Back Pathologies Flashcards
What is kyphosis
Excessive curvature of spine (usually thoracocervical) in sagittal plane >40°
Dislocations can cause cord compression -> paraplegia
Kyphosis causes
Congenital (+spinal bifida) Osteoporosis Ankylosing spondylitis TB/Polio Paget's disease
What is Scheuermann’s disease
Form of osteochondrosis
Ossification of ring epiphyses of thoracic vertebrae affected, results in kyphosis
Scheuermann’s disease presentation
13-16 yrs, round-shouldered + hunched
Present with deformity rather than pain
X-ray shows irregular vertebral endplates, Schmorl’s nodes + reduced disc space
Scheuermann’s disease treatment
Posture control + exercise
Physio + spinal braces
Surgery if kyphosis >75° with neuro deficit/refractory pain/curve progression
What is scoliosis
Lateral spinal curvature with 2° vertebral rotation
Cobb angle >10° of lumbar spine
Scoliosis causes
Idiopathic (diff age onsets)
Neuromuscular
Syndromic (Marfan’s/neurofibromatosis)
Other (tumour, osteoporosis etc)
Adolescent idiopathic scoliosis complications
More common in girls + more likely to progress in girls
Pain
Cosmesis
Lung function impairment
Adolescent idiopathic scoliosis treatment
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
Intervertebral disc prolapse presentation
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
Intervertebral disc prolapse tests
MRI to exclude cauda equina compression
Neuro exam to assess nerve distribution affected
Intervertebral disc prolapse treatment
Brief rest + early mobilisation + analgesia + physio in most
Discectomy in cauda equina syndrome, progressive muscle weakness or continuing pain
Degenerative disc disease treatment
Aetiology unknown, may lead to herniation so surgical interventions used e.g. prosthetic disc replacement
Spondylolisthesis causes
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
Spondylolisthesis treatment
XR/MRI to assess n. compression
Temporary relief with bracing + physio
Curative treatment with spinal fusion (needed for >50% slip)
Lumbar spinal/lateral recess stenosis presentation
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
Lumbar spinal/lateral recess stenosis treatment
NSAIDs, epidural steroid injections + corsets
Decompressive laminectomy if rest fail
Spinal tumour signs
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
Spinal tumour tests
FBC, ESR, LFT, bone profile if red flags/pain >4 wks
Myeloma screen if >50 yrs
XR, CT, MRI
Pyogenic spine infection causes
Half are staph
Strep, Proteus, E. coli, Salmonella + TB also occur
Pyogenic spine infection signs
Pain and restricted movement, usually due to discitis
No fever/tenderness/WCC inc
ESR raised
May see bone erosion on XR
Pyogenic spine infection treatment
Antibiotics
Rest back with bed rest, brace/plaster jacket
Surgery if unresponsive to medical therapies
Pott’s disease presentation
Spinal TB
Tends to affect young adults with systemic symptoms
Gradual onset localised back pain + stiffness
Most commonly T10-L1
Spinal deformity common
Pott’s disease diagnosis
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
