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LOCO 2 > Back Problems > Flashcards

Back Problems Flashcards

1
Q

Back pain is extremely common. How many % of adults will experience at least one episode?

A

80%

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2
Q

How many new cases of back pain are added each year?

A

1-4% of the population

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3
Q

How many (out of 10) have some degree of chronic back pain?

A

1:10

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4
Q

By how much have cases of back pain increased over the last 40 years?

A

Doubled

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5
Q

What defines an abnormal curve?

A

Increase or decrease in one of the normal curves

OR a new curve (lateral)

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6
Q

What is the layman term for (excessive thoracic) kyphosis? What causes it?

A

Hunchback/humpback

Erosion/fracture of anterior part of one or more vertebrae

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7
Q

What causes abnormal curves?

A

Due to developmental anomalies or pathological conditions (e.g. missing half vertebrae, and osteoporosis).

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8
Q

What are the four normal curves?

A

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Sacral kyphosis

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9
Q

What are the primary curves?

What are the secondary curves?

A

Thoracic and sacral kyphosis

Cervical and lumbar lordosis (they develop as we grow and learn to sit/hold our head up)

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10
Q

How many moveable vertebrae are there?

A

24

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11
Q

What is done in a vertebroplasty procedure for severe kyphosis?
What is the result of this?

A

Insert instrument into fractured vertebrae, inflate balloon template, and then fill with support cast/bone cement.
This pushes up the cortical bone of vertebrae back up to higher height and increases the intervertebral foramina to stop spinal nerves being compressed.

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12
Q

What else is a vertebroplasty called? (2)

A

Kyphoplasty

Vertebral augmentation

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13
Q

What is adolescent kyphosis called?

A

Sheuermann’s disease

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14
Q

What are the symptoms of Sheuermann’s disease? (2)

A

Pain

Difficulty breathing

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15
Q

How many % of children are affected by Sheuermann’s disease?

A

1%

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16
Q

What causes Sheuermann’s disease and happens in the disease?

A

Epiphyseal growth plates of vertebral bodies are affected in one or more thoracic vertebrae.
Causes wedging of the bone and exaggerated kyphosis.

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17
Q

What is seen on x-ray in Sheuermann’s disease?

A

Depressions in centre of vertebrae (Schmorl’s nodes) - they are protrusions of nucleus pulposus being pushed through the endplate into the damaged vertebral body.

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18
Q

How is Sheuermann’s disease treated?

A

Treated with a brace, or surgery for large curves (60 degrees or more).

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19
Q

What is (excessive lumbar) lordosis also called?

A

Hollow-back/sway-back

Or weakened hip flexors

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20
Q

What is (excessive lumbar) lordosis associated with?

A

Weakened trunk muscles.

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21
Q

When can (excessive lumbar) lordosis develop? (3)

A

In late pregnancy
With obesity
Weakened hip flexors

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22
Q

Anterior rotation of the pelvis produces increased…?

A

Lumbar curvature

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23
Q

What are the symptoms of excessive lordosis?

Why?

A

Back ache
Sciatica
The vertebral bodies are designed for weight bearing but now weight is shifted onto posterior elements.
Also the intervertebral foramina are relatively small in the lumbar area for the exit of large spinal nerves.

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24
Q

Explain how weak hip flexors causes excessive lumbar lordosis.

A

Chronic shortening or tightness of the psoas (the main hip flexor), associated with weakness of the abdominal muscles results in excessive and inappropriate muscle exertion (lordosis of the lower back). This is due to shortening and tightening of the erector spinae muscles of the lower back and the thoraco-lumbar fascia. It causes stretching and weakness of abdominal muscles. If psoas is shortened, the hip is pushed more into extension due to the pull of hamstrings and gluteal muscles, which are tightened/hypertonic.

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25
Q

What is the difference between anterior pelvic tilt/lordotic back and posterior pelvic tilt/flat back?

A

In anterior pelvic tilt, the pelvis tilts forward and pulls lumbar spine into lordosis
In posterior pelvic tilt, pelvis tilts backward and pulls lumbar spine flat

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26
Q

What causes flat back? (3)

A

Ankylosing spondylitis
Degenerative disc
Spinal fusion

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27
Q

Why is breathing shallow in flat back?

A

Tight musculature between ribs

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28
Q

What is scoliosis?

A

Crooked or curved back - an abnormal lateral curvature, usually accompanied with rotation of the vertebrae (normally in thoracic/lumbar region).

29
Q

How many % of the population have scoliosis?

Who does it mainly affect?

A

3%

Mainly girls around puberty

30
Q

What causes scoliosis? (4)

A

Developmental defects
Asymmetric muscle strength
Poor posture
Idiopathic

31
Q

How is scoliosis treated?

A

Less than 20 degree curve – no treatment
20-40 degree curve – brace
Greater than 50 degree curve – vertebral fusion, or Harrington rods

32
Q

Why are Harrington rods used instead of vertebral fusion?

A

Vertebral fusion can lead to flat back

Harrington rods are newer and are flexible rods attached to each vertebrae.

33
Q

What is the difference between syndesmophytes and osteophytes?

A

Syndesmophytes are found around the vertebral body

Osteophytes are found around synovial joints

34
Q

What things are looked for in degenerative spine disorders? (5)

A 
Osteophytes (syndesmophytes)
Loss of disc height
Loss or increase in curves
Spinal Stenosis
Ossification of vertebral ligaments
35
Q

Why do problems of the intervertebral discs cause back problems?

A

The intervertebral disc are 1/4th of the length of the vertebral column, so problems of the discs lead to back problems.

36
Q

What type of joint is the IV disc?

A

Cartilaginous joint (symphysis)

37
Q

The IV disc is made of two parts - nucleus pulposus and annulus fibrosus. What makes up the nucleus pulposus?

A

70-90% water, and proteoglycans (that hold the water)

38
Q

What is the purpose of the nucleus pulposus?

A

Shock absorber

39
Q

Is the nucleus pulposus innervated?

A

Avascular

No innervation

40
Q

Annulus fibrosus - what is it made up of?

A

Alternating layers of type 1 collagen

41
Q

What is the purpose of the annulus fibrosus?

A

Gives strength and attachment to vertebrae above and below

Firmly attached to outer margin of vertebral body

42
Q

Is the annulus fibrosus innervated?

A

Outer 1/3rd is innervated and has blood supply

43
Q

What happens to the IV discs after the age of 30?

A

IV discs dry out – nuclei pulposi are drier and less resilient. The result is loss of height.

44
Q

Where do herniated discs occur?

A

Can be anywhere along whole length of vertebral column, but most commonly IV disc between L4/5 or L5/S1

45
Q

Do herniated discs tend to go anteriorly or posteriorly?

A

Posteriorly

46
Q

Why do herniated discs cause pain?

A

Ruptures or tears in annulus fibrosus, so the nucleus pulposus bulges out and irritates and/or compressed the spinal nerve root (or even the spinal cord in severe cases). Pain is felt along the distribution of the compressed/irritated nerve root.

47
Q

What is cauda equina syndrome?

A

A serious neurological condition where the herniated disc goes posteriorly and hits the cauda equina (collection of nerve roots coming from spinal cord), compressing multiple nerve roots going to the sacrum e.g. sciatic, obturator, pudendal nerves.

48
Q

What are the symptoms of cauda equina syndrome? (6)

A

Low back pain
Unilateral or bilateral sciatica
Saddle and perineal hypothesia or anesthesia
Bowel and bladder disturbances
Lower extremity motor weakness and sensory deficits
Reduced or absent lower extremity reflexes

49
Q

How is cauda equina syndrome treated? (2)

A

Discetomy – removal of the disc, sucked out. Replace with bone graft.
Laminectomy – remove spinous process, remove lamina and get down to the canal. Relieves pressure on the cauda.

50
Q

What are the immediate complications of a burst fracture?

A

Compression of the spinal cord or nerve roots

Instability

51
Q

What are the late complications of a burst fracture?

A

Haematoma/necrosis – blood can get into the IV disc (nucleus pulposus), causing necrosis of the disc.

52
Q

What happens in ageing to the vertebrae?

A

Osteophytes commonly develop around margins of vertebral body and zygapophysial joints
e.g. Spondylosis and Osteoarthrosis

53
Q

What causes vertebral-basilar artery insufficiency?

A

OA or degenerative disc disease

Osteophytes can cover the foramen in transverse process for the vertebral artery.

54
Q

What are the symptoms of vertebral-basilar artery insufficiency?

A

Loss of consciousness (due to loss of blood supply to brainstem)

55
Q

Diffuse idiopathic skeletal hyperostosis - what is it?

A

Ossification of other things, e.g. ligaments (anterior longitudinal ligament) +/- osteophytes. Disc height maintained.

56
Q

What joint does diffuse idiopathic skeletal hyperostosis not involve?

A

Sacroiliac joint

57
Q

What group does diffuse idiopathic skeletal hyperostosis affect?

A

50-75 year olds

58
Q

Ankylosing spondylitis - what group does it affect?

A

19-25 year olds

59
Q

What is ankylosing spondylitis?

A

Chronic inflammatory disorder, mainly involving the axial skeleton.

60
Q

What is seen on x-ray with ankylosing spondylitis?

A

“Bamboo-spine”
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

61
Q

What HLA is ankylosing spondylitis related to?
How many % of patients are positive for it?
Those with the HLA, what is their chance of developing AS?

A

HLA-B27
>95%
5% chance

62
Q

What is the male to female ratio for AS?

A

3:1

63
Q

Enthesopathy is seen in AS. What is it?

A

Attachments of tendons and ligaments into bone

64
Q

HLA B27 influences the composition of the…?

B27 flora predisposes to a…? What does this cause?

A

Endogenous gut flora
Leaky gut - this allows substances to trigger cascades of inflammatory reactions e.g. toxins, microbial antigens, undigested food, waste or larger than normal macromolecules.

65
Q

What can prevent AS?

A

Antibiotic therapy

66
Q

What are the synovial joints of the vertebral column? (2)

A 
Zygapophysial joints (facet joints)
C1 and C2 pivot synovial joint
67
Q

Cervical spine involvement is common in RA. How many % of patients?

A

~90%

68
Q

How many % of RA patients have subluxations (partial dislocations)?
What type is the most common?

A 
32%
Atlantoaxial subluxation (40%)
69
Q

Why do atlantoaxial subluxations occur?

A

From pannus that forms, causing erosions. If you erode the dens, it becomes thinner and unstable so C1/2 vertebrae will move. Can compress the brainstem and spinal cord, causing neurological symptoms, and may also compress vertebral arteries.

LOCO 2 (28 decks)

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