NMS

7/27/99

Lumbar disc

• Lumbago—generalized, non-neurological back pain—purely somatic in nature
• Dura—as nerve exits a branch off posterior branch—recurrent Meningeal
• Dural sleeve, level above, below and itself
• Dural sleeve and cord dura
• Recurrent nerve is sensory and autonomic (VE and SA)
• Mixed up innervation of the cord dura
• Dual sleeve is segmentally innervated
• Cord dura is multi-segmentally innervated
• Irritation in the cord, disc bulges posteriorly, likely become an irritant to the cord dura
• Would feel pain in a general area
• Sclerotome pain down the leg (one day down one leg, next day the other side, next day both legs, next day neither day)
• Has a disc bulge or osteophytes, spur, tearing of the ligament
• Positive valsalva
• SLR, WLR, neck flexion (soto hall)—stretches the meninges
• Cyriax—these 4 tests are dural signs
• If pt has dural involvement, one or more of these tests should be positive
• If known are positive, it can't be the dura
• Attacks LMN if would breech the dura producing a radiculopathy
• What if bulge would be posterior lateral bulge—dual sleeve (segmentally)—sclerotomal and down the leg
• Difference b/w lateral and medial disc bulge
• Antalgia
• Medial bulge—leaning into the pain—all four tests positive
• Lateral bulge—leaning away from the pain—all positive except WLR
• Facet—valsalva is negative for facets
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