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Ortho > Back Pathologies > Flashcards

Back Pathologies Flashcards

1
Q

What is kyphosis

A

Excessive curvature of spine (usually thoracocervical) in sagittal plane >40­­°
Dislocations can cause cord compression -> paraplegia

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2
Q

Kyphosis causes

A 
Congenital (+spinal bifida)
Osteoporosis
Ankylosing spondylitis
TB/Polio
Paget's disease
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3
Q

What is Scheuermann’s disease

A

Form of osteochondrosis

Ossification of ring epiphyses of thoracic vertebrae affected, results in kyphosis

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4
Q

Scheuermann’s disease presentation

A

13-16 yrs, round-shouldered + hunched
Present with deformity rather than pain
X-ray shows irregular vertebral endplates, Schmorl’s nodes + reduced disc space

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5
Q

Scheuermann’s disease treatment

A

Posture control + exercise
Physio + spinal braces
Surgery if kyphosis >75° with neuro deficit/refractory pain/curve progression

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6
Q

What is scoliosis

A

Lateral spinal curvature with 2° vertebral rotation

Cobb angle >10° of lumbar spine

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7
Q

Scoliosis causes

A

Idiopathic (diff age onsets)
Neuromuscular
Syndromic (Marfan’s/neurofibromatosis)
Other (tumour, osteoporosis etc)

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8
Q

Adolescent idiopathic scoliosis complications

A

More common in girls + more likely to progress in girls
Pain
Cosmesis
Lung function impairment

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9
Q

Adolescent idiopathic scoliosis treatment

A

Brace for 20h a day (poor adherence) to slow progression
Surgery in <7 yrs but only done in older if they are suffering due to complications, intraop spinal cord monitoring to prevent paralysis

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10
Q

Intervertebral disc prolapse presentation

A

Lumbar discs most likely to rupture
Pain on coughing, sneezing, twisting a few days following back strain
Forward flexion + extension limited
Neuro signs if nerve impingement

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11
Q

Intervertebral disc prolapse tests

A

MRI to exclude cauda equina compression

Neuro exam to assess nerve distribution affected

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12
Q

Intervertebral disc prolapse treatment

A

Brief rest + early mobilisation + analgesia + physio in most

Discectomy in cauda equina syndrome, progressive muscle weakness or continuing pain

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13
Q

Degenerative disc disease treatment

A

Aetiology unknown, may lead to herniation so surgical interventions used e.g. prosthetic disc replacement

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14
Q

Spondylolisthesis causes

A

Displacement of lumbar vertebra upon one below
Spondylosis (age-related degeneration)
Spondylolysis (from defect in pars interarticularis)
Articular process malformation
OA of posterior facet joints

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15
Q

Spondylolisthesis treatment

A

XR/MRI to assess n. compression
Temporary relief with bracing + physio
Curative treatment with spinal fusion (needed for >50% slip)

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16
Q

Lumbar spinal/lateral recess stenosis presentation

A

Typically caused by facet joint OA
Pain worse on walking w aching/heaviness
Pain on extension
Negative straight leg extension test, few CNS signs
Typical pt prefers leaning over shopping trollies, uphill to downhill, cycling to flex back

17
Q

Lumbar spinal/lateral recess stenosis treatment

A

NSAIDs, epidural steroid injections + corsets

Decompressive laminectomy if rest fail

18
Q

Spinal tumour signs

A

Pain, LMN signs at level and UMN signs below if compressing cord
Peripheral signs e.g. hyporeflexia, weakness, dec sensation
Saddle anaesthesia with cauda equina involvement
Metastases may affect cancellous bone

19
Q

Spinal tumour tests

A

FBC, ESR, LFT, bone profile if red flags/pain >4 wks
Myeloma screen if >50 yrs
XR, CT, MRI

20
Q

Pyogenic spine infection causes

A

Half are staph

Strep, Proteus, E. coli, Salmonella + TB also occur

21
Q

Pyogenic spine infection signs

A

Pain and restricted movement, usually due to discitis

No fever/tenderness/WCC inc

ESR raised
May see bone erosion on XR

22
Q

Pyogenic spine infection treatment

A

Antibiotics
Rest back with bed rest, brace/plaster jacket
Surgery if unresponsive to medical therapies

23
Q

Pott’s disease presentation

A

Spinal TB
Tends to affect young adults with systemic symptoms
Gradual onset localised back pain + stiffness
Most commonly T10-L1
Spinal deformity common

24
Q

Pott’s disease diagnosis

A

MRI more specific than CT
Bone scans help differentiate from malignancy
PET is best but generally MRI used
CXR for pulmonary TB check and cultures

25
Q

Cauda Equina syndrome signs

A

Severe back pain

Poor anal tone
Saddle anaesthesia
Incontinence/retention of faeces/urine

Paralysis/sensory loss

26
Q

Cauda Equina syndrome tests

A

MRI within 4 hours

Ortho (13 decks)

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