never regained normal sensation
• 25% with perianal paraesthesiae did not return to normal
• 26% had persistent sexual dysfunction

Question 22

Cervical and Lumbar Spondylosis

Answer 22

Defect in the isthmus of the vertebra, the part between the superior and inferior facets.

Question 23

Spinal Ligaments

Answer 23

• The anterior longitudinal ligament (ALL – along the front of the vertebral bodies is broad and strong)
• The posterior longitudinal ligament (along the back of the vertebral bodies)
• Ligamentum flavum – between the laminae
• The interspinous and supraspinous ligaments – between the spinous processes
• Intratransverse ligament – between the transverse processes

Question 24

Spinal claudication

Answer 24

• Usually bilateral
• Sensory dysaesthesia
• Poss weakness
• Takes several minutes to ease after stopping walking
• Worse when walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding a bicycle.

Question 25

Lateral recess stenosis

Answer 25

Nerves become compressed by the overhanging facet joints so the patient present with sciatica which is worse with standing and walking but releaved by sitting. Treatment is nerve root injection, epidural or decompression

Question 26

Central stenosis

Answer 26

Epidural steroid injection or surgery

Question 27

Foraminal stenosis

Answer 27

nerve root injection

Question 28

Spondylolisthesis

Answer 28

this is the anterior vertebral translation (slippage) of the cephalad vertebra (above) or caudad vertebra (below). It can be split into two separate things – radiographic (meyerding) and aetiologic (Wiltse

Question 29

Symptoms of spondylosis

Answer 29

Lower back pain and occasional radicular symptoms

Question 30

Investigation of spondylosis

Answer 30

X-ray, CT, MRI, radio-isotope bone scan

Question 31

Treatment of spondylosis

Answer 31

injection therapy and surgery.