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pt clin med > Thoracic Spine Pathology > Flashcards

Thoracic Spine Pathology Flashcards

1
Q

What percent of symptomatic disc herniations are thoracic disc

A

1%

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2
Q

What percent are asymptomatic disc protrusion

A

37%

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3
Q

What percent of patients returned to premorbid level of function after surgical repair of symptomatic thoracic disc herniation

A

77%

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4
Q

Who generally experiences a higher incidence of thoracic spine disorders

A

Females

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5
Q

What is the prevalence range of thoracic spine conditions at 12 months

A

15-34.8%

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6
Q

What is the prevalence of thoracic spin conditions in adolescents

A

41%

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7
Q

What is the general pathophysiology of scoliosis

A

Deformity of spinal column rather than a disease process

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8
Q

What is scoliosis named for

A

convexity and region

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9
Q

What does a type 1 dysfunction of scoliosis signify

A

Lateral curvature spine

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10
Q

What is a nonstructural scoliosis

A

Reversible lateral curvature

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11
Q

What is a structural scoliosis

A

Irreversible lateral curvature

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12
Q

What does a major curve equal

A

Primary curve

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13
Q

What does a compensatory curve equal

A

Secondary curve

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14
Q

What are the 3 types of idiopathic curve patterns

A
  1. Primary Lumbar
  2. Thoracolumbar
  3. Primary Thoracic
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15
Q

What percent of curve patterns are primary lumbar

A

23.6%

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16
Q

What percent of curve patterns are thoracolumbar

A

16%

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17
Q

What percent of curve patterns are primary thoracic

A

22.1%

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18
Q

Which curve pattern is not severely deforming and is between thoracic and lumbar

A

Thoracolumbar

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19
Q

What curve pattern is worst, progresses rapidly and is severe

A

Primary thoracic

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20
Q

What curve pattern is most benign and least deforming

A

Primary lumbar

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21
Q

How long does it take for a potential increase in the curve for primary thoracic

A

5 years

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22
Q

What causes nonstructural scoliosis (3)

A
  1. Posture
  2. Pain and muscle spasm
  3. Limb length discrepancy
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23
Q

What are the types of pain and muscle spasm that can cause nonstructural scoliosis (3)

A
  1. Painful lesion of spinal nerve root
  2. Painful lesion of spine
  3. Painful lesion of the abdomen
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24
Q

What are the 4 types of structural scoliosis

A
  1. Idiopathic scoliosis
  2. Osteopathic scoliosis
  3. Neuropathic scoliosis
  4. Myopathic scoliosis
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25
Q

What are the types of idiopathic scoliosis (3)

A
  1. Infantile
  2. Juvenile
  3. Adolescent
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26
Q

What percent of all scoliosis is idiopathic scoliosis

A

85%

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27
Q

When does infantile scoliosis occur

A

Birth to 3 years

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28
Q

When does juvenile scoliosis appear

A

4-9 years

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29
Q

When does adolescent scoliosis occur

A

10 to end of growth period

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30
Q

What are the 2 types of osteopathic scoliosis

A
  1. Congenital

2. Acquired

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31
Q

What are the divisions of congenital osteopathic scoliosis (2)

A
  1. Localized

2. Generalized

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32
Q

What causes acquired osteopathic scoliosis (3)

A
  1. Fractures
  2. Dislocations
  3. Rickets
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33
Q

What are the types of neuropathic scoliosis (2)

A
  1. Congenital

2. Acquired

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34
Q

What is an example of congenital neuropathic scoliosis

A

Spina bifida

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35
Q

What is an example of acquired neuropathic scoliosis

A

Cerebral palsy and paraplegia

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36
Q

What are the 2 types of myopathic scoliosis

A
  1. Congenital

2. Acquired

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37
Q

What causes congenital myopathic scoliosis

A

Hypotonia of neuromuscular origin

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38
Q

What is an example of congenital myopathic scoliosis

A

Spinal muscular atrophy

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39
Q

What is an example of acquired myopathic scoliosis

A

Muscular dystrophy

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40
Q

What pecent of the population has idiopathic scoliosis

A

0.5%

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41
Q

Which gender more commonly has infantile idiopathic scoliosis

A

Boys

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42
Q

Which gender more commonly has juvenile and adolescent idiopathic scoliosis

A

Girls

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43
Q

What are the characteristics of idiopathic scoliosis (3)

A
  1. Rapid progression in adolescents
  2. Can be slow, insidious, and painless
  3. As curve progresses wedge-shaped vertebrae form
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44
Q

Where do wedge shaped vertebrae form in people with idiopathic scoliosis

A

Concave side

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45
Q

How much does the degree of idiopathic change per year

A

As little as 1 degree

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46
Q

What is a normal curve for idiopathic scoliosis

A

Less than 10 degrees

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47
Q

What is a mild lateral curve for idiopathic scoliosis

A

Less than 30 degrees

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48
Q

What is a severe lateral curve for idiopathic scoliosis

A

Greater than 40 degrees

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49
Q

When is idiopathic scoliosis normally detected

A

roughly 30 degrees of curve

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50
Q

What is the Cobb Method

A

Find apex of curve then draw a right angle above and below apex and measure curve at cross of right angles

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51
Q

What is the angle measure during the Cobb method

A

Cobb angle

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52
Q

How do you address idiopathic scoliosis nonoperatively

A

Excercise, body cast, and braces

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53
Q

What are the 2 types of braces

A
  1. Milwaukee

2. Boston

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54
Q

What is the Milwaukee brace used for

A

Primary thoracic

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55
Q

What is the Boston brace used for (2)

A
  1. Lumbar

2. Thoracolumbar curves

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56
Q

What is the operative method to fix idiopathic scoliosis

A

Internal spinal instrumentation and fusion

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57
Q

When was Harrington Rodding found

A

1962

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58
Q

What are the 2 systems used for spinal fusion

A
  1. Cotrel-Dubousset (CD) system

2. Texas Scottish Rite Hospital (TSRH) system

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59
Q

How long does the body cast have to be on to ensure consolidation of the fusion

60
Q

When do you do nonoperative interventions of idiopathic scoliosis

A

20-40 degrees

61
Q

When do you do operative interventions of idiopathic scoliosis

A

greater than 40 degrees

62
Q

How old should the child be to perform operative intervention

63
Q

What are the 2 types of osteochondrosis

A
  1. Scheuermann’s disease

2. Calve’s disease

64
Q

Scheuermann’s disease is osteochondrosis of what

A

Secondary centers of ossification in the spine

65
Q

What is another name for the secondary centers

A

Pressure epiphysis

66
Q

Calve’s disease is osteochondrosis of what

A

Primary center of ossification in the spine

67
Q

What is idiopathic avascular necrosis effecting the epiphyses

A

Osteochondrosis

68
Q

What occurs with osteochondrosis (3)

A
  1. Avascular necrosis of subchondral bone
  2. Loss of blood supply
  3. During pathological process epiphysis may permanently deform
69
Q

What ages is osteochondrosis most common in

70
Q

Who gets osteochondrosis more boys or girls

71
Q

Where is osteochondrosis more common lower or upper limbs

A

Lower limbs

72
Q

What are the 4 phase of osteochondrosis

A
  1. Early phase of necrosis (avascularity)
  2. Phase of revascularization with bone deposition and resorptin
  3. Phase of bone healing
  4. Phase of residual deformity
73
Q

True or False:

Osteochondrosis heals spontaneously

74
Q

True or False:

The onset of osteochondrosis is idiopathic

75
Q

What occurs during the early phase of necrosis (3)

A
  1. Loss of BV to epiphysis
  2. Death of marrow and osteocytes
  3. Articular cartilage lives and grows
76
Q

What occurs during the phase of revascularization with bone deposition and resorption (3)

A
  1. Revascularization of epiphysis
  2. Woven bone forms
  3. Pathological fractures arise
77
Q

What occurs during the phase of bone healing (2)

A
  1. Resorption ceases and deposition continues

2. Biologic plasticity

78
Q

What occurs during the phase of residual deformity (2)

A
  1. Contour now unchanged

2. Function can continue for some years

79
Q

What is Scheuermann’s disease

A

Growth disturbance of epiphyseal plates anteriorly

80
Q

What does Scheuermann’s disease result in

A

Increased kyphosis

81
Q

When is Scheuermann’s disease most common

A

Puberty to late teens

82
Q

How many joints does Scheuermann’s disease involve

83
Q

True or False:

Scheuermann’s disease can be inherited

84
Q

What are the clinical features of Scheuermann’s disease (4)

A
  1. Poor posture/rounded shoulders
  2. Moderate back pain
  3. Increase thoracic kyphosis and lumbar lordosis
  4. Tenderness over spinous processes
85
Q

True or False:

When growth ceases the symptoms of Scheuermann’s disease subside but the deformity remains the same

86
Q

What are the types of intervention for Scheuermann’s disease

A

Milwaukee brace for moderate cases and spinal instrumentation and fusion for more severe cases

87
Q

Which disease is more common Calve’s or Scheuermann’s

A

Scheuermann’s disease

88
Q

What ages does Calve’s disease most commonly occur in

89
Q

True or False:

Calve’s disease is almost always limited to one vertebral body

90
Q

What is avascular necrosis secondary to Langerhans cell histiocytosis that creates discrete but destructive lesions in bone

A

Calve’s disease

91
Q

What are the clinical feature of Calve’s disease (3)

A
  1. Mild back pain
  2. Slight kyphosis and muscle spasm
  3. Wafer thin vertebrae on x-ray
92
Q

How long does it take for reossification of bone to complete restoration of the vertebra

93
Q

What is postural syndrome

A

Prolonged end range stress place on normal tissues

94
Q

What age group usually gets postural sydrome

A

20-35 year olds with a sedentary lifestyle

95
Q

Who gets postural syndrome more commonly

96
Q

How do you correct postural syndrome

A

Correct posture

97
Q

What is compression of the neurovascular bundle as it emerges from the thorax and enters the limb

A

Thoracic outlet syndrome

98
Q

Where is the thoracic outlet

A

Space between clavicle and the first rib compartmentalized by the scalenes

99
Q

What vein enters from the arm and exits between clavicle, first rib, and anterior scalenes

A

Subclavian

100
Q

What exit between the anterior and middle scalenes and first rib

A

brachial plexus and subclavian artery

101
Q

What forms the scalene triangle

A

Base: First rib
Anterior: Anterior scalene
Posterior: Middle scalene

102
Q

How do the scalenes cause narrowing of the scalene triangle (4)

A
  1. Shortening
  2. Tightening
  3. Hypertrophy
  4. Spasm
103
Q

How does the first rib cause narrowing of the scalene triangle

A

Inhalation

104
Q

What is the clavicle space between

A

Clavicle and first rib

105
Q

What can cause narrowing of the clavicular space (2)

A
  1. Cervical rib

2. Clavicle fracture malunion affecting normal mechanics

106
Q

What is a cervical rib

A

Rib off of C7 vertebrae

107
Q

What percent of the population as a cervical rib

108
Q

What causes narrowing of the pectoralis minor

A

Shortening or tightening of the pectoralis minor or hyperabduction

109
Q

How can the corocoid process cause narrowing of the pectoralis minor (2)

A
  1. Tethered

2. Compression

110
Q

What are the signs of thoracic outlet syndrome (6)

A
  1. Numbness or paresthegias
  2. Weakness of hand
  3. Pallor or cyanosis
  4. Cold to touch
  5. Heaviness fatigue
  6. Intermittent
111
Q

What is the conservative intervention for thoracic outlet syndrome

112
Q

What are some surgical interventions of thoracic outlet syndrome (3)

A
  1. Cervical rib resection
  2. First rib resection
  3. Scalenectomy
113
Q

What are the most common types of thoracic spine and rib fractures

A

Compression

114
Q

What are signs of wedge compression fractures

A

Mild local tenderness

115
Q

Which type of x-ray is most beneficial for wedge compression fractures

116
Q

What are the types of interventions for wedge compression fractures

A

Cast, bed rest, and AROM

117
Q

True or False:

Ligaments are intact and spinal cord is relatively stable for burst compression fractures

118
Q

True or False:

Spinal cord or cauda equina injury can result from burst compression fractures do to fragments of fracture

119
Q

Signs of burst compression fracture

A

Severe local tenderness

120
Q

Which type of x-ray is most beneficial for burst compression fractures

121
Q

What are the interventions for burst compression fractures

A

No reduction needed, surgery to remove fragments, bed rest, and plaster body cast

122
Q

How long is a person on bed rest with burst compression fractures

A

First few weeks

123
Q

How long does a person have a plaster body cast for burst compression fractures

124
Q

How do fracture dislocations occur

A

High velocity injuries

125
Q

What are signs of fracture dislocations

A

Shock and neurological deficit evident

126
Q

What is the intervention for fracture dislocations

A

Treat neurologic compromise first and open reduction internal fixation (ORIF) with bone grafting

127
Q

Signs of rib fractures

A

Local pain, aggravated breathing, coughing, and sneezing,

128
Q

What x-rays are best for detecting rib fractures

A

plain radiographs

129
Q

What are the interventions for rib fractures

A

Immobilize chest and PT maybe

130
Q

Do rib fractures suck

A

YES’M!!!!!!!!

131
Q

Is idiopathic scoliosis something someone is born with or acquires

132
Q

How do you classify deformities

A

Based on what movements cause symptoms to improve or worsen

133
Q

What happens on the concave and convex side of scoliosis

A

Concave: Muscles shorten
Convex: Muscles lengthen

134
Q

What is a type I scoliosis (4)

A
  1. Idiopathic
  2. Congenital
  3. Structural
  4. Chronic
135
Q

What is a type II scoliosis (2)

A
  1. Non-structural

2. Acute

136
Q

Do you normally see a type II scoliosis in the thoracic region and why

A

No, because of the ribs

137
Q

Is this S was the scoliosis how would you note the top curve

A

L Thoracic convexity

138
Q

What do you use to determine the direction of rotation caused by a scoliosis

A

The vertebral body not the spinous process

139
Q

Nonstructural scoliosis is type I or type II

140
Q

Structural scoliosis is type I or type II

141
Q

What is it called when a disorder reaches a peak then heals spontaneously

A

Self limiting disorder

142
Q

What is the extrusion of the nuclear material of the disc that becomes hardened called

A

Schmorl’s Nodes

143
Q

What plane does a scoliosis occur in

A

Frontal/Coronal

144
Q

What planes does Scheueramnn’s disease occur in

A

Sagittal/Median

145
Q

True or False:

Fusion of the spinal column uses the patient’s own bone or bone from a cadaver

146
Q

What type of scoliosis, type I or type II, is an s shaped curve

147
Q

What type of scoliosis, type I or type II, is a more distinct angle

pt clin med (15 decks)

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