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PassPMR - 08 Prosthetics & Orthotics > 9. Spine Medicine & Spinal Orthosis > Flashcards

9. Spine Medicine & Spinal Orthosis Flashcards

1
Q

Innervation of facet joint πŸ”‘πŸ”‘

A

Cervical: Medial branch at the level and the below level (C1 facet from C1, 2)

Thoracic & Lumbar: Medial branch at the level and the above level (L5 facet from L4, 5)

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2
Q

Face joint and relation to spine mobility. πŸ”‘πŸ”‘ Dr. Jamal & Dr. Abdulrazaq

A

Cervical Vertebra

  • Free flexion and extension
  • Limited bending and rotation
  • Horizontal facing facet

Thoracic Vertebra

  • Free lateral flexion
  • Restricted flexion and extension
  • Limited rotation
  • Frontal/Coronal aligned facet joint

Lumbar Vertebra

  • Good flexion, extension and lateral flexion.
  • Limited rotation.
  • Sagittal facet joints.
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3
Q

Components of intervertebral disc πŸ”‘πŸ”‘

A

Three distinct components

  1. Central nucleus pulposus (NP)

Type II collagen

  1. Peripheral annulus fibrosus (AF)

Type I collagen

  1. Two vertebral endplates (VEPs).

What is the function of proteoglycan? Bonus Q

The major biological function of proteoglycans derives from the physicochemical characteristics of the glycosaminoglycan component of the molecule, which provides hydration and swelling pressure to the tissue enabling it to withstand compressional forces.

What is the function of collagen? Bonus Q

Collagen makes up articular cartilage, the tissue that covers the ends of bones at the joints and allows them to move smoothly against one another and provides bone, tendons and ligaments with tensile strength and skin with elasticity

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4
Q

Innervation of intervertebral disc πŸ”‘πŸ”‘ EXAM 2019

A
  1. Anterolateral part of the annulus fibrosis is innervated by ventral rami and gray rami communicans
  2. Posterior part of the annulus fibrosis is innervated by sinuvertebral nerves

Cuccurullo 4th Edition Chapter 4 MSK pg284

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5
Q

List 3 possible sites for needle insertion when doing epidural steroid injection πŸ”‘πŸ”‘

A
  1. Transforaminal approach
  2. Interlaminar approach
  3. Caudal approach

Ref: Cuccurullo page 331 + Braddom

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6
Q

Explain spine ROM (Flex-Ext-Bend-Rotate) in each region of the vertebra πŸ”‘πŸ”‘ Dr. Abdulrazaq

A

Cervical

  • Extension Occipital-C1 junction.
  • Axial rotation C1–C2 levels
  • Lateral bending C3–C4 and C4–C5 levels.

Thoracic region

  • Axial rotation occurs mostly at the T1–T2 level, decrease toward the lumbar spine.
  • Lateral bending is fairly evenly distributed throughout the thoracic levels.
  • Flexion and extension T11–T12 and T12– L1 levels.

Lumbar region

  • Lateral bending predominantly at the L3–L4 level.
  • Insignificant axial rotation in the lumbar spinal segment.
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7
Q

Atlanto-Axial joint biomechanics

A

The odontoid process lies anterior to the spinal cord as a pivot for the rotation of the head.

The C1 vertebra, carrying the cranium, rotates on odontoid process.

The craniovertebral joint between the atlas and the axis is called, the atlanto-axial joint.

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8
Q

Name the major ligaments of the spine and the spine motions they resist πŸ”‘πŸ”‘ MOCK

A
  1. Anterior longitudinal ligament β†’ extension
  2. Posterior longitudinal ligament β†’ flexion
  3. Ligamentum flavum and facet joint β†’ flexion
  4. Interspinous and supraspinous ligaments β†’ flexion

PMR Secrets – 3rd edition – page 16

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9
Q

Define Denis Three Column Model. πŸ”‘πŸ”‘

EXAM Mention the β€œmiddle column” components of Denis’s model 3 Marks πŸ”‘πŸ”‘ MOCK

When do you consider bracing or not? which type of brace? πŸ”‘πŸ”‘ Dr. Jamal

A

MIDDLE COLUMM

  1. posterior longitudinal ligament
  2. posterior one third of the vertebral body
  3. posterior one third of the annulus fibrosis

Braddom (ch. Spinal cord injuries – spinal mechanics and stability)

BRACING

πŸ’‘ When the middle column and either the anterior or posterior column are compromised, the spine may be unstable

  • Unstable fracture require HALO
  • Stable fracture require less restrictive Orthosis (Minerva- Four Poster - SOMI)
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10
Q

Mention 3 types of odontoid fractures πŸ”‘πŸ”‘ EXAM

A

Type 1 is a fracture through the tip of the odontoid

Type 2 is a fracture through the base of the odontoid

Type 3 is a fracture that extends from the base of the odontoid into the axis proper

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11
Q

Indication & Contraindication of Soft & Rigid CO

A

Soft CO:

  1. Symptomatic treatment of soft tissue injuries of the neck (i.e., whiplash injury)
  2. Psychological reassurance
  3. Kinesthetic reminders to limit cervical range of motion;
  4. Provide some warmth and comfort

Rigid CO:

  1. Mid-cervical bony or ligamentous injuries
  2. Stable cervical fractures
  3. Postoperative stabilization
    1. Anterior cervical fusion
    2. Anterior discectomy
    3. Patients dealing with tracheostomy
  4. Post-halo removal

Contraindication

  • Spinal instability
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12
Q

List 4 Complications of cervical orthosis πŸ”‘πŸ”‘

A
  1. Limit vision to the walking ground β†’ tripping hazards, that is toys on the floor, cracks in the sidewalk, pets, loose rugs, etc β†’ managed by home visit via OT
  2. Decrease in maximal mouth opening β†’ dysphagia β†’ aspiration pneumonia (head elevation, slight cervical extension, and limited chin tuck)
  3. Reduction in tidal volume
  4. Affects the driving performance (Increase blind spot, can’t look to side lane) β†’ drive slowly
  5. Pressure ulcer formation (occipital protuberance, mandible (chin), clavicles, and ears)
  6. Excessive perspiration
  7. Marginal mandibular nerve palsy
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13
Q

Name, Type, Indication, Restriction, Disadvantages, Precaution πŸ”‘πŸ”‘

A

SOFT CERVICAL COLLAR

Type

  • Soft CO

Indication

  • Symptomatic treatment of soft tissue injuries (whiplash injury) for 10 days

Restriction:

  • 75% flexion/extension 90% Lateral bending 80% Rotation

Disadvantages

  1. Muscle atrophy
  2. Psychological dependency
  3. Delayed return to work (twice as long)
  4. Perceiving more pain and disability in both 6 weeks and 6 months post injury.

Precaution

  • Not to be used in fractures (both stable or unstable)
  • Does not provide structural support

Cuccurollo 4th Edition Chapter 6 P&O pg527

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14
Q

Name, Type, Indication (1)

A

Thomas Collar

Type

  • Rigid CO

Indication

  • Soft tissue injuries

Cuccurollo 4th Edition Chapter 6 P&O pg

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15
Q

Name, Type, Restriction, Indication (2)

A

Philadelphia (Cheese)

Type

  • Rigid CO

Indication

  1. Cervical sprains, strains, or stable fractures.
  2. After anterior cervical fusions and anterior diskectomy procedures
  3. Wean off from more restrictive orthoses to limit sudden strain on the neck

Restriction

  • 30% flexion/extension 65% bending 45% rotation

Contraindication

  1. Unstable spine
  2. Lose effectiveness at higher and lower cervical levels (occiput–C2 and C6–C7)

Cuccurollo 4th Edition Chapter 6 P&O pg527

Braddom 6th Edition Chapter 13 Spinal Orthosis pg252

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16
Q

Name, Type, Benefits, Indication (3-6)

A

Variants of the Philadelphia collar

Name: Aspen, Vista, Miami J, Malibu

Type: Rigid Cervical Collars

Benefits

  1. Cervical strain.
  2. Postoperative stabilization
  3. Post-halo removal.
17
Q

Name, Type, Restriction, Indication, Contraindication

A

Sternal Occipital Mandibular Immobilizer (SOMI) Ψ³Ω…ΩŠΨ©

Type

  • Cervicothoracic orthosis (CTO)

Restriction

  • 25% flexion/extension 65% bending 35% rotation
  • Effective in limiting C1-C5 flexion
  • Less effective in limiting extension
  • Appropriate option for bedridden patients

Indication:

  1. Cervical sprains, strains, or stable fractures with intact ligaments.
  2. Cervical arthritis
  3. Postsurgical fusions
  4. RA: Atlantoaxial instability and neural arch fractures (Better than Philadelphia)

Contraindication:

  • Unstable fractures with ligament instability.

Cuccurollo 4th Edition Chapter 6 P&O pg527

Braddom 6th Edition Chapter 13 Spinal Orthosis pg253

18
Q

Name, Description, Indication

A

Four-Poster Orthosis

Type

  • Cervical Thoracic Orthoses

Restriction

  • 20% flexion/extension 45% bending 30% rotation
  • Adjustable length via anterior or posterior posters

Indication:

  1. Sprains, strains
  2. Stable fractures with intact ligaments
  3. Arthritis

Cuccurollo 4th Edition Chapter 6 P&O pg528

19
Q

Name, Restriction, Indication, Contraindication

A

Yale Orthosis

Type

  • CTO
  • Extended Philadelphia Collar = Higher and Lower than Philadelphia

Restriction

  • 12% Flexion/Extension 50% Bending 20% Rotation

Indication:

  1. Most restriction of ROM occurs below the level of C5
  2. Sprains, strains
  3. Stable fractures with intact ligaments

Contraindication

  1. Insufficient for immobilizing the unstable spine
  2. Lose effectiveness at higher and lower cervical levels (occiput–C2 and C6–C7)

Cuccurollo 4th Edition Chapter 6 P&O pg528

20
Q

Name, Restriction, Indication, Advantages, Disadvantages

A

Minerva Body Jacket / Minerva Ω…Ω†Ω‰

Type

  • CTO

Restriction

  • 15% Flexion/Extension 15% Bending 0% Rotation

Advantages:

  1. Forehead band provides good control of all cervical motions
  2. Lighter weight than the halo vest
  3. No pins (no β€œinvasive” supports that carry risks of infection and slippage)

Indications

  1. Management of unstable cervical spine
  2. Preferred over halo due to ↑ comfort ↓ weight
  3. Allows early mobilization for rehabilitation, while providing the necessary stability

Disadvantages

  • Less restriction of motion compared to a halo vest

Cuccurollo 4th Edition Chapter 6 P&O pg528-529

21
Q

Name, Restriction, 4 Indication, 2 Contraindication, Guide, Most Common Complication. πŸ”‘

A

Halo Vest & Lerman Non Invasive Halo

Type

  • CTO

Restriction:

  • Invasive 4% Flexion-Extension 4% Bending 1% Rotation
  • Non-Invasive 12% Flexion-Extension 8% Bending 3% Rotation

Indication

  1. Unstable cervical fractures: C1 Jefferson - C2 Hangman - C2 Odontoid
  2. Postoperative management.
  3. Primary method for conservative upper and mid-cervical fracture.
  4. Surgical intervention is contraindicated
  5. Alternative for patients patient refusing operative

Contraindication

  1. Stable fractures or when less invasive management could be used.
  2. Extremely soft skull might not tolerate the pin placement.

Guides

  • It is worn for 3 to 4 months.
  • Increasing the strap tension decreased the motion, especially in lateral bending
  • Weight loss due to diuresis or changes in appetite can affect chest circumference, and strap adjustments may be indicated
  • Patients and caregivers should be strongly discouraged from arbitrarily manipulating these straps without consulting the physician.
  • Patient’s shoulder abduction to 90 degrees and avoid shoulder shrugging
  • Cleaning with sterile cotton-tip applicators with antimicrobial soap and normal saline.
  • Avoid povidone-iodine (Betadine), hydrogen peroxide, and alcohol: risk of pin corrosion, interference with bacterial autolysis, ineffective infection reduction, and disruption of the healing process.

Pin loosening (Most Common)

  • Subjectively, the patient may report clicking/grating/creaking sounds, a sensation of looseness, pain at the pin site, headache, or halo vest movement.
  • Loose pins are either retightened or removed and reinserted elsewhere

Cuccurollo 4th Edition Chapter 6 P&O pg

22
Q

Complications Associated With Halo Vest Use. 8 marks πŸ”‘πŸ”‘ EXAM 2017-2018

A
  1. Pin loosening (most common)
  2. Failure to develop spinal stability after wearing the halo
  3. Pressure sore development
  4. Pin site pain
  5. Pin penetration of the skull
  6. Pin tract infection
  7. Brain abscess
  8. Local osteoporosis
  9. Forehead scarring
  10. Acute equilibrium impairments
  11. Dysphasia
  12. Halo ring migration
  13. Cranial nerve palsy
  14. Brachial plexopathy
  15. Reduction in vital capacity
  16. Loss of spinal reduction while wearing a halo

Cuccurollo 4th Edition Chapter 6 P&O pg530 Table 6-16

EXTRA

  1. Temporalis muscle penetration
  2. Pin site pain during mastication
  3. Epileptic seizures.

DeLisa 5th Edition Chapter 77 Spinal Orthosis pg2088 Table 77.4

23
Q

Name, Type, Indication, Contraindication πŸ”‘πŸ”‘

What are the three factors to decide on wearing this type of spinal orthosis?

A

Milwaukee Brace

Type

  • CTLSO

Indication & Contraindication Based on:

  1. Degree of curve
  2. Apex
  3. Skeletal Maturity

Cuccurollo 4th Edition Chapter 6 P&O pg532

24
Q

Name, Type, Restriction, Indication, Contraindication (1&2)

A

Jewett Brace & CASH

Type:

  • Flexion control TLSO

Restriction:

  • Prevent only flexion
  • Jewett offer more lateral support than the CASH

Indication β†’ Bend spine

  1. Compression fracture of the thoracolumbar (TL) spine
  2. For use with stable fractures of T3 to L3 with less than 50% compression
  3. Thoracolumbar Scheuermann’s disease
  4. Thoracic osteoporotic kyphosis (with limited efficacy)

Contraindication:

  • Unstable fractures
  • Burst fractures
  • Spondylolisthesis.

Cuccurollo 4th Edition Chapter 6 P&O pg531

Braddom 6th Edition Chapter 13 Spinal Orthosis pg254-255

25
Q

Name, Description, Indication, Contraindication πŸ”‘πŸ”‘ EXAM 2019

A

Taylor

Flexion-Extension Control TLSO

Knight-Taylor

Flexion-Extension-Lateral Control TLSO

Knight w/ horse, needing lateral control, hence lateral bar

Indication:

  1. Stable thoracic or lumbar fracture (Postsurgical or nonsurgical)
  2. Pott’s disease (Tuberculosis spondylitis)
  3. Spondylolisthesis
  4. Spinal stenosis
  5. Herniated disks
  6. Disk infections

Contraindication:

  • Unstable fractures that require maximum stabilization.

Disadvantages:

  • Shoulder pain limiting the patient’s compliance.

Cuccurollo 4th Edition Chapter 6 P&O pg531

26
Q

Name, Restriction, Indication, Contraindication (Better off with surgery)

A

Boston Brace

Type

  • TLSO

Restriction

  • Prevent lower curve progression and to stabilize the spine.

Indication

  1. Apex of T7 or lower.
  2. Documented progression of a thoracic or thoracolumbar idiopathic scoliosis
  3. Cobb measures 25 degrees to 35 degrees
  4. Immature skeleton

Contraindication

  1. Curves that measure more than 40 degrees
  2. Mature skeleton

Braddom 6th Edition Chapter 13 Spinal Orthosis pg

PassPMR - 08 Prosthetics & Orthotics (9 decks)

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