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Right L 5 nerve root is cut off sign of nerve root compression by disc
prolapse
Disc herniation
Intervertebral arthritis
Intervertebral arthrosis (degenerative process)
B: osteophyte, compressing on nerve root
intervertebral disc still intact
Antalgic postureTypical clinical sign in disc disease, or sciatica (sciatic nerve is affected)
A: disc protrusion under the nerve root leaning towards this side releaves the
pain
B: disc protrusion is above nerve root leaning towards the opposite side releaves
the pain
Antalgic posture leanes away from the side of pain: sign of Pisa
Intervertebral disc types according to localisation:
a- central (may compress the spinal cord),
b- mediolateral
Compression of S 1 nerve root:
Motor signs weak flexors
Reflex sign: Achilles areflexia
Sensory signs: outer edge of foot hyposensibility
Lasgue sign, or straight leg raising: if nerve roots of sciatic nerve are affected,
extreme pain can be provoked (typical sign in sciatica)
Spinal canal
A: normal width
b.: spinal stenosis narrowing of spinal canal, may cause spinal cord
compression
(can be caused by disc prolapse, fracture of vertebral body, tumour)
Operation: discectomy (can be done percutaneously, with endoscope too)
Transpedicular fixation introduction of screws through pedicles into vertebral
body, screws connected on each side with metal bar
Used for treatment of spinal instability
TBC of spine: Potts gibbus, Potts paraplegia (if spinal cord is compressed)
Tb of spine: Destruction of 7.-8.-9- thoracic vertebral bodies, with wide
paravertebral soft tissue shadow- cold abscess (it will sink eventually downwards
and cause fistulation around the inguinal region)
[Fistula=abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not
connect]
Tubecrulous sinus filled up with contrast (sinogram) cold abscess seen on buttock
Compression of cervical spinal cord: due to destruction of C 5 vertebral body TB)
Tuberculosis of spine
Treatment:
Combines antituberculous chemotherapy (streptomycin, INH etc at least three
drugs at the same time,at least for 6 months)
Surgery: evacuation of abscess, decompression of spinal cord
Low back pain:
It is so frequent, that it became a disease in itself
3 forms:
1. Transient backache- simple back strain - , rest, antiinflammatory drugs are
sufficient
2. Sudden acute pain with sciatica:pain radiating along The sciatic nerve - disc
prolapse is likely - operate if severe disc prolapse is detected
3. Chronic low back pain- arthritis oir arthrosis of intervertebral joints (may
mimic disc prolapse, MR or CT are helpful diagnostic tools) spinal instability
may be the underlying cause too
BEWARE: TUMOR INSIDE The PELVIS OR METASTATIC BONE TUMORS MAY BE ThE
UNDELYING CAUSE AS WELL!! (ALWAYS NEEDS CHECKUP THOROUGH
EXAMINATION TO EXCLUDE MORE SEVERE DISEASES)
Causes of low back pain from the spine, from organs inside the pelvis,
metastatic disease
Osteoporosis treatment(?)
KYPHOPLASTICA TECHNIQUE
Ballon pressure 3,4-20,4 atm
Th5-10
lateral-extrapedicular INSERTION OF CANULA
Th10-L5 transpedicular insertion of canula, through
which bone cement is injected into balloon in collapsed vertebral body