Back Clinical Flashcards
Vertebral body osteoporosis
Demineralization of the spongy bone in vertebrae. Vertical striping on X-rays due to loss of horizontal tuberculae. Occurs mainly in post menopausal women. Osteroporosis affects mainly the spine, femur, fingers, and radius. Can cause thoracic kyphosis.
Laminectomy
Surgical excision of the dorsal segment of a vertebrae by cutting along the lamina or pedicle. Allows for access to the spinal cord.
Dislocation of cervical vertebrae
Less interlocking cervical vertebrae are at risk for dislocation. Slight dislocation can occur without damaging the spinal cord. Dislocation may cause “facet jumping” or self reduce, an MRI will identify soft tissue damage.
Fracture and dislocation of Atlas
Vertical forces can fracture the arches.
Jefferson fracture of the Atlas
Severe vertical force can cause fracture of the Atlas and rupture of the transverse ligament.
Fracture and dislocation of Axis
Fractures of the vertebral arch is common with hyperextension of the neck (whiplash or hanging). Fracture occurs in the pars articularis- at the base of the spinous process. Aka traumatic spondylolysis of C2. Can cause dislocation of the vertebrae and spinal cord damage including paralysis.
Lumbar Spinal Stenosis
Narrow vertebral foramen in one of the lumbar vertebrae. Hereditary, increases risk for degenerative changes. May compress a spinal nerve root. Treatment is a decompressive laminectomy.
Cervical ribs
Extra rib on C7 may pressure underlying structures such as the subclavian or inferior trunk of the brachial plexus. May cause thoracic outlet syndrome.
Caudal Epidural Anesthesia
A local anesthetic is injected into the sacral canal to anesthetize the sacral nerves. Injection is through the sacral hiatus and sacrococcygeal ligament. Use the 4th sacral process and Sacral cornua as landmarks.
Injury of Coccyx
Fracture of coccyx or sacrococcygeal joint dislocation. Displacement is common with surgery necessary, ongoing pain is common.
Abnormal fusion of vertebrae
L5 is incorporated into sacrum or S1 is separated. When L5 is incorporated, the L4-L5 level is weak and degenerates.
Aging on Vertebrae
Lumbar vertebrae triple in height between birht-age 5. Increases 50% ages 5-13. Rate decreases until adulthood. Middle and old age have a decrease in bone density and the bodies may bow inwards causing narrowing between vertebrae without IV disc loss.
Aging of Vertebrae- Spondylylosis
Bony spurs develop around vertebral body, normal aging. May or may not cause pain.
Spina Bifida occulta
Undeveloped neural arches of L5, S1. Tuft of hair at the location.
Spina bifida cystica
Unformed vertebral arches, herniation of meninges and/or spinal cord posteriorly. Can have severe neurological consequences.
Aging of IV discs
Nucleus pulposus dehydrate and become stiffer. Anulus fibrosis thickens to compensate. Increase in size with age.
Herniation of nucleus pulposus
Posterior lateral hernia through a weakened anulus pulposus can cause lower back pain. Causes localized and referred pain. Most common L4-L5.
Sciatica
Herniation at L5-S1 causing lower back and hip radiating pain. IV foramina decrease in size and the
Causes of IV disc heriation
Rare in young adults unless there is violent hyperflexion or rotation (golf swing, football collision). More common with age because the anulus pulposus weakens.
Fracture of Dens
Commonly fractured at the base with the transverse ligament between the 2 bones or fracture of the body spanning the dens. Can cause avascular necrosis because blood supply to the fragment is cut off. Unlikely to cause spinal cord compression, held in place by the transverse ligament.
Rupture of transverse ligament
Results in atlanto-axial subluxation (dislocation). More common in people with underlying connective tissue disorders or Down Syndrome. Likely to cause spinal cord compression.
Rupture of Alar ligaments
Tears caused by flexion and rotation result in increased movement on the contralateral side. Not as strong as transverse ligaments.
Fractures and Dislocations of Vertebrae
Compression fracture due to flexion may be combined with dislocation and fracture of the articular facets and the interspinous ligaments.
Injury and disease of Zygapophysial joints
Injury or osteoarthritis may affect spinal nerves leaving the spinal canal. Causes pain or spasms in all muscles innervated by that nerve. Dennervation to remove the nerve with radiofrequency is the treatment.
Back pain DDx
Fibroskeletal structures: periosteum, ligaments, and IV discs (associated with aging).
Kyphosis
Hunch back, increased thoracic curvature. Often caused by osteoarthritis.
Lordosis
Sway back, anterior tilting of the pelvis. Often due to weak trunk musculature, pregnancy, and obesity.
Scoliosis
Lateral curvature/rotation of the back.
Back sprain
Ligamentous injury
Back strain
Muscle injury.
Reduced blood supply to the brainstem
Arteriosclerosis obstructs the vertebral arteries from passing through the transverse foramina and the suboccipital triangles. Prolonged turning/bending of the neck may cause light-headedness.
Myelography
Contrast dye is injected into CSF allowing for visualization of the subarachnoid space, spinal cord, and roots. Now replaced by MRI.
Development of meninges and subarachnoid space
The leptomeninges (pia and arachnoid maters) develop as one membrane around the embryonic spinal cord. Fluid filled spaces form and coalesce to form the subarachnoid space.
Lumbar puncture
Withdrawal of CSF. Needle inserted L3-4 or L4-5. Spinal cord ends at L2 in adults, so there’s no risk of injury. Spinal cord passes through the skin, fat, ligamentum flavum and into the subarachnoid space.
Spinal anesthesia
Anesthesia is injected into the subarachnoid space
Epidural anesthesia
Anesthesia is injected into the epidural space.
Ischemia of the spinal cord
Deficient blood supply can lead to neuron death, muscle weakness, and paralysis.
Spinal cord injuries
Cervical dislocation, IV disc herniation, or weakened ligementum flavum may cause spinal cord shock and paralysis because the vertebral foramen are small.
