Back Disorders Flashcards
Define:
- lordosis
- kyphosis
- scoliosis
Lordosis: increased anterior convexity in the curvature of the spine.
Kyphosis: exagggeration of the posterior convexity of the thoracic vertebral column found found commonly with OA and osteoporosis
Scoliosis: lateral curve of the spine usually right convex thoracic
Define:
- spondylolisthesis
- stenosis
- spondylolysis
Spondylolisthesis: anterior slip of the vertebrae, bilateral pars defect, congenitally usually L5 on S1(youngins), degenerative L4 on L5 (old folk)
Stenosis: narrowing of spinal canal or neural foramen producing root ischemia or neurogenic claudication
Spondylolysis: stress fx of the pars interarticularis
L4 Nerve:
- reflex is where?
- motor effects?
- sensation is felt where?
Reflex: patellar
Motor effects: dorsiflexion via the anterior tibialis
Sensation found along medial foot and leg
L5 Nerve:
- reflex is where?
- motor effects?
- sensation is felt where?
Reflex: none
Motor effects: great toe extension via extensor hallucus longus
Sensation is felt along lateral leg and dorsum of foot.
S1 Nerve:
- reflex is where?
- motor effects?
- sensation is felt where?
Reflex: achilles
motor effects; ankle eversion via peroneus longus and brevis
Sensation is felt in the lateral foot.
What are the disks between the vertebrae composed of?
Function of the disk?
What are the ligaments of the spine?
composed of the nucleus pulposus surrounded by several layers of fibrocartilaginous laminae (annulus)
Function: provide cushion and facilitate movement of the spine.
Ligaments:
- anterior longitudinal ligament
- posterior longitudinal ligament
- Interspinous ligament
- supraspinous ligament
Spinal cord passes through what? Spinal nerves/blood vessels pass through what?
Spinal cord passes through the verterbral foramen
Spinal nerves/blood vessels pass through the intervertebral foramen.
Diagnostic Tests for Back pain?
Plain radiograph
Bone Scan
Diskography
CT myelogram
MRI w/o contrast, but may use contrast if you think they have a tumor, infection, or recurrent disk herniation
Labs; CBC, sed rate
herniated disk:
- What is this?
- sx
- MC disk herniation
- PE findings
- imaging
- tx
Herniated disk occurs when disk fragment comes from the nucleus pulposus of the disk.
Sx:
- +/- back pain
- pain usually radiates into the leg
- achy, burning, electrical shock, shooting or stabbing pain
MC disk herniation is L5-S1 causing lateral and posterior thigh and leg pain
PE findings:
- may be nuerologically normal or may have profound radiculopathy
- straight let raise sign
- gait abnormal (muscle weakness may be revealed when walking on the heels and toes.)
Imaging:
-MRI*
Tx:
- conservative: NSAIDS, PO steroids, muscle relaxants, epidural steroid injections
- Surgical: if presenting with cauda equina syndrome or profound motor deficits, profound sciatic pain, failure of conservative management.
Spinal Stenosis:
- what is this?
- causes
- sx
What: spinal canal narrowing with possible subsequent neural compression.
Causes:
- facet hypertrophy of vertebrae
- vertebral body osteophytes
- ligamentum flavum hypertrophy
- disk generation
- narrowing at the disk space
- neoplasm, acromegaly, pagets dz, ankylosing spondylitis
Sx:
- bilateral neural claudication
- neural claudication pain is exacerbated by standing erect and downhill ambulation, alleviated by lying supine and forward flexion.
Spinal Stenosis:
- PE findings
- imaging
- tx
PE findings:
- pain with extension that is relieved with flexion
- radiculopathy may be noted with motor,sensory, and/or reflex abnormalities
- loss of lumbar lordosis and forward flexed gait.
Imaging:
- Xray
- MRI***
Tx:
- PT stressing good spinal flexion.
- surgery; laminectomy
Degenerative Disk Disease:
- what is this?
- sx
- PE findings
- imaging
- Tx
What: disc dries out and loses shock absorption effects.
Sx:
- pain in lower back and one or both buttocks
- mechanical activity increases pain
PE:
-pain and decreased ROM with flexion and extension of spine standing up
Imaging: Xray
Tx:
-NSAIDS and back education programs
Facet Syndrome:
- What is this?
- sx
- Dx
- Tx
What: Degenerative joint disease of articulating surfaces of vertebae.
Sx: similar findings in DDD.
Dx: Xray
Tx: NSAIDS, focal injections into the facet joint or nerve obliteration are invasive tx for intractable pain.
Muscle Sprain/Strain:
- cause
- sx
- PE findings
- imaging
- tx
Cause:
-repetitive lifting, bending, or other trauma
Sx:
- localized pain that lasts days to weeks.
- muscle tenderness and reproducible pain with muscle testing/movement
- inflamed and swolen musce
PE:
-normal neuro exam
Imaging:
-normal Xray
Tx:
-NSAIDS, back education pain, rest and activity modification
Cauda equina syndrome:
- Cause
- sx
- PE findings
- tx
Causes: trauma, spinal cord injury, compression of sacral nerve roots.
*MC is disk herniation.
Sx: poop in your pants, and neurogenic bladder (overflow incontinence, frequency, urgency, urge incontinence, and retention)
PE findings:
- rectal tone
- bulbocavernousus reflex (place a foley and pull on the foley with the balloon inflated and your anal sphincter will contract. With cauda equina syndrome this reflex wont occur.)
Tx: refer immediately. EMERGENT!
Ankylosing spondylitis:
- what is this?
- primarily affects which joints?
- genetic component?
- sx
- PE
What: formation of bony ridges between adjacent vertebae, progressive ossification of extraspinal joint capsules and ligaments. Tissue replaces the disk fibers with new bone.
Primarily affects the sacroilliac and spinal facet joints.
HLA-B27, MC in young males 15-35YO
Sx:
- low back pain**
- may radiate into groin and buttocks
- wake up at night
- spinal stiffness in the AM.
PE:
- loss of lateral flexion of lumbar spine
- chest expansion becomes restricted
- sacroiliitis (detected by tenderness response during percussion over the sacroiliac joints)
Ankylosing Spondylitis:
- xray findings
- Tx
Xray: bamboo spine
Tx:
-regular lifelong exercises andd NSAIDS!!!!
Compression Fx:
- cause
- MC finding on Xray
- sx
- PE findings
- imaging
- tx
Cause:
-acute trauma but MC occur in osteoporotic elderly
MC finding on xray: wedge shaped vertebrae.
Sx:
- midline back pain***
- pain is axial, nonradiating, aching, or stabbing
- lower extremity weakness or numbness
PE finding:
- kyphotic posture that cannot be corrected
- palpation to elicit pain at the level of injury
Imaging:
- xray
- MRI (distinguishes new from old)
Tx:
-conservative:bracing, analgesic meds, rest
-surgery
Scoliosis:
- causes what spinal deformity?
- sx
- dx
- tx
- what is cobb angle?
Spinal deformity: lateral curvature of the spin, greater than 10 degrees away from the central axis.
Sx: should not be painful
-MC curve in right thoracic spine
Dx:
- forward flexion test
- high sided scapula/shoulder
Tx:
- curve less than 25 degrees: observe with xray
- bracing for curves 20-40degress
- surgical tx for inflexible curves greater than 40 degrees and essentially any curve greater than 50 degrees.
Cobb angle: a measure of the resulting scoliosis angle based on radiographs.
if you have suspicion of what life threatening conditions you need to call for help immediately.
Emergency circumstances:
- aching nocturnal pain unrelieved by rest
- S/S AAA
- B/B Incontinence
- Cauda equina
- spine Fx with instability
