Back and Neck Disorders Stowell Flashcards
1
Q
What is the MC cause of work disability?
A
Low back pain
2
Q
Cause of low back pain
A
Unable to determine in most cases
3
Q
70-90% of low back pain cases are:
A
Nonspecific (aka mechanical)
4
Q
Majority of low back pain cases resolve within:
A
4-12 wks
5
Q
Various causes of low back pain
A
- Non specific (70%)
- Ortho pathology (25%)
6
Q
Inflammatory arthritis causing low back pain is often a/w:
A
HLA-B27
7
Q
What are examples of orthopedic pathology that can cause low back pain?
A
- Degenerative changes (OA)
- Disc herniation
- Compression fracture
- Spinal stenosis
- Trauma (fracture)
8
Q
What clinical factors increase probability of neoplasm causing low back pain?
A
- Previous history of non-skin cancer
- Age over 50
- Unexplained wt loss
- Failure of conservative tx for LBP
9
Q
Etiologies of infection causing low back pain?
A
- Post-traumatic
- Vascular insufficiency (DM)
- Hematogenous seeding (S aureus)
10
Q
What clinical features suggest ankylosing spondylitis?
A
- Age less than 40
- Morning stiffness
- Duration more than 3 months
- Symptoms improve w/easy exercise
- Not relieved w/rest
11
Q
What PE findings can be found with ankylosing spondylitis?
A
- Sacroiliac tenderness
- Limited chest expansion
- Limited lumbar ROM
12
Q
Imaging findings of ankylosing spondylitis
A
- Grading of sacroilitis
- Bamboo sign (fusing of vertebral bodies)
13
Q
Describe the HLA-B27 gene and its relation to AS
A
- Normal finding in 8% of Caucasians
- Only 2% of people w/the gene will develop AS
- So it is NOT diagnostic for AS
- Can be a finding though
14
Q
What abnormal lab is found in 70% of patients with AS?
A
Elevated ESR
15
Q
What is cauda equina syndrome (CES)?
A
- Compression of lower spinal nerve roots
- Impairs motor and sensory function to lower extremities and bladder
- MEDICAL EMERGENCY
16
Q
What is the MC finding a/w CES?
A
Urinary retention
17
Q
What is saddle anesthesia and what is it a/w?
A
- Unable to feel anything in body areas that sit on a saddle
- A/w CES
18
Q
Define degenerative joint disease (DJD)
A
Term used interchangeably with osteoarthritis (OA)
19
Q
Define degenerative disc disease
A
- Degenerative changes of disc
- Fissures develop
- Reduced ability to maintain fluid flow (loss of disc height)
- Can be a source of chronic LBP
20
Q
Define ankylosis
A
- Joint stiffness d/t disease or surgery
- Union of proximal/distal bones of joint
21
Q
Describe osteoarthritis
A
Gradual progression of disc degeneration and articular cartilage mechanical breakdown
22
Q
What dynamic is altered in OA?
A
Cartilage/disc fluid (decreased ability to absorb/distribute mechanical stress)
23
Q
What joint alterations occur with OA?
A
- Osteophytes (bone spurs)
- Spondylosis
- Spondylolisthesis
- Stenosis
- Decreased disc height
24
Q
Why/how do osteophytes (bone spurs) form in OA?
A
- Secondary to facet joint dysfunction
- Body’s way of trying to splint or limit use of joint
- Joints above and below will suffer additional/abnormal mechanical forces
25
Clinical features of OA
- Age over 50
- Gradual onset
- Worse in AM or after prolonged rest
- Relieved w/light activity
26
MOI for OA
- Prolonged postural activity (painting, gardening)
- Weekend warrior
- Grandparenting syndrome
* Usually not acute trauma
27
What is the common ROM pattern with OA?
- Extension (side bending) feels worse
| - Flexion feels better
28
What imaging confirms OA?
Plain film x-ray (AP and lat)
29
How do labs present in OA?
Normal
30
What is a disc bulge?
- Herniated nucleus pulposa (HNP)
| - May or may not compress/stretch a nerve root (asymp or symptomatic)
31
Define discogenic pain
Nociceptors in disc generate pain to back/LE
32
If a disc bulge compresses the nerve root, what is produced?
LE radiculopathy
33
Define radiculopathy
Spinal nerve root impingement d/t space occupying lesion in vertebral canal or IVF
34
MC lumbar radiculopathy
L5 and S1 followed by L4
35
Possible causes of radiculopathy
- Herniated nucleus pulposa
- OA
- Spondylolisthesis (severe)
- Lumbar spinal stenosis
36
Disc herniation w/radiculopathy ROM pattern
Flexion makes it worse (provokes radicular symptoms)
37
OA vs. disc herniation w/radiculopathy ROM patterns
- Flexion feels better in OA
| - Flexion feels worse in radiculopathy
38
Motor and reflex findings of disc herniation w/radiculopathy
- Motor: weakness of myotome of involved nerve root
| - Reflex: diminished DTR of involved nerve root
39
2 common neural tension tests to assess radicular symptoms
- Straight leg raise (supine)
| - Slump test (sitting)
40
Imaging for diagnosis of disc herniation w/radiculopathy
Not indicated! Unless red flags or need to rule in or out other
41
Non-surgical management of disc herniation w/radiculopathy
- OTC pain meds (often not good enough)
- Steroid taper
- Epidural steroid injections
- McKenzie Method (centralization technique by PTs and chiropractors)
- Patient education for coping
42
Surgical management of disc herniation w/radiculopathy
- Micro-discectomy
| - Discectomy
43
Pros of surgical management of disc herniation w/radiculopathy
- Pts w/dominant leg pain can have excellent results
| - 85-90% return to full function
44
Cons of surgical management of disc herniation w/radiculopathy
Up to 15% of patients have continued back pain that may limit their return to full function
45
Define spinal stenosis
Narrowing of vertebral canal and/or IVF
46
Causes of spinal stenosis
- Disc, tumor, cyst
- Congenital narrowing
- OA
47
How does spinal stenosis present?
- Age over 55-60 yrs
- Radiating leg pain that gets worse with downhill walking (extension worsens it)
- LE symptoms consistent w/neurogenic claudication (relieved forward flexion)
- May or may not have back pain
48
Surgical treatment of spinal stenosis
- X stop implant
- Laminectomy (decompress the nerves)
- Fusion (if unstable segments)
49
Describe X stop implant
- Spinal stenosis surgery
- Titanium wedge inserted b/w spinous processes
- Outpatient procedure
- Permanent but does not attach to bone or ligaments
50
Define spondylolysis
Defect in pars interarticularis of a vertebra
51
Define spondylolisthesis
- Defect in pars interarticularis of a vertebra
| - WITH anterior displacement of the vertebra
52
Define spondylosis
Stiffening or fusing of joint (often from degenerative changes)
53
Classifications of spondylolisthesis
```
Type 1: congenital
Type 2: isthmic (classic presentation of adolescent patient)
Type 3: degenerative
Type 4: traumatic
Type 5: pathologic
```
54
Who are those affected by spondylolisthesis?
- Adolescents
| - Athletes in extension type sport (football, gymnastics, figure skating)
55
When do symptoms usually develop in spondylolisthesis?
Usually around a growth spurt
56
How does spondylolisthesis present clincially?
- Extension is worse
| - Straight leg raise positive
57
Diagnosis of spondylolisthesis
- Need to order plain film oblique view!
| - Scotty dog defect
58
Treatment of spondylolisthesis
- Rest and remove provoking activity
- Pain management
- Bracing only if severe
- Protocols for return to sport
59
Grading of spondylolisthesis
```
1 = 0-25%
2 = 25-50%
3 = 50-75%
4 = 75-100%
5 = 100+%
```
60
Define scoliosis
Lateral curve of the spine (at least 10 degrees) with a rotational deformity
61
What is the MC spinal deformity?
Scoliosis
62
Define structural scoliosis
- Bony deformity
| - Curve NOT reducible w/flexion or lateral flexion
63
Define non-strucutral scoliosis
- Fixed (curve NOT reducible)
| - Non-fixed (curve reducible w/flexion or lat flexion)
64
Define functional scoliosis
- Flexible
| - Curve able to be reduced partially or completely w/flexion or lateral flexion
65
Types of scoliosis
- Structural
- Non-structural
- Functional
66
Causes of scoliosis
- Idiopathic
- Congenital
- Neurouscular
- Misc (tumor, abscess)
67
Types of idiopathic scoliosis
- Infantile (under 3 yo, majority resolve spontaneously)
- Juvenile (3-9 yo, high rate of progression and lead to severe deformity)
- Adolescent (80-90% of idiopathic cases, onset at puberty)
68
Describe adolescent idiopathic scoliosis
- Puberty (10-13 yo)
| - Female 3.6 to male 1
69
Diagnosis of scoliosis
- Postural screen (look from posterior and lateral)
| - Forward flexion test (look for rib hump)
70
Treatment of scoliosis curves greater than 20-25 degrees
May need bracing and exercise
71
Treatment of scoliosis curves greater than 45 degrees
Cannot be effectively braced
72
Treatment of scoliosis curves greater than 45-50 degrees
May need surgery
73
How often do we monitor younger patients w/scoliosis?
Every 4-6 months
74
Describe bracing in scoliosis
- Goal is to stop worsening curve
- Wear 23 hours a day (some just at night)
- May have to wear months to years
75
How does cervical myelopathy present?
Hyperreflexia of DTRs
| Hoffman's sign (finger flexor reflex)
76
Most cervical spine fractures occur where?
C2 or C6-7
77
Most fatal cervical spine injuries occur where?
C1-C2
78
Jefferson fracture and types
C1 fracture
- Posterior arch (MC)
- Burst
79
Hangman's fracture
Pedicle of C2 resulting from hyperextension injury
80
Cervical compression fracture types
I: simple wedge fx
II: teardrop
III: comminuted burst body fx
IV and V: complex involving posterior elements
81
MC locations of cervical disc herniation w/radiculopathy
- C7 (60%)
| - C6 (25%)
