Anne Flashcards
Arthordesis
The surgical fixation of a joint to promote fusion of the bones
Crankshaft deformity
They potential deformity which occurs when the posterior elements of the skeletally mature patient fuse. The vertebral bodies may continue to grow after posterior fusion, resulting in deformity resembling the crankshaft of an automobile engine
Decompensation
Relative to scoliosis, the loss of spinal balance when the thoracic cage is not centered over the pelvis in the coronal plane.
Discectomy
The removal of all or part of intravertebral disc
Discogram
Radiographic procedure in which contrast material is injected into the vertebral disc under fluoroscopy, and the patient see the patency of the disc is evaluated.
Ablation
The removal of a body part or destruction of its function
Etiology
The cause or origin of a path ologies; also spelled aetiology
Hyperkyphosis
A spinal deformity of the sagittal plane in which excessive flexion occurs. The deformity be maybe smooth with a small degree of excessive flexion at multiple levels or angular with acute flexion at one or two segments. Commonly referred to as humpback or hunchback
Hypokyphosis
Alignment of the sagittal plane in which there is less than normal amount of flexion, the way the sagittal plane continues to have anterior concavity
Iatrogenic
The clinical response, usually unfavorable, to a medical or surgical treatment.
Idiopathic
Of unknown cause comment or etiology.
Kyphosis
The posterior curve in the sagittal plane of the spine; a normal spine has a kyphotic curve at the thoracic level of approximately 20° to 40°, as well as a sacral kyphosis.
The layers of collagen and elastin fibers that are arranged concentrically to make up the annulus fibrosis of the intervertebral disc. The horizontal fibers each lamella run in the opposite direction of the adjacent layers to create strong, flexible lattice structures.
Lamella, pl. lamellae
Surgical removal of part or all of the posterior vertebral elements to allow space for the neural structures
Laminectomy
Surgical reconstruction of the posterior vertebral elements to increase base for the neural structures while maintaining the posterior arch.
Laminoplasty
And interior curb in the sagittal plane of the spine; most wind has a lordotic curve at the cervical level of approximately 20° to 40° and at the bombard level of approximately 30° to 50°.
Lordosis
What planes does the king classification relate to and what region of the spine does it describe?
Thoracic, coronal region
Which planes to the lenke classification system relate to and what regions of the spine does it describe?
Sagittal plane, lumbar
What are the five main indicators to help determine the risk of curve progression?
- Gender of the patient
- Magnitude of the curve
- Curve patten.
- Age at onset of the curve
- Skeletal maturity of the patient
Describe how the Risser sign is used
Iliac crest is divided into four regions. As the patient grows these regions progressively fuse. Designated by scale of one through five according to which region fused.
List and describe the three basic treatment options for adolescent idiopathic scoliosis
- Observation
- Non-operative treatment with observation
- Surgical intervention
Briefly describe each of the following steps and evaluation process of scoliosis: Family in general health history
A complete review of the medical history of the patient and family should undergo (familial incidence of scoliosis)
Describe physical examination in the evaluation process of scoliosis
Patient shoulder, thorax, back, and pelvis her observed (red pump measurement with scoliometer degrees of rotation)
Describe radiographic evaluation in the evaluation process of scoliosis
Standing, sitting, or recumbent x-rays taken in the AP and lateral of entire spine
Describe the Cobb angle measurement in the evaluation process of scoliosis
Measures magnitude of severity of scoliotic curve in degrees of curvature
Describe determination of skeletal maturity in the evaluation of scoliosis
Risser sign: radiographic observation of the iliac crest growth plate
Briefly describe nonoperative treatment in the evaluation process of scoliosis
Electrical stimulation, biofeedback, and manipulation (casting, orthotics, braces etc.)
Describe the differences between patients who have adult idiopathic scoliosis under 40 versus over 40
Under 40: present because of continued progression or cosmetic appearance of their curve.
Over 40: generally present to a doctor because of pain
List for indications for treatment of adult scoliosis
- Progression of the deformity
- Unrelieved pain
- Decreased pulmonary function (rare)
- Cosmesis (controversial)
What is DeNovo scoliosis?
Degenerative scoliosis, onset of the scoliotic curve in a previously straight spine.
Define spondylosis
Did generative changes invertebrate at the articulation point
Define spondylolysis
Defect in the vertebrae, usually at the pars articulation.
Spondyloptosis
Spondylolisthesis in which the entire L5 body has fallen below the horizontal line across the top of the sacrum
Most vertebral slips are the result of the defect in the __________ area of the _______.
Pars interarticularis
Lamina
Describe type I spondylolisthesis as defined as Wiltse’s classification system
Dysplastic. L5 slips forward at the sacrum. Defective S1 articular process
Describe type II Spondylolisthesis as defined by Wiltse’s classification system
Isthmic. Most common type of spondylolisthesis. Defect in pars interarticularis area of the lamina.
Describe type 2Atypes of spondylolisthesis as defined by Wiltse’s classification system
Stress fracture of pars caused by recurrent microfractures in pars from hyperextension. Common in football lineman gymnast and weightlifters
Describe type IIC Types of spondylolisthesis as defined by Wiltse’s classification system
An acute fracture of pars. Very rare
Describe type III Types of spondylolisthesis as defined by Wiltse’s classification system
Most common at L4 L5. degenerative changes in facets
Describe type IV Types of spondylolisthesis as defined by Wiltse’s classification system
Occurs from fractured pedicle, lamina, or facets
Describe type V Types of spondylolisthesis as defined by Wiltse’s classification system
Caused by a tumor or metabolic type of bone disease
Describe type VI Types of spondylolisthesis as defined by Wiltse’s classification system
Iatrogenic Spondylolisthesis caused by excessive surgical decompression in the posterior elements
Describe “Low dysplastic spondylolisthesis”
Translational shift of one vertebra
Define “high dysplastic spondylolisthesis”
Forms significant segmental kyphosis associated with transitional shift. (Either lysis or elongation)
The cartilaginous layer is highly porous and nutrition diffuses across the surface from the __________ layer.
Bony
The facet joints are important in stabilizing the spine. Their ______ and ______ affect the mobility of each spinal region.
Anatomical position and orientation
The facet joints in the lumbar region are oriented in the ______ plane and limit the _______ In rotation.
Sagittal and range of motion
Ligaments have many functions. Name four:
- Provides stability
- Protect spine and neurological structures
- Prevent exceeding of motion segment
- Allow for normal spine motion
List the seven ligaments that attach the motion segment together
- ALL
- PLL
- Ligamentum flavum
- Interspinous
- Supraspinous
- Inter transverse ligament
- Facet capsular
Major trauma or repetitive minor trauma may lead to _______
Nonspecific synovitis
The articular process begins to override each other as the joint capsules become stretched. This results in……
Malalignment of the joints and abnormal biomechanical function of the motion segment.
How did the spinal ligaments show the effects of aging
Through partial ruptures, necrosis, and calcifications of the fibers.
List 7 changes to the motion segment that may occur due to degenerative disc disease
- Just loses water, causing it to shrink in volume
- Disc space begins to narrow
- Compressive loads are transferred away from the nucleus pulposis/ Central endplate interface to the peripheral annulus/ vert. Endplate margins
- Sclerosis of the central endplate further reduce his disc nutrition
- Motion segment becomes hypermobile do to narrowed intervertebral space and overriding of the facets.
- Osteophytes develop in an attempt to stabilize excessive motion
- Osteophytes may encroach on neurological structures
Though degenerative disc disease may be found in every spinal level, what are the most frequently affected levels by region?
C-5 C6/ L4 L5/ L5 S1
What does stenosis mean
The narrowing of the tube
What is the most common form of spinal stenosis?
Acquired degenerative type
What are the most frequent discs to herniate in the cervical and lumbar regions of the spine?
C-5 C6, C6-C7, and C-4 C-5,
L4- L5, L5- S1, L3-L4.
Define nuclear herniation
Occurs when the nucleus ruptures through the innermost fibers of the process but does not cause any disruption or distortion of outer annulus fibrosis
What is nuclear extrusion
A complete split in the anulus that allows nuclear material to leak out into the surroundings basis. The profound material remains attached to the nucleus remaining inside of the desk.
What is disc protrusion?
Ruptured nucleus distorts the outermost fibers of anulus, causing them to pull it out word. Also called a prolapsed disc.
What is a sequestered nucleus?
The extruded nuclear substance is no longer attached to the material remaining inside the desk. The sequestered fragments may float around the spinal canal and become totally removed from which it originally extruded.
What is sciatica
Disc herniation in a position to contact physically and exert pressure on the existing nerve root at the level.. at that point the patient begins to experience pain down the back and the leg
What are the most common symptoms with SI radiculopathy
Pain in the posterior aspect of the thigh and calf in the lateral aspect of the bottom of the foot from the heel to last two toes
What are the most appropriate radiographic studies done for evaluating herniated lumbar disc
MRI & CT
What are the most common surgical procedures for lumbar disc herniation
Laminectomy with discectomy, Microdiscectomy, endoscopic discectomy and ablation
Describe the presentation of the patient with cervical herniated disc
Neck pain, radicular arm pain, myelopathy, or neural taxis of the upper arm
What are the most appropriate radiographic studies were evaluating herniated cervical disc?
- MRI
2. CT scan and cervical myelogram maybe used occasionally
What are the most common surgical procedures for cervical disc herniation?
- ACDF
- ACDF without fusion
- Partial anterior discectomy
- Posterior laminectomy
- Posterior laminoplasty
What is a stable fracture?
No significant displacement of deformity to the pony or soft tissue architecture
What is an instable fracture
The spine may not be able to carry normal loads without risk of causing new or additional neurological injury
Describe Denis’ classification of spinal structures
A frequently used classification method based on a three column theory of the spine developed by Denis. Anterior, middle, posterior.
Describe magerl’s classification of spinal structures
Classification method for thoracolumbar fractions
What is “ cauda equine syndrome”?
Neurological injury below L1
How many pairs of spinal nerves are found in the spinal column
31
Describe frankel’s Classification of neurologic impairment
- Complete loss of motor and sensory function
- Only sensory function remains
- Motor function present, but no practical use (i.e. person can move legs but is unable to ambulate)
- Motor function impaired (I.e person can ambulate but not with normal gate)
- No neurological impairment noted
What is a craniovertebral junction injury?
An injury that affects the base of the skull (C0), The Atlas (c1) and/or the axis (c2)
What are the three types of Thoracolumbar injuries
- Burst fractures:
- Flexion/compression fracture: fractures
- Flexion/ distraction fractures
Flexion/ distraction fractures:
also known as a chance fracture. All three columns my fail by distraction forces. Bone, ligaments us subluxation is often encountered. flexion/ distraction injuries are often caused by automobile seat belts.
Define Flexion/ compression fracture
frequently occur at T 12 through L1. Interior column failure depended on amount of compressive force. Usually some loss of vertebral height with this injury
Define a burst fracture
The table height is significantly decreased in the unstable fracture
List two types of low lumbar injuries
- Flexion distraction fracture
2. Compression/ torsion/ translational fractures
Define Flexion/ distraction fractures
Also called a jumpers fracture, results from severe compressive load on the anterior column and destructive forces on the middle and posterior columns.
Define torsion/ translational fractures
Usually occurs together with or without flexion. Compression effects may occur on the lateral margin of the vertebral body, while torsional and translational forces may affect the body or disc and ligamentous structures
Where is the most common site for metastasis in the skeleton
The vertebral column
What is the five-year survival rate for all forms of lung cancer
Less than 10%
What is the five-year survival rate for breast cancer
Exceeds 75%
What is the five year survival rate for patients with global metastases of prostate cancer
Approximately 20%
What is osteoporosis
A progressive disease that is age-related it is distinguished by a decrease in the skeletal bone mass
What factors may influence osteoporotic bone loss
Race and genetic factors
Describe the conservative treatment for compression fractures
Bedrest, pain medication, bracing
Describe the treatment for secondary osteoporosis
Treating the underlying malady or discontinuing the offending agent
What is “Paget’s disease”?
A chronic, usually localized, skeletal disorder resulting from the rapid metabolism of new bone
What is osteomalacia
Soft bones
What are the most common causes of osteomalacia
Vitamin D deficiency due to inadequate nutritional intake or inadequate sunlight exposure, hereditary, or acquired disorders of metabolism of phosphates
Describe the clinical presentation of tuberculosis (TB) infections of the spine.
It progresses gradually and symptoms may not be apparent
What is the treatment of choice for spinal tuberculosis
Multiple drug therapy For at least six months. Surgical intervention is indicated when there is a significant bony collapse and deformity
What is “osteomyelitis” of the spine
Inflammation of the bone marrow of vertebral body and the adjacent cortical bone due to an infection
What is the difference between casting and orthotics
Cast: plaster jacket
Orthotics: also called bracing. It does not correct the curve.. It prevents the progression of the curve
