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Orthopaedic Surgery


Answer 1
  1. Spinal stenosis. Intervertebral disc degeneration can result in facet hypertrophy, spinal instability, and subsequent spinal canal narrowing (spinal stenosis). Many of these patients are asymptomatic; however, with time and progressive spinal canal narrowing, patients can develop nerve root impingement and symptoms of neurogenic claudication. Forward flexion and sitting increases the cross-sectional area in the lumbar spine and is a natural attempt to decompress the spinal nerves. Conversely, extension results in narrowing of the spinal canal and will aggravate the symptoms. In the patient with vascular claudication, the symptoms typically are not affected by lumbar position and are relieved when then the patient stops walking. In addition, normal peripheral pulses make a vascular etiology less likely. Traumatic herniated discs typically occur in younger patients who have a specific event resulting in the onset of symptoms. This is not the presentation for patients with cauda equine syndrome or internal disc disruption.

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