Back and Spine Flashcards
vertebrae
protect the spinal cord
-a series of small bones forming the backbone
How many vertebrae
33
How many cervical vertebrae
7
How many thoracic vertebrae
12
How many lumbar vertebrae
5
sacrum
5 fused sacral vertebrae
coccyx
3-5 fused coccygeal vertebrae
Causes of Bone Pain
-Fracture
-osteoporosis/medications
-cancer
-IV drug use
Cancer
-Primary carcinoma
-secondary carcinoma
-multiple myeloma
Primary carcinoma
starts in the back
Secondary carcinoma
starts somewhere else and metastasizes to the back
Multiple myeloma
spinal cancer
LEAD KETTLE
-Can metastasize to bone
-PB KTL
(prostate, breast, kidney, thyroid, lung)
Spinal nerves
exit through intervertebral foramen which is the space between two discs
Dermatomes
area on the surface of the body innervated by afferent fibers from one spinal root
Signa of Carcinoma
-fever with no origin
-weight loss
-night sweats
Intervertebral disc
-cushion like pad
-act as shock absorbers during running, walking, and jumping
-allow spine to flex and extend and to a lesser extent bend laterally
-over time they loose flexibility and compressibility
Intervertebral disc composed of
nucleus pulposus and annulus fibrosis
nucleus pulposus
inner semifluid which gives disc elasticity and compressibility
annulus fibrosis
strong outer ring of fibrocartilage which contains the nucleus pulposus and limits its expansion
Radiographic Assessments of the Back
-Spinal Radiographs
-MRI
Spinal Radiographs
High radiation load!
-gives information regarding BONE disease
MRI
Diagnostic Test of Choice!
-evaluates herniated discs
-evaluates nerve impingement
-imaging modality of choice to evaluate a herniated nucleus pulposus
Treatment Options are driven by
-degree of curvature as measured by Cobb Angle
-Skeletal maturity or non-skeletal maturity status
Cobb Angles of 50 degrees or more
surgery should be discussed
How many curvatures of the spine
4; cervical, thoracic, lumbar, pelvic
cervical curvature
concave, least pronounced
thoracic curvature
convex
lumbar curvature
concave
pelvic curvature
concave, forward and downward
Lordosis
accentuated lumbar curvature
-counterbalances a protuberant abdomen (pregnancy or obesity)
-infants
Kyphosis
accentuated thoracic curvature “hunchback”
-faulty posture
-elderly (senile kyphosis secondary to osteoporosis)
-smooth curvature of spine
-common especially in women
Frequency of Low Back Pain
2nd most common reason for seeking medical attention from primary care
Prevalence of Low Back Pain
between 20-50 yrs old: 60-80%
*Back pain is the most common reason for disability and lost productivity in adults younger than 45
Regardless of treatment for back pain ….
60-70% will recover from pain in 6 weeks
80% will recover form pain in 12 weeks
Primary Care Clinician’s Responsibility
Differentiate between life threatening and non life threatening diseases
common cause of back pain
muscle strain
life threatening causes of back pain
-myocardial infarction
-aortic diseases
-kidney issues
-ectopic pregnancy
What percent of back pain is caused by muscle strain
95%
what percent of back pain is caused by herniated discs
5%
Muscle Strain
THE MOST COMMON CAUSE OF BACK PAIN
Pathophysiology of Muscle Strain
a paraspinal muscle is strained
-often poor muscle tone
-can be caused by repeated movements such as twisting, sleeping, lifting
-often occurs doing the simplest of movements
Signs and Symptoms of Muscle Strain
-pain with movement, relieved with rest
-pain above knee
-no numbness/tingling
-spasms
pain in muscle not the spinous process
Physical Exam findings for Muscle Strain
-pain worse with extension (patient will walk legs up legs to stand up)
-neurovascular within normal limits
Tests for Muscle Strain
none
Treatment for Muscle strain
-education on proper posture and back exercises
-teach how to protect back by properly lifting using the legs
-bed rest no longer than two days
-ice 20 min with deep massage
-physical therapy for acute simple back pain
Elements of physical therapy for Muscle Strain
-abdominal and paraspinal muscle strengthening
-spinal and hamstring flexibility
-awareness of posture
-lifting techniques
Pharmacological Treatment for Muscle Strain
-NSAIDS
-Tylenol (Acetaminophen)
Tylenol (Acetaminophen)
-relieves pain
-reduced fever
-only works in the central nervous system
-bad for kidneys
Advil and Motrin (Ibuprofen)
-NSAIDs (nonsteroidal anti inflammatory drugs)
-reduce inflammation
-Also reduces pain and fever
-can cause gastric and duodenal ulcers
-bad for stomach
Pathophysiology of a Herniated Disc
nucleus pulposus protrudes into the annulus fibrosus and impinges a spinal nerve exiting the spinal column
Prevalence of Herniated Disc
only 2-5% of those experiencing back pain
How long does a herniated disc take to resolve on its own
usually within 6 weeks
Where in the Spine do Herniated discs commonly occur
lumbar spine
herniated discs are more common as we age because of
degenerative changes of the discs
Symptoms of Herniated discs
-severe pain following a nerve dermatome
-pain often worse in leg than in the back
-difficulty performong tasks such as standing, walking, sitting
-NO DISRUPTION TO BOWEL OR BLADDER
-may complain of weakness
PE Herniated Disc
-Anal sphincter is tight and closed
-positive neurological findings that are dermatomal (decreased reflexes,, strength, and sensation)
-electric shock down one leg
-GATES
GATES
L5 nerve- unable to heel walk
S1 Nerve- Unable to toe walk
Herniated Disc Treatment
-NSAIDs
-Decreased activity for 1-2 days
-narcotic medication no longer than 7 days
-epidural steroid injections (up to 3 in 6 month period)
-oral corticosteroids to reduce inflammation (prednisone)
*no quick surgical fix available
Cauda Equina Syndrome
A TRUE BACK EMERGENCY
-results from a sudden reduction in the volume of the lumbar spinal canal that causes compression of multiple nerve root and leads to muscle paralysis
-sacral roots that control the bladder and anal sphincter are midline and particularly vulnerable (S2 to S4)
What is the Cauda Equina
formed by nerve roots caudal to the level of spinal cord termination
Cauda Equina Syndrome General Information
-rare
-comprises 0.2-2% of herniated discs
-potentially devastating consequences
Pathophysiology of CES
Central Disc Protrusion that pushes on spinal cord
-massive herniation
Classic Presentation of CES
The Triad
-severe bilateral leg pain involving weakness and sensory loss; difficulty standing from chair without using hands
- loss of sensation in anal, perianal, and genital region (Do you feel different when you wipe)
-bladder retention or incontinence
if there is lax anal sphincter tone
the S2 spinal nerve is involved
Treatment of CES
immediate surgical referral!!!
-delay in decompression ca lead to permanent loss of bowel and bladder control, and sensory abnormalities
Scoliosis
from the Greek word crookedness
curvature of the spinal greater than 10 degrees
scoliosis onset
infancy, early childhood, adolescence
Cause of Adolescent Idiopathic Scoliosis
Idiopathic=unknown origin
heredity?
Prevalence of Adolescent Idiopathic Scoliosis
accounts for up to 85% of scoliosis cases
more females than males
(females more likely to require treatment as well)
age 10-16 (often seen during puberty)
Structural change of scoliosis
-vertebral bodies rotate towards convexity
-spinous processes rotate towards concavity
-ribs also move as they are attached to spine
Symptoms of Scoliosis
USUALLY ASYMPTOMATIC
rotation does not cause pain
-can restrict pulmonary function (rare before 100 degrees)
Scoliosis PE findings
-shoulder height assymetry
-unilateral scapula prominence
-waistline asymmetry
-distance between elbow and flank is asymmetric
-with patients leaning forward with legs and palms together:
-rib hump
-intercostal space discrepancy
Scoliosis Diagnosis
Cobb Angle- measures degree of curvature
Scoliosis Treatment
determined by cobb angle and age of patient
