Spinal Nerve Root Lesions Overview
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Questions and Answers

What is a key distinguishing symptom of central stenosis compared to lateral stenosis?

  • Burning or electrical pain
  • Insidious onset of pain
  • Bilateral symptoms (correct)
  • Unilateral symptoms

Which of the following best characterizes foraminal stenosis?

  • Osteophyte formation exclusively
  • Cauda equina syndrome
  • Asymmetrical signs affecting a single nerve root (correct)
  • Bilateral symptoms

What condition could develop as a result of severe lumbar stenosis?

  • Synovial cyst formation
  • Radiculopathy
  • Osteoarthritis
  • Cauda equina syndrome (correct)

What lifestyle factor is noted to worsen degenerative processes related to spinal stenosis?

<p>Smoking (C)</p> Signup and view all the answers

Which group is most likely to be affected by lateral lumbar stenosis?

<p>People aged 65 and older (B)</p> Signup and view all the answers

What are the typical symptoms of lateral lumbar stenosis?

<p>Insidious, intermittent diffuse pain with paraesthesia (A)</p> Signup and view all the answers

How does the degenerative process affecting spinal stenosis typically develop?

<p>Slowly over many years (B)</p> Signup and view all the answers

What is a characteristic sign that may indicate nerve root compression due to lateral stenosis?

<p>Flaccid weakness (B)</p> Signup and view all the answers

What characterizes a Stage 1 disc degeneration?

<p>Chemical changes and physical stress weaken annular fibres. (B)</p> Signup and view all the answers

Which stage of disc herniation involves the nucleus pulposus breaking through the fibrous wall while remaining within the disc?

<p>Extrusion (B)</p> Signup and view all the answers

Which type of herniation is most likely to occur in the cervical spine?

<p>Central disc herniation (C)</p> Signup and view all the answers

In which segment of the spine are thoracic disc herniations most commonly observed?

<p>Thoracic spine is rarely affected (D)</p> Signup and view all the answers

What is a significant clinical finding associated with the sequestration stage of disc herniation?

<p>The nucleus spills into the spinal canal causing inflammation. (A)</p> Signup and view all the answers

Which is the most common type of disc herniation that leads to nerve irritation without actual compression?

<p>Prolapsed disc (B)</p> Signup and view all the answers

What age range is most commonly affected by acute disc herniation?

<p>Late 30s to 40s (C)</p> Signup and view all the answers

What classification method is used for disc herniations based on MRI findings?

<p>Location classification by axial view (C)</p> Signup and view all the answers

What is the main characteristic associated with severe disc pain?

<p>Burning or electrical pain in the legs or arms (A)</p> Signup and view all the answers

Which of the following statements about disc herniation is true?

<p>Most disc prolapses will fully resorb on their own. (B)</p> Signup and view all the answers

What is a common early diagnostic test for nerve tension in patients with suspected disc herniation?

<p>Straight leg raise (SLR) (A)</p> Signup and view all the answers

What type of patient history might suggest the need for imaging or referral?

<p>Persistent pain despite treatment (B)</p> Signup and view all the answers

Which mechanism leads to lower extremity pain in disc herniation?

<p>Nerve root irritation by inflammatory mediators (D)</p> Signup and view all the answers

What is an antalgic gait?

<p>A subconscious mechanism to avoid putting pressure on a nerve root (C)</p> Signup and view all the answers

Which finding would indicate a severe disc herniation during physical examination?

<p>Myotomal weakness and flaccidity (A)</p> Signup and view all the answers

What is a contraindicated treatment for disc herniation?

<p>Rotatory adjustments at the level of herniation (C)</p> Signup and view all the answers

Which imaging method provides a high-risk assessment for neurological compression but has high costs and delays?

<p>MRI (B)</p> Signup and view all the answers

What is a common sign of cauda equina syndrome?

<p>Bilateral leg weakness (D)</p> Signup and view all the answers

What do patients often experience after a symptomatic resolution of disc issues?

<p>Residual symptoms despite the bulging disc remaining observable on MRI (B)</p> Signup and view all the answers

What is a typical recovery timeline for symptomatic reduction after a disc prolapse?

<p>6-8 weeks (B)</p> Signup and view all the answers

Which statement accurately reflects the nature of spinal stenosis?

<p>It refers to the narrowing of the spinal canal, potentially leading to nerve compression. (A)</p> Signup and view all the answers

How does age affect the strength and elasticity of spinal discs?

<p>Younger discs are stronger unless subjected to early, heavy stress. (A)</p> Signup and view all the answers

Flashcards

Disc Herniation

Occurs when the inner gel-like nucleus pulposus pushes outwards through the outer fibrous layer of the intervertebral disc, often to the posterior-lateral aspect.

Stage 1: Disc Degeneration

The first stage of disc degeneration, characterized by chemical changes in the disc, weakening of the annular fibres, and a contained nucleus pulposus.

Stage 2: Prolapsed Disc

The inner disc material pushes further into the outer layer, creating a bulge, but doesn't completely break through the fibrous wall.

Stage 3: Extrusion

The nucleus pulposus breaks through the outer wall of the disc and enters the spinal canal, but remains within the disc, leading to more severe symptoms due to greater damage.

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Stage 4: Sequestration

The nucleus pulposus breaks through the outer wall of the disc and spills out completely into the spinal canal, potentially causing significant nerve inflammation and pain.

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Central Disc Herniation

A disc herniation located in the center portion of the disc, affecting the spinal cord or nerve roots directly.

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Paracentral Disc Herniation

A disc herniation located to the side of the center of the disc, affecting nerve roots exiting through the foramen.

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Foraminal Disc Herniation

A disc herniation that occurs at the level of the foramen, affecting the nerve roots exiting through the foramen.

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Central Spinal Stenosis

A narrowing of the spinal canal that compresses the spinal cord, resulting in bilateral symptoms like pain, numbness, and weakness in both legs.

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Lateral Spinal Stenosis

A narrowing of the space where nerve roots exit the spine, affecting only one side of the body (unilateral).

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Foraminal Spinal Stenosis

Narrowing of the space around the intervertebral foramen (IVF), where nerve roots exit the spinal canal, resulting in unilateral pain and weakness.

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Cauda Equina Syndrome

A rare but serious condition caused by severe lumbar stenosis that compresses the cauda equina, leading to bowel and bladder dysfunction, as well as leg weakness.

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Degenerative Spinal Stenosis

The natural wear and tear of the spine that leads to bone spurs, facet joint hypertrophy, and synovial cysts, all of which can compress nerves and cause stenosis.

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Facet Joint Hypertrophy

The overgrowth of the facet joints that enclose the IVF (intervertebral foramen), compressing the nerve root, resulting in lateral stenosis.

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Bone Spur (Osteophyte) Formation

A bone spur that forms on the vertebrae due to osteoarthritis, potentially pinching the nerve root and causing pain.

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Synovial Cyst Formation

A fluid-filled sac that forms in the joint space, often near the facet joints, which can compress nerves and cause pain.

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Disc Bulge

A condition where the intervertebral disc protrudes beyond the normal boundaries of the vertebral column, often caused by the loss of elasticity in the annular fibers.

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Radicular Pain

The characteristic burning or electrical pain radiating down the leg or arm, often experienced with disc herniation.

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Nerve Root Irritation

The inflammation of a nerve root due to compression or irritation, often seen in disc herniation.

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Antalgic Gait

A type of gait pattern where the individual shifts or leans away from the affected side to reduce pressure on the nerve root.

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Straight Leg Raise (SLR)

A diagnostic test used to detect nerve root compression or irritation by stretching the sciatic nerve.

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Slump Test

A diagnostic test used to detect nerve root compression or irritation by stretching the nerves of the lower back and legs.

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Range of Motion (ROM)

A diagnostic test used to assess the flexibility and mobility of the spine, specifically looking for pain or restricted movement.

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Disc Resorption

The natural healing process of a disc prolapse where the herniated material is resorbed and the disc heals.

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Spinal Stenosis

The condition where the spinal canal narrows, often due to degenerative changes in the spine, resulting in compression of the spinal cord or nerve roots.

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Rotatory Adjustments

A type of adjustment technique used for spinal manipulation that involves rotating the spine at the affected level. This technique is contraindicated in disc herniation.

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McKenzie Technique

A specific type of adjustment technique used in chiropractic care to treat spinal conditions.

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Magnetic Resonance Imaging (MRI)

A diagnostic tool that uses magnetic fields to create images of the internal structures of the body, including the spine.

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Diversified Adjustment

A type of spinal manipulation technique that involves applying a high-velocity, low-amplitude thrust to the spine.

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Study Notes

Spinal Nerve Root Lesions

  • Disc Herniation: A tear in the annular fibers allows the nucleus pulposus to bulge outwards, typically posteriorly and laterally.
  • Common Locations: Lower cervical and lower lumbar spine most frequently affected; thoracic spine less common due to rib cage stabilization.
  • Causes: Trauma or conditions contributing to uneven weight distribution (e.g., Scheuermann's disease).
  • Stages of Disc Herniation:
    • Stage 1 (Disc Degeneration): Chemical changes, physical stress (e.g., repetitive strain), or flexion/rotation injury weaken the annular fibers, though the nucleus remains contained. Often asymptomatic and pre-existing.
    • Stage 2 (Prolapsed/Bulging Disc): The inner disc material pushes further outwards, but doesn't break through the outer layer. Can cause chemical irritation, or compression of nerves/structures.
    • Stage 3 (Extrusion): The nucleus has broken through the outer layer but remains within the disc. Usually prompts more severe symptoms. Recent evidence suggests conservative management effectively reduces extrusion size.
    • Stage 4 (Sequestration): The nucleus breaks through and escapes the disc into the spinal canal. This can lead to nerve inflammation, irritation, and pain in the affected nerve root, and potentially those above/below it. Cauda equina syndrome is a possible complication, particularly in the lumbar spine.
  • Location Classification (MRI): Axial view used; disc viewed like a clock. Central herniation (6 o'clock), paracentral (5/7 o'clock), foraminal (4/8 o'clock), and far lateral. Central and paracentral most common; foraminal and far lateral less common but more severe.
  • Prevalence: Usually between 25-50 yo, but more frequently in the 30s-40s. Younger discs are stronger unless subjected to early trauma; older discs become more stable.
  • Symptoms: Severe pain (6-10 on VOS scale), burning or electrical pain (leg or arm), back pain (less significant). Myotomal weakness, reduced reflexes, and potential exaggerated reflexes below the affected level. Antalgic gait (avoiding pain-causing movements) is common.
  • Signs: Myotomal weakness, antalgic gait, guarding (muscle tightness), and possible muscle spasm on palpation. Range of motion (ROM) flexion/rotation/extension is assessed.
  • Diagnosis: Imaging (MRI); high cost but potentially required to determine treatment necessity if severe neurological compression or failure to improve with conservative treatment.
  • Treatment: Improve blood flow, biomechanics, avoid aggravating ROM, offloading advice, massage around but not on the affected level, non-surgical interventions. Rotatory adjustments and diversified techniques are contraindicated.

Spinal Stenosis

  • Definition: Narrowing of the spinal canal, or the area around the nerve roots.
  • Common Cause: Degenerative changes, including osteoarthritis, bone spur formation (osteophytes), and hypertrophy of facet joints, all causing IVF narrowing.
  • Types of Stenosis:
    • Central: Compresses central cord; often related to other spinal conditions.
    • Lateral/Foraminal: Affects nerve roots as they exit the spinal canal. Clinically similar; both present unilaterally in nerve root compression.
  • Pathophysiology: Aging, osteoarthritis. Although common in the elderly, it can manifest in younger patients.
  • Prevalence: More common in older individuals (65+). Many over 50 are asymptomatic.
  • Symptoms: Intermittent, diffuse, crampy pain with paresthesia (e.g. pins and needles). Severe nerve compression causes burning or electrical pain. Weakness, atrophy, and reflex changes may also arise.
  • Signs: Weakness, atrophy, hyporeflexia (decreased reflexes). Symptoms relieved by opening movements (e.g., flexion, contralateral lateral flexion). Exacerbated by closing movements (e.g., extension, ipsilateral lateral flexion).

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Description

This quiz explores spinal nerve root lesions, focusing on disc herniation, its common locations, causes, and stages. Participants will learn about the impact of trauma and conditions like Scheuermann's disease on spinal health, and the progression of disc herniation. Ideal for medical students or healthcare professionals.

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