Back Clinical

Question 1

Vertebral body osteoporosis

Answer 1

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.

Question 2

Laminectomy

Answer 2

Surgical excision of the dorsal segment of a vertebrae by cutting along the lamina or pedicle. Allows for access to the spinal cord.

Question 3

Dislocation of cervical vertebrae

Answer 3

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.

Question 4

Fracture and dislocation of Atlas

Answer 4

Vertical forces can fracture the arches.

Question 5

Jefferson fracture of the Atlas

Answer 5

Severe vertical force can cause fracture of the Atlas and rupture of the transverse ligament.

Question 6

Fracture and dislocation of Axis

Answer 6

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.

Question 7

Lumbar Spinal Stenosis

Answer 7

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.

Question 8

Cervical ribs

Answer 8

Extra rib on C7 may pressure underlying structures such as the subclavian or inferior trunk of the brachial plexus. May cause thoracic outlet syndrome.

Question 9

Caudal Epidural Anesthesia

Answer 9

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.

Question 10

Injury of Coccyx

Answer 10

Fracture of coccyx or sacrococcygeal joint dislocation. Displacement is common with surgery necessary, ongoing pain is common.

Question 11

Abnormal fusion of vertebrae

Answer 11

L5 is incorporated into sacrum or S1 is separated. When L5 is incorporated, the L4-L5 level is weak and degenerates.

Question 12

Aging on Vertebrae

Answer 12

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.

Question 13

Aging of Vertebrae- Spondylylosis

Answer 13

Bony spurs develop around vertebral body, normal aging. May or may not cause pain.

Question 14

Spina Bifida occulta

Answer 14

Undeveloped neural arches of L5, S1. Tuft of hair at the location.

Question 15

Spina bifida cystica

Answer 15

Unformed vertebral arches, herniation of meninges and/or spinal cord posteriorly. Can have severe neurological consequences.

Question 16

Aging of IV discs

Answer 16

Nucleus pulposus dehydrate and become stiffer. Anulus fibrosis thickens to compensate. Increase in size with age.

Question 17

Herniation of nucleus pulposus

Answer 17

Posterior lateral hernia through a weakened anulus pulposus can cause lower back pain. Causes localized and referred pain. Most common L4-L5.

Question 18

Sciatica

Answer 18

Herniation at L5-S1 causing lower back and hip radiating pain. IV foramina decrease in size and the

Question 19

Causes of IV disc heriation

Answer 19

Rare in young adults unless there is violent hyperflexion or rotation (golf swing, football collision). More common with age because the anulus pulposus weakens.

Question 20

Fracture of Dens

Answer 20

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.

Question 21

Rupture of transverse ligament

Answer 21

Results in atlanto-axial subluxation (dislocation). More common in people with underlying connective tissue disorders or Down Syndrome. Likely to cause spinal cord compression.

Question 22

Rupture of Alar ligaments

Answer 22

Tears caused by flexion and rotation result in increased movement on the contralateral side. Not as strong as transverse ligaments.

Question 23

Fractures and Dislocations of Vertebrae

Answer 23

Compression fracture due to flexion may be combined with dislocation and fracture of the articular facets and the interspinous ligaments.

Question 24

Injury and disease of Zygapophysial joints

Answer 24

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.

Question 25

Back pain DDx

Answer 25

Fibroskeletal structures: periosteum, ligaments, and IV discs (associated with aging).

Question 26

Kyphosis

Answer 26

Hunch back, increased thoracic curvature. Often caused by osteoarthritis.

Question 27

Lordosis

Answer 27

Sway back, anterior tilting of the pelvis. Often due to weak trunk musculature, pregnancy, and obesity.

Question 28

Scoliosis

Answer 28

Lateral curvature/rotation of the back.

Question 29

Back sprain

Answer 29

Ligamentous injury

Question 30

Back strain

Answer 30

Muscle injury.

Question 31

Reduced blood supply to the brainstem

Answer 31

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.

Question 32

Myelography

Answer 32

Contrast dye is injected into CSF allowing for visualization of the subarachnoid space, spinal cord, and roots. Now replaced by MRI.

Question 33

Development of meninges and subarachnoid space

Answer 33

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.

Question 34

Lumbar puncture

Answer 34

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.

Question 35

Spinal anesthesia

Answer 35

Anesthesia is injected into the subarachnoid space

Question 36

Epidural anesthesia

Answer 36

Anesthesia is injected into the epidural space.

Question 37

Ischemia of the spinal cord

Answer 37

Deficient blood supply can lead to neuron death, muscle weakness, and paralysis.

Question 38

Spinal cord injuries

Answer 38

Cervical dislocation, IV disc herniation, or weakened ligementum flavum may cause spinal cord shock and paralysis because the vertebral foramen are small.