common back problems

COMMON BACK PROBLEMS

ByDr. Tarek A. ElHewala

Lecturer of Orthopaedic SurgeryFaculty of Medicine, Zagazig University

ZAGAZIG UNIVERSITYFACULTY OF MEDICINE

ORTHOPAEDIC DEPARTMENT

Spinal Anatomy

• The Human spine is formed of:1. 7 cervical vertebrae.2. 12 thoracic

vertebrae.3. 5 lumbar vertebrae.4. Fused sacral and

coccyx vertebrae.

Spinal Anatomy

• These bony structures articulate through the vertebral disc to provide:1. Protection of the

spinal cord and its nerve roots.

2. Mobility of the trunk.

Spinal Anatomy

• Schematic representation of a functional spinal unit (motion segment) in lumbar spine.

Spinal Anatomy

• Mid-sagittal section through a healthy young intervertebral disc. The white cartilage endplates, the gel-like nucleus pulposus and the surrounding anulus

fibrosus can easily be distinguished.

Spinal Anatomy

The lumbar spinal canal anatomy and lumbar ligaments

Spinal Anatomy

Normal intervertebral foramen relations and contents.

Lumbar Disc Herniation

• Lumbar disc herniation is most frequently found in the 3rd and 4th decades of life at the level of L4/5 and L5/S1.

• The cardinal symptom of lumbar disc herniation is radicular leg pain with or without a sensorimotor deficit of the affected nerve root.

Lumbar Disc Herniation

• The radiculopathy is not only caused by a mechanical compression of the nerve root but also by an inflammatory process caused by nucleus pulposus tissue

Lumbar Disc Herniation

• MRI is the imaging modality of choice for the diagnosis of disc herniation

Lumbar Disc Herniation

• In contrast to large disc extrusion and sequestrations, disc protrusions are frequently found in asymptomatic individuals

Lumbar Disc Herniation

• The best discriminator of symptomatic and asymptomatic disc herniation is nerve root

compromise

Lumbar Disc Herniation

• Mild radiculopathy responds well to non-operative treatment, but surgical treatment results in better short-term results in selected patients.

• Severe radiculopathy responds poorly to non-operative treatment and should be treated surgically.

• The surgical treatment of choice is an open standard interlaminar discectomy or microsurgical discectomy.

Lumbar Disc Herniation

Lumbar Disc Herniation

• Cauda Equina Syndrome caused by a central disc herniation.

• Symptoms include bilateral leg pain, loss of perianal sensation, paralysis of the bladder, and weakness of the anal sphincter

• Cauda equina syndromes require an emergency decompression and should be treated by complete laminectomy and wide decompression.

Spinal Stenosis

• Lumbar spinal stenosis can be defined as any narrowing of the spinal canal, lateral recess or intervertebral foramen.

Spinal Stenosis

Spinal Stenosis

• Spinal stenosis most frequently results from degenerative alterations of the motion segment.

• Lumbar spinal stenosis is a common condition in elderly patients.

• Spinal stenosis is often associated with degenerative spondylolisthesis.

• Degenerative spondylolisthesis most frequently occurs at the L4/5 level in females

Spinal Stenosis

Spinal Stenosis

Spinal Stenosis

Spinal Stenosis

• The cardinal symptom of spinal stenosis is neurogenic claudication.

• Neurologic examination of a patient often is remarkably normal.

• The most important differential diagnosis is intermittent ischemic claudication.

Spinal Stenosis

Spinal Stenosis• MRI is the imaging modality of choice.

Spinal Stenosis

• Conservative treatment may only relieve symptoms for a short time period.

• Conservative treatment does not affect the natural history of spinal canal narrowing.

Spinal Stenosis

• Surgery is generally accepted when the quality of life is substantially limited because of the neurogenic claudication.

• Selective decompression (laminotomy) with preservation of the lamina is the preferred technique in the absence of segmental instability.

• Instrumented fusion as an adjunct to laminectomy improves the long-term results in degenerative spondylolisthesis with spinal stenosis.

Spinal Stenosis

Lumbar Spondylo-Listhesis

• The term spondylolisthesis comes from the Greek spondylo, meaning “vertebra,” and olisthesis, meaning “movement or slipping.”

• Spondylolisthesis describes the pathologic state of one vertebra slipping on another; this can be forward (anterolisthesis) or backward (retrolisthesis).

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Lumbar Spondylo-Listhesis• Spondylolithesis:

• Spondylo = Spine.• Lithesis = Dislocation.

• Spondylolithesis of L4 on L5

• Retrolithesis of L5 on S1

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Lumbar Spondylo-Listhesis

• Spondylolysis:• Spondylo = Spine.• Lysis = Disintegrate.

• Pars Defect.

• Spondylolysis of L5

• Spondylolysis of L5 with spondylolithesis of L5 on S1

Lumbar Spondylo-Listhesis

Lumbar Spondylo-Listhesis

• Mechanical LBP may result from abnormal load distribution.• Discogenic, facet-joint and neurogenic, referred pain may coexist in spondylolisthesis.

Lumbar Spondylo-Listhesis

• Physical findings:– tight hamstrings– sensorimotor deficits– pain on backward bending and rotation (often

facet joint pain)– pain on forward bending (often discogenic pain)– pain on extension from the forward bent position– limitation of walking distance

Lumbar Spondylo-Listhesis

Lumbar Spondylo-Listhesis

Lumbar Spondylo-Listhesis

Lumbar Spondylo-Listhesis

Lumbar Spondylo-Listhesis

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