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Spinal Pathology Notes

Medicine Notes > Orthopaedics Notes

This is an extract of our Spinal Pathology document, which we sell as part of our Orthopaedics Notes collection written by the top tier of University Of Leicester students.

The following is a more accessble plain text extract of the PDF sample above, taken from our Orthopaedics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Spinal Pathology Sciatica
= Pain and paraesthesia in the distribution of the sciatic nerve (from buttock down posterior thigh, calf and heel) Sciatic nerve = L4-S1 Arises from lumbrosacral plexus - Exits pelvis below piriformis muscle Motor - hamstrings and all muscles below the knee Sensation - foot and lateral lower leg Aetiology
- Any pathology resulting in compression of sciatic nerve o Lumbar disc herniation
? Degeneration of outer annulus fibrosis, inner nucleus pulposus bulges out
? Commonest = L5/S1 o Spinal stenosis o Tumours o Osteomyelitis o Paget's o Ank Spond. o Spinal trauma Pathology
- Sciatic pain arises from spinal nerve root compression which occurs in o Intervertebral root foramina
? Causes unilateral symptoms in affected dermatomes and muscles o At cauda equina
? Causes bilateral symptoms affecting buttocks, genitalia, sphincters and lower limb Examination
- Straight leg raise with dorsiflexion of the foot
- Compression of popliteal fossa
- Cross-over test Investigations
- Only investigate further if there are any red flag signs or no signs of improvement in 6-8 weeks
- If so; o Imaging (MRI, lumbar xray) o Bloods (FBC, U+E) Management
- Bed rest for 2-3 days then mobilise
- Analgesia
- Muscle relaxant (diazepam)
- Physiotherapy
- Steroid injection - root block/epidural

-

Surgery = discectomy/decompression

Spondylolisthesis
= Anterior displacement of a lumbar vertebra over the vertebra beneath it Aetiology
- Normal laminae and facets constitute a locking mechanism which prevents each vertebra moving forwards on the one below
- If mechanism fails - forward shift occurs
- Usually between L4/5 L5/S1
- Usually happens because of o Separation or stress fracture through neural arch allowing anterior part of vertebra to slip forward o Osteoarthritic degeneration of facet joints o Destructive conditions e.g fracture, TB, Neoplasia o Dysplasia of facet joints Clinical features
- Dysplastic spondylolisthesis: o Seen in children o Usually painless o May be associated scoliosis
- Lytic spondylolisthesis o Commonest o Intermittent back pain o Pain exacerbated by exercise or strain o On examination
? Buttocks look flat
? Sacrum appears to extend to waist
? Permanent transverse loin creases
? "step" may be felt on palpation of spine
- Degenerative spondylolisthesis o Usually occurs in women > 40 with longstanding backache due to facet joint arthritis o May present with spinal claudication Investigations
- Imaging o Xray - forward shift of vertebra. Defective facets o CT - shows gap in neural arch Management
- Conservative treatment o Bed rest during acute attack o Supportive corset
- Surgical treatment o Spinal fusion to fix unstable segment

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