Page 121 - ASOP ROT Study Guide

Clinical presentation
The sufferer is typically a person of either sex usually over forty who has a previous history of backache
of a mechanical type. These patients are usually known back sufferers who develop new symptoms of leg
pain radiating to the foot, usually made worse by exercise. Such a syndrome is rather poorly named spinal
claudication, (spinal cramp) as it is similar in effect to a vascular disease which does cause cramps in
the calves during exercise.
Episodes are usually acute and recurrent against a chronic history of back pain. The episodes may remain
mild or may progress to affect the patient's lifestyle. Physiotherapy is unlikely to help and should pain be
severe then surgery may be necessary.
Etiology
The cause of the condition is commonly due to bony overgrowth around the vertebral foramina where the
nerve roots emerge. The cause of the bony overgrowth would appear to be secondary to degenerative
changes in the adjacent facet joints. These may degenerate from primary osteoarthritis or as a result
of disc degeneration (not prolapse!).
Management
Removal of the disc in such patients may make the condition worse and removal of bone is needed to free
trapped nerve roots. This may result in disturbance in spinal stability and lead to a need for fusion of the
affected vertebrae. The decision to operate is entirely determined by the severity of the patient's
symptoms.

5. CERVICAL SPINE
The cervical spine is a very mobile part of the vertebral column and it is no surprise to find that it is prone
to disease and injury. Most conditions are exactly analogous to those found in the lumbar spine.

5 . 1 Cervical Spondylosis
This is very like the degenerative disc and joint disease seen in the lumbar spine and the etiology.

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9852.htm