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LOCO2 > Back Pain > Flashcards

Back Pain Flashcards

1
Q

Name this abnormal curvature of the spine [1]

Which vertebrae does this most commonly occur in? [1]

A

Scheuermann kyphosis

Condition of hyperkyphosis that involves the vertebral bodies and discs of the spine identified by anterior wedging of greater than or equal to 5 degrees in 3 or more adjacent vertebral bodies

Thoracic spine is most commonly involved, although involvement can include the thoracolumbar/lumbar region as well

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2
Q

State the normal curvatures of the spine [4]l if they are primary or secondary [4] and if they are kyphosis or lordosis [4]

A

cervical: secondary: lordosis
thoracic: primary; kyphosis
lumbar: secondary; lordosis
sacral: primary; kyphosis

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3
Q

Which condition caused this kyphosis [1]

A

Osteoporosis

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4
Q

A hunchback is an exaggeration of what type of normal curve? [1]

How does a hunchback occur? [1]

A

Increased thoracic kyphosis

Erosion/fracture of anterior part of one or more vertebrae

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5
Q

How does osteoporisis cause kyphosis? [1]

A

loss of trabaculae bone inside the vertebral body; causes anterior wedge that increases the curvature of the thoracic region

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6
Q

Describe mechanism of treating XS kyphosis using Kyphoplasty (vertebroplasty, vertebral augmentation) [4]

A
  • Put in a small tube that has balloon in it
  • Inflate balloon
  • This lifts the vertebral body up
  • Pump in bone cement PMMA
  • Solidifies the trabeculae and lifts the vertebrae up
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7
Q
A
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8
Q

Describe the pathophsioloy of adolescent kyphosis: Sheuermann’s disease [3]

A

Epiphyseal growth plates of vertebral bodies are affected in one or more thoracic vertebrae; causes Smorl’s nodes

Smorl’s nodes: nucleus pulposes pushes into the vertebral body above it

Causing wedging of the bone and exaggerated kyphosis

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9
Q

What are the arrows pointing to?

A

Schmorl’s nodes are a common spinal disc herniation in which the soft tissue of the intervertebral disc bulges out into the adjacent vertebrae through an endplate defect.

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10
Q

Describe treatment used for adolescent kyphosis (Sheuermann’s disease) [3]
How much doe

A

Physiotherapy
Increased strength of paraspinals

Bracing
Less than 65o
Corrects by 15o

Surgical
Curves greater than 65o
Intractable pain or neurological issues

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11
Q

Which curvature does this show?

A

Lordosis

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12
Q

State three causes of lumbar lordosis [3]

A

Associated with weakened trunk muscles.
Can develop in late pregnancy or with obesity: more anterior weight
Or weakened hip flexors (ilopsoas)

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13
Q

Name a pathological disease that causes lordosis

A

Muscular dystrophy

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14
Q

Symptoms for lordosis? [2]

A

Back ache
Sciatica: impingement of nerve root

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15
Q

Describe the pathophysiology of XS lordosis [3]

A

Vertebral bodies designed for weight bearing but now weight is shifted onto posterior elements: especially the facet joints; can sublux due to not being aligned

Inverterbral disc narrowed at the back; but stretched at the front - can cause hernation

Small intervertebral foramina can impinge exit of large spinal nerves

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16
Q

Which muscles particularly causes lordosis? [2]

Explain why this occurs [3]

A

Ilopsoas; psoas major and iliacus: hip flexors

Chronic psoas shortening and tightness causes increased lordosis

Also results compensatory stretching and weakness of abdominal muscles AND
Hamstring and gluteal muscles tightened often hypertonic

17
Q

Describe the how flat back syndrome is caused [1]

Describe the effects having a flat back has on the following and what this means physiologically [8]

  • Ribs
  • Hamstrings
  • Hip flexors
  • Head
A

Pelvic tilts backwards and and pulls lumbar spine flat. Causing:

  • Tight musculature between ribs makes breathing shallow
  • Hamstrings tight – knees flexed
  • Hip flexors weak – hip flexed (gravity)
  • Pelvis tilts backwards pulls vertebral column flat
  • Head forward – puts stress on shoulder and neck
18
Q

Which immunological disease can cause flat back syndrome? [1]

Name two other causes [2]

A

Ankylosing spondylitis

degenerative disc; spinal fusion

19
Q

Why may girls develop scoliosis more than boys? [1]

A

Relaxin is released during menstrual cycle

20
Q

How do you assess to see if have scoliosis? [1]

What other sign may scoliosis patients have? [1]

A

Ask to bend over; look at shoulder difference

One pelvis is higher than the other - apparent leg length discrepency (but not actually)

21
Q

What degree of curvature would indicated scoliosis:

Brace [1]
Surgery [1]:
* what surgical interventions could you use? [2]

A

Brace: 20-40 degrees
Surgery: > 50 degrees
* Vertebral fusions
* Harrington rods

22
Q

Name this treatment for scoliosis [1]

A

Harrington rods

23
Q

Describe age related changes that are pathological to the spinal cord [2]

A

After the age of 30 IV discs dry out – nucleus pulposus dries out due to reducting in proteoglycan structure

Osteoarthritis: osteophytes

Ossification of vertebral ligaments

Spinal Stenosis

24
Q

Posterior osteophytes impinge of which structure? [1]

Anterior osteophytes impinge of which structure? [1]

A

Anterior longitudinal ligament

Posterior longitudinal ligament

25
Q

Which parts of the innvertebral disc have innervation? [1]

A

Lacks innervation in nucleus pulposus
Outer 1/3rd of annulus fibrosus innervated

26
Q

Most common hernated discs are found where? [2]

A

Most commonly IV disc between L4/5 or L5/S1

27
Q

Describe causes of cauda equina syndrome [5]

A

Cauda equina syndrome is caused by compression of the cauda equina:

  • Disc herniation (most common cause) – most commonly occuring at L5/S1 and L4/L5 level
  • Trauma – including vertebral fracture and subluxation
  • Neoplasm – either primary or metastatic
    The most common cancers that spread to spinal vertebrae are thyroid, breast, lung, renal and prostate
  • Infection – e.g. discitis or Potts disease
  • Chronic spinal inflammation – e.g. ankylosing spondylitis
  • Iatrogenic – e.g. haematoma secondary to spinal anaesthesia
28
Q

Describe the signs / symptoms of cauda equina syndrome [5]

A

Cauda equina syndrome results in lower motor neurone signs and symptoms:

  • reduced or absent lower extremity reflexes
  • reduced lower limb sensation (often bilateral)
  • bladder or bowel dysfunction
  • lower limb motor weakness
  • severe back pain
  • impotence.
29
Q

How do you treat cauda equina syndrome? [2]

A

Discetomy
laminectomy

30
Q

What is a burst facture? [1]

Describe immediate [2] and late [1] complications of burst fractures

A

When a vertebra is crushed in all directions

Immediate problems:
* Compression of the spinal cord or nerve roots
* Instability

Late problems:
* Haematoma; necrosis

31
Q

Describe how OA can cause compression of vertebral artery? [2]

A

Osteophytes development around margin of vertebral body and zygapophysial (facet) joints

Can block off the flow of the vertebral artery

32
Q

OA or degenerative disc disease blocking the vertebral artery caues what pathology? [1]

A

Vertebral-basilar artery insufficiency

33
Q

Describe pathophsiology of Diffuse idiopathic skeletal hyperostosis (DISH) [2]

A

Unilateral ossification of anterior longitudinal ligament (+/- osteophytes)

Not complete ossification: looks like candle wax

Disc height maintained

34
Q

Classic presentation of ankylosing spondylitis? [2]

A

Back pain
Ankylosing spondylitis is 3 times more frequent in men than in women and begins most often between ages 20 and 40

35
Q

Describe pathophsiology of AS

A

95% of patients have HLA B27

Narrowing and sclerosis of both sacroiliac joints

Sclerosis and ankylosis of vertebral bodies with no loss of disc space

Bone formation extends across anterior and lateral margins of IV discs

36
Q

Describe how HLA B27 is thought to cause ankylosing spondylitis [2]

A

HLA B27 influences the composition of the endogenous gut flora:
* B27 flora predisposes to a leaky gut
* Leaky gut allows substances that trigger cascades of inflammatory reactions

37
Q

Describe how RA has cervical spine invovlement [3]

A

Pannus formation resulting in bony erosion and ligamentous laxity

This cascade can lead to cervical spinal instability in the form of atlantoaxial instability (AAI)

Also compression of vertebral arteries

LOCO2 (58 decks)

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