15 - Back Problems Flashcards
What percent of the population will experience back problems
80%
Cause of an abnormal curve
Developmental abnormalities
Pathological
Osteoporosis
What is kyphosis
Excessive thoracic curvature
Hunchback
What causes kyphosis
Erosion/fracture of anterior part of one or more vertebrae
What is a kyphoplasty
aka vertebroplasty
Provides pain relief + prevents further collapse
Put in a needle percutaneously - insert inflatable balloon - reinflate vertebrae and insert cement to support
What is Sheuermann’s disease
Adolescent kyphosis
Whereby the epiphyseal growth plates of vertebral bodies are affected
causes kyphosis
Severe symptoms of sheuermanns disease
Pain
difficulty breathing
What is Schmorls node
indentaion in the middle of the vertebrae caused by protusions of nucleus pulposus through the endplate into the vertebral body
Treatment for sheuermanns disesae
brace until grown
What is Lordosis
Hollow back
Excessive lumbar lordosis
What causes lordosis
Anterior rotation of pelvis Weakened trunk muscles Weakened hip flexors Pregnancy/obesity Due to vertebral bodies being designed for the weight bearing - however now weight is shifted onto posterior elements
What is psoas dysfunction and how does it cause lordosis
Aka weakened hip flexors
- Chronic psoas shortening
- Lumbar lordosis
- Shortening of thoraco-lumbar fascia + erector spinae muscles
- Stretching and weakness of abdominal muscles
- Hamstring + gluteal muscles tightened and hypertonic
Symptoms of lordosis
Back ache
Sciatica
as easier to compress lumbar spinal nerves
Flat back syndrome
Hamstrings are tight
Hip flexors are weak
Pelvis tilts backwards pulls vertebral column flat
Ankylosing spondylitis
Scoliosis
Crooked, curved back
Abnormal lateral curve + rotation of vertebrae (sometimes)
Causes of scoliosis
Hormonal changes at puberty
Developmental defects
Asymmetrical muscle strength
Poor posture
Treatment for scoliosis
0-20 degrees = nothing
20 - 40degrees = Brace
>50degrees = Surgery (vertebral fusion, harrington rods)
What do you look for for age related changes of the spine
Oseophytes (syndesmophytes) Loss of disk height Loss or increase in curves Spinal stenosis Ossification of vertebral ligaments
What type of joint is the intervertebral dis
Cartilaginous joint
What is the nucleus pulposus
70-80% water
Proteoglycans
Avascular
No innervation
What is the annulus fibrosus
Altering layers of type 1 collagen
Outer 1/3rd is innervated
Where is a prolapsed disk most common
between L4/5 or L5/S1 as most weight bearing - under most stress
What are symptoms of cauda equina syndrome
Low back pain
Sciatica
Saddle and perineal hypothesia or anesthesia
Bowel and bladder disturbances
Lower motor extremity weakness and sensory deficits
Reduced/absent lower reflexes
Treatment for cauda equinasyndrome
Disectomy
Removing the vertebrae segment
or
Laminectomy
immediate complication of burst fracture
Compression of the spinal cord/nerve roots
Instability
Late complication of burst fracture
Hematoma/necrosis
Hardening of the IV disk due to blood clot
Where do Osteophytes commonly develop
Margins of vertebral body
zygapophysial joints
Vertebral arteries blood flow to brain
Brainstem
posterior 1/3rd of brain
What is diffuse idiopathic skeletal hyperostosis
Ossification of anterior longitudinal ligament +/- osteophytes
Disk height is maintained
Ankylosing Spondylitis
A chronic inflammatory disorder mainly involving the axial skeleton causing the fusion of bones - BAMBOO spine on xray
Narrowing and sclerosis of both sacroilliac joint
What is the gene which patients with Ankylosing spondylitis are positive?
HLA-B27
>95% of patients are positive
How does HLA B27 influence gut flora
B27 flora predisposes a leaky guy
Antibiotic therapy prevents spondylitis and colitis
Leaky gut allows substange trigger cascades of inflammatory reaction
Synovial joints of the vertebral column
o Zygapophysial joints (Facet joints)
o C1 and C2 pivot synovial joint
