Back And Neck

Question 1

What is Marie strumpell’s disease?

Answer 1

Also called ankylosing spondylitis and bechterew’s disease. Inflammatory condition mainly affecting spine that causes progressive stiffness and pain. It’s part of the seronegative spondyloanthropathy group of conditions relating to the HLA B27 gene ( others are reactive and psoriatic anthritis)

Question 2

What clin test perform for ankylosing spondylitis

Answer 2

Schober’s test

Question 3

Clinical feature of cervical myelopathy

Answer 3

Increased LL reflexes, increased or decreased UL reflexes

Question 4

What is Dennis 3 column classification

Answer 4

Used when assessing stability of thoracolumbrar fractures.
Ant column: ant longitudinal ligament + ant half vertebral body and disc
Middle: post half vertebral body and disc + post longitudinal ligament
Post: post elements (post lig complex, incl facet joint capsule, ligamentum flavum, interspinous + supraspinous ligs) and intervening vertebral arches.

Question 5

AO classification of thoracolumbar fractures

Answer 5

Type A: compression injury
Type B: distraction injury
Type C: translation injury

Question 6

XR feature of compression fractures

Answer 6

Ant vs post vertebral body height lat XR - loss height!

Question 7

What is a burst fracture

Answer 7

Type of compression fracture of thoracolumbar spine. Compressive force act through ant + middle column vertebrae, resulting in retropulsion of bone into spinal canal. Vertebral body is crushed in all directions simultaneously (sudden axial loading force)
Unstable because involve 2 Dennis columns
Seen on X-ray as multiple fragments of the vertebral body.

Question 8

2 XR features of burst fracture

Answer 8

1 retropulsion of post wall of vertebral body - fragments seen
2 wide interpedicular distance

Question 9

What is a distraction injury of thoracolumbar spine

Answer 9

“Laceration” of vertebra caused by seatbelt injury eg.

Question 10

XR feature distraction injury thoracolumbar spine

Answer 10

Wide space btwn spinous processes

Question 11

Is # transv/spinous processes stable/unstable? 2 compl?

Answer 11

Stable

Look for kidney + ureter injury

Question 12

Rx stable + unstable thoracolumbar #

Answer 12

Stable: bed rest + brace
Unstable: ORIF

Question 13

Most common site thoracolumbar #

Answer 13

T11 - L2

Question 14

Usual consequences of injury to C3 and above

Answer 14

Ventilator dependant/diaphragmatic pacemaker

Dependent for mobility, transfer and self-care. (Quadriplegia)

Question 15

Consequences of C4 injury

Answer 15

Quadriplegia but still head and neck injury - may shrug shoulders

Question 16

C5 injury consequences

Answer 16

Has head and neck control, shrug shoulders
Shoulder control.
Can bend elbows and supinate
Therefore can feed, groom, push manual chair on flat surfaces

Question 17

C6 spinal cord lesion injury consequences

Answer 17

Wrist extension therefore can use tenodesis grasp, drive adapted car, push wheelchair

Question 18

C7 - T1 quadriplegic injury expectations with rehab

Answer 18

Can straighten elbows-easier transfers

Question 19

T2-T8 injury expectations with rehab

Answer 19

High paraplegia injury
N use head, neck, arms, hands.
Decreased use rib and chest muscles, poor trunk control.

Question 20

Cauda equina lesions expectations with rehab

Answer 20

Walk with assistive devices eg AFO and crutches

Incontinent bladder and bowel (LMN) - self-catheterisation and colon lavage

Question 21

American spinal injury association (ASIA) impairment scale classification

Answer 21

A= complete. No motor or sensory preserved in s4- s5
B= incomplete. Sensory but no motor k presented below near level (include s4- s5) = anterior cord syndrome
C= incomplete. Motor and sensory fx preserved below neuro level, more than half key muscles below level have power <3.
D = incomplete. Sensory and motor sparing.... Muscle power ≥3
E = normal.

Question 22

What expect from pt with ASIA B lesion

Answer 22

Anterior cord syndrome
Loss spasticity, hypersensitive, pain, motor fx dependent on level injury
Sensory maintained below lesion, not motor

Question 23

Presentation of pt with anterior spinal cord lesion

Answer 23

Sensory sparing spasms, loss muscle power, reduced pain and temperature below lesion
(Sensory spinothalamic , and motor.dorsal column spared)

Question 24

Presentation of pt with central spinal cord syndrome

Answer 24

Walk but poor arm function

Hands > affected legs

Question 25

Pt presentation with posterior cord syndrome

Answer 25

Walk but poor proprioception and balance | Dorsal column = fine touch, vibration, proprioception

Question 26

Pt presentation with Brown Sequard syndrome

Answer 26

Loss sensation contralat and mm strength ipsilat. Most walk.

Question 27

What is autonomic dysreflexia and where is lesion

Answer 27

Potentially life threatening imbalanced sympathetic discharge. Usually in patients with spinal cord lesion at at /above t6

Question 28

Symptoms autonomic dysreflexia (7)

Answer 28

``` Headache pounding Profuse sweating Flushed Goose bumps Feeling of impending doom and anxiety HIGH BLOOD PRESSURE Overfull bladder/bowel ```

Question 29

How assess spinothalamic tract

Answer 29

Pain -pin prick

Question 30

How assess posterior columns of spinal cord

Answer 30

Fine touch and proprioception

Question 31

How assess corticospinal tract of spinal cord

Answer 31

Power muscles grading

Question 32

Spinal shock definition

Answer 32

Areflexia in initial period injury Ends when bulbocavernosus reflex returns in supra-sacral lesions Hypotensive and bradycardia

Question 33

How determine stability of Thoracolumbar spine.

Answer 33

Use Dennis classification. >2 columns affected-unstable.

Question 34

Complication autonomic dysreflexia

Answer 34

Intracranial haemorrhage

Question 35

Treat autonomic dysreflexia (5)

Answer 35

1. Remove cause 2. Sit pt up 3. Nifedipine (CCB) or glyceryl trinitrate po 4. If BP cont to rise, give IV phentolamine (alpha 1 and 2 antag) 5. Rarely: spinal/epidural anaesthesia

Question 36

Identify pathology picture 37 in trauma section

Answer 36

Compression fracture

Question 37

Identify pathology picture 38 in trauma section

Answer 37

Compression #

Question 38

Name 10 red flags of back pain

Answer 38

``` BACK PAIN Bowel/bladder dysfunction Anorexia /weight loss Constitutional symptoms or malignancy; cancer history; hypercalcaemia Khronic disease Paraesthesias - especially saddle paraesthesia; pain at night or while sleep, at rest, morning stiffness; pyrexia Age > 50 or <15 Iv drug use Neuromotor deficits ```

Question 39

What is difference between unifacetal and bifacetal vertebral dislocation?

Answer 39

Unifacetal= 25% subluxation | Bifacetal =50% subluxation

Question 40

Clinical features Tb spine? ( 6 )

Answer 40

• Constitutional symptoms: chronic illness, malaise, night sweats, weight loss • back pain: late signafter significant destruction and deformity • kyphotic deformity; gibbus • neurological deficits Due to - mechanical pressure on cord by abscess, granulation tissue, tubercular debris, caseous tissue - mechanical instability from subluxation or dislocation - stenosis from ossification of ligamentum flavum adjacent to severe kyphosis

Question 41

Treatment Tb spine?

Answer 41

* Ripe: riampicin, isoniazid, pyrazanamide, ethambutol 2 months, then ri 9 to 18 months. * spinal orthosis to prevent deformity

Question 42

What is a teardrop extension fracture?

Answer 42

Caused by forced extension of neck with resulting avulsion of anteroinferior corner vertebral body , fragment usually triangular like teardrop.

Question 43

Define spondylosis

Answer 43

Painful condition of spine from degeneration of the intervertebral discs.

Question 44

Name 8 clinical signs scoliosis

Answer 44

• Apparent curvature of spine when viewed from behind with patient erect , and in presence of curvature >10 degrees • rib hump if thoracic curve, lumbar hump if lumbar curve on forward bending (Adam's test ) • occiput not vertically over midline sacrum. Plumb line is used - pt erect, from occipital protuberance or from spinous process c7 or T1 • prominent scapulae, creased flank, asymmetric pelvis . Associated posterior midline skin lesions in neuromuscular scoliosis: café-au-lait spots, dimples, neurofibromas, axillary freckling, hemangiomas, hair patches . Apparent LLD • primary curve where several vertebrae affected. Secondary curves above and below fixed 1° curves to try maintain normal position head and pelvis • May have back pain, asymmetric shoulder height when bend forward, pes cavus or leg atrophy (More common in females )

Question 45

Name radiological signs scoliosis

Answer 45

• Cobb angle >10: lines pwallel to upper border of upper vertebral body and lower border of lowest vertebra of curve, then erect perpendiculars from these lines to cross each other. Measure angle between perpendiculars (top angle)

Question 46

Name 5 causes scoliosis

Answer 46

•Idiopathic 90% (adolescent idiopathic scoliosis AIS) • congenital: vertebrae fail to form or segment • neuromuscular: umn or LMN lesion, myopathy (arthrogryposis, muscle dystrophy),cp • postural: compensate for leg length discrepancy, muscle spasm, sciatica, inflammation • osteochondrodystrophies, neoplastic, neurofibromatosis, Marfan's • trauma: #, sx, radiation .

Question 47

Treatment scoliosis? (3)

Answer 47

Based on Cobb angle • <25°: active surveillance •>25° or progressive: bracing that halts or slows curve progression, but doesn't reverse deformity • >45°, cosmetically unacceptable or resp problems: spinal fusion

Question 48

Spine examination?

Answer 48

• ATLS, spine board log roll- clear Cspine Look • scars, posture (scoliosis), asymmetry shoulder girdle (scoliosis, arthritis, fractures, dislocation) • pelvic tilt (scoliosis, LLD, hip abductor weakness) • cervical lordosis (hyper = chronic degenerative joint disease), kyphosis thoraces (normal 20-45) hyper = Schuermann's disease, lumbar lordosis (loss= sacroiliac joint disease eg ankylosing spondylitis) •Spinal alignment, iliac crest alignment (lld, hip abductor weak), wasting paraspinal muscles, abnormal hair, bruising... . Gait Feel • . spinous processes, sacroiliac joints, para vertebral joints • paraspinal muscles Move • cervical: flexion 0- 80, extension 0- 50, lateral flexion 0- 45; rotation 0- 80. • lumbar: flexion touch toes, extension lean back 10-20, lat flex • thoracic: rotation Special tests • Schober's test (ankylosing spondylitis) • sciatic stretch test (straight leg raise) • femoral nerve stretch test • dermatomes key point /2 • myotome / 5 power