Back And Neck Flashcards
What is Marie strumpell’s disease?
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)
What clin test perform for ankylosing spondylitis
Schober’s test
Clinical feature of cervical myelopathy
Increased LL reflexes, increased or decreased UL reflexes
What is Dennis 3 column classification
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.
AO classification of thoracolumbar fractures
Type A: compression injury
Type B: distraction injury
Type C: translation injury
XR feature of compression fractures
Ant vs post vertebral body height lat XR - loss height!
What is a burst fracture
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.
2 XR features of burst fracture
1 retropulsion of post wall of vertebral body - fragments seen
2 wide interpedicular distance
What is a distraction injury of thoracolumbar spine
“Laceration” of vertebra caused by seatbelt injury eg.
XR feature distraction injury thoracolumbar spine
Wide space btwn spinous processes
Is # transv/spinous processes stable/unstable? 2 compl?
Stable
Look for kidney + ureter injury
Rx stable + unstable thoracolumbar #
Stable: bed rest + brace
Unstable: ORIF
Most common site thoracolumbar #
T11 - L2
Usual consequences of injury to C3 and above
Ventilator dependant/diaphragmatic pacemaker
Dependent for mobility, transfer and self-care. (Quadriplegia)
Consequences of C4 injury
Quadriplegia but still head and neck injury - may shrug shoulders
C5 injury consequences
Has head and neck control, shrug shoulders
Shoulder control.
Can bend elbows and supinate
Therefore can feed, groom, push manual chair on flat surfaces
C6 spinal cord lesion injury consequences
Wrist extension therefore can use tenodesis grasp, drive adapted car, push wheelchair
C7 - T1 quadriplegic injury expectations with rehab
Can straighten elbows-easier transfers
T2-T8 injury expectations with rehab
High paraplegia injury
N use head, neck, arms, hands.
Decreased use rib and chest muscles, poor trunk control.
Cauda equina lesions expectations with rehab
Walk with assistive devices eg AFO and crutches
Incontinent bladder and bowel (LMN) - self-catheterisation and colon lavage
American spinal injury association (ASIA) impairment scale classification
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.
What expect from pt with ASIA B lesion
Anterior cord syndrome
Loss spasticity, hypersensitive, pain, motor fx dependent on level injury
Sensory maintained below lesion, not motor
Presentation of pt with anterior spinal cord lesion
Sensory sparing spasms, loss muscle power, reduced pain and temperature below lesion
(Sensory spinothalamic , and motor.dorsal column spared)
Presentation of pt with central spinal cord syndrome
Walk but poor arm function
Hands > affected legs
Pt presentation with posterior cord syndrome
Walk but poor proprioception and balance
Dorsal column = fine touch, vibration, proprioception
Pt presentation with Brown Sequard syndrome
Loss sensation contralat and mm strength ipsilat. Most walk.
What is autonomic dysreflexia and where is lesion
Potentially life threatening imbalanced sympathetic discharge. Usually in patients with spinal cord lesion at at /above t6
Symptoms autonomic dysreflexia (7)
Headache pounding Profuse sweating Flushed Goose bumps Feeling of impending doom and anxiety HIGH BLOOD PRESSURE Overfull bladder/bowel
How assess spinothalamic tract
Pain -pin prick
How assess posterior columns of spinal cord
Fine touch and proprioception
How assess corticospinal tract of spinal cord
Power muscles grading
Spinal shock definition
Areflexia in initial period injury
Ends when bulbocavernosus reflex returns in supra-sacral lesions
Hypotensive and bradycardia
How determine stability of Thoracolumbar spine.
Use Dennis classification. >2 columns affected-unstable.
Complication autonomic dysreflexia
Intracranial haemorrhage
Treat autonomic dysreflexia (5)
- Remove cause
- Sit pt up
- Nifedipine (CCB) or glyceryl trinitrate po
- If BP cont to rise, give IV phentolamine (alpha 1 and 2 antag)
- Rarely: spinal/epidural anaesthesia
Identify pathology picture 37 in trauma section
Compression fracture
Identify pathology picture 38 in trauma section
Compression #
Name 10 red flags of back pain
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
What is difference between unifacetal and bifacetal vertebral dislocation?
Unifacetal= 25% subluxation
Bifacetal =50% subluxation
Clinical features Tb spine? ( 6 )
• 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
Treatment Tb spine?
- Ripe: riampicin, isoniazid, pyrazanamide, ethambutol 2 months, then ri 9 to 18 months.
- spinal orthosis to prevent deformity
What is a teardrop extension fracture?
Caused by forced extension of neck with resulting avulsion of anteroinferior corner vertebral body , fragment usually triangular like teardrop.
Define spondylosis
Painful condition of spine from degeneration of the intervertebral discs.
Name 8 clinical signs scoliosis
• 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 )
Name radiological signs scoliosis
• 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)
Name 5 causes scoliosis
•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
.
Treatment scoliosis? (3)
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
Spine examination?
• 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
