WHIPLASH

Conditions associated with whiplash include:

  • Cervical muscle spasm
  • Cervical nerve root injury
  • Spinal cord injury
  • Spinal fracture

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LUMBAR SPINAL STENOSIS

Lumbar spinal stenosis has been defined as any type of narrowing of the spinal canal, nerve root canals, or intervertebral foramen. This narrowing can put pressure on the contents of the spinal canal (spinal cord and nerve roots) resulting in symptoms of lumbar stenosis. It can present at any age but usually presents in patients over the age of 50. The most common levels of lumbar spinal stenosis are L3-4 & L4-5. Nearly 15% of the patients with degenerative lumbar spinal stenosis also have cervical spinal stenosis.

The Causes: The narrowing can be caused by soft tissue abnormalities (e.g. disc herniation, ligament enlargement), bony abnormalities (e.g. facet enlargement or bone spurs), or a combination of both. The resultant nerve root compression leads to nerve root ischemia, which gives the clinical picture of lumbar spinal stenosis. The narrowing of the spinal canal structures can be congenital and or acquired (more common). The primary cause of the acquired spinal stenosis is degenerative disc disease. Less common causes are spondylolisthesis, scoliosis, trauma, and rarely, spinal tumors.

The Diagnosis: A thorough medical history and physical examination are the keys to the correct diagnosis. If no relief is achieved with conservative care, other workups or studies may become necessary, including X-rays, MRI, and CT scans.

X-rays of the lumbar spine are usually the first diagnostic study and give an assessment of the degenerative spine disease, disc space narrowing, spur formations, spine instability, foraminal narrowing, and other bony abnormalities.

MRI studies use the magnetic field and radiofrequency waves to give detailed pictures of the lumbar spine, including disc herniations, bone spurs, the extent and level of narrowing in different planes, and horizontal or vertical cut sections.

CT scans give detailed information regarding spine structures, especially bony structures, but are limited in the evaluation of soft tissues. This can be of significant help in clinical situations where MRI studies are not indicated, e.g., patients with pacemakers or surgical clips. A CT myelogram is rarely needed in clinical situations when the MRI study is limited due to metallic artifact from spine implants and fusions.

Electrodiagnostic studies involve the electrical study of nerves and muscles, which is helpful in the diagnosis of nerve damage or irritation. Nerve root blocks or transforaminal epidural injections are commonly used to make a focal diagnosis of the spinal pain or are used prior to spinal surgery. Points: On rare occasions, numbness, weakness, and/or impairment of bladder or bowel function—either the inability to start or stop—could constitute cauda equina syndrome, which is an absolute emergency necessitating immediate attention in the emergency department.

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