Back Problems Flashcards
What are abnormal curves?
- increase or decrease in one of normal curves
- due to developmental anomalies or pathological conditions
What is extreme kyphosis?
- convex/outwards
- humpback/hunchback
- thoracic region as sacrum is fused so cannot change
- erosion of anterior part of 1 or more vertebrae so move posteriorly
What can cause extreme kyphosis?
- osteoporosis kyphosis (due to crush/compression fracture)
- adolescent kyphosis/Sheuermann’s disease
What is Sheurermann’s disease?
- EGP of vertebral bodies affected in 1 or more thoracic vertebrae = wedging of bone
- severe kyphosis
- only very prominent when lean forward
- pain, difficulty breathing
What is the treatment for extreme kyphosis?
- kyphoplasty (vertebroplasty)
- safe, highly effective at providing pain relief/preventing collapse
- percutaneously place balloon into vertebral body and inflate it
- in space created inject cement to support vertebra
What is extreme lordosis?
- concave
- inwards
- hollow back, sway back
- lumbar region
- anterior rotation of pelvis increases lumbar curvature
- weakened hip flexors
- develop in late pregnancy or obesity
- weight of vertebral bodies shifted onto posterior elements
What are the muscles involved with extreme lordosis?
- chronic psoas shortening and weakness
- shortening of thoracic-lumbar fascia and erector spinae muscles
- stretching and weakness of abdominal muscles
- hamstring and gluteal muscles tightened
What are the symptoms of extreme lordosis?
- back ache
- sciatica (small shift in lumbar nerves can impinge them as so large)
What is flat back syndrome?
Pelvic Tilt
- tight musculature between ribs makes breathing shallow
- also mankes hamstrings tight
- hip flexors weak
- pelvis tilts backwards pulling vertebral column flat
What are the types of pelvic tilt?
- anterior = lordotic back
- posterior = flat back
- neutral pelvis = neutral back
What is scoliosis?
- curved back
- usually accompanied with rotation of vertebrae
- mainly affects girls around puberty (hormone related)
- result of development defects, asymmetric muscle strength, poor posture
- idiopathic mostly
- often goes right at an angle then left at the same angle
What is the treatment of scoliosis?
- goal is stabilisation
- brace (20-40 degrees)
- curves greater than 50 degrees
- vertebral fusion
- Harrington rods
- newer flexible rods (attached to each vertebrae)
How do degenerative spine disorders present?
- both vertebrae and disc affected
- osteophytes
- loss of disc height
- loss or increase in curves
- spinal stenosis
- ossification of vertebral ligaments
What is the anatomy of the intervertebral disc?
- IV disc is cartilaginous joint (symphysis)
- nucleus pulposus
- annulus fibrosus
What is the nucleus pulposus?
- mostly water
- proteoglycans
- avascular
- no innervation
- dry out with age so lose height
What is the annulus fibrosus?
- alternating collagen I layers
- outer 1/3 innervated
- firmly attached to outer margin of vertebral body
What is a herniated disc?
- greater risk when nucleus pulposus dried out
- common between L4/L5 or L5/S1
- nucleus pulposus irritates and compresses spinal nerve root
- stimulates action potentials so pain felt along distribution of compressed nerve root
What is cauda equina syndrome? What are the symptoms?
- herniated L3/L4
- low back pain
- uni/bilateral sciatica
- saddle and perineal hypothesia
- bowel and bladder disturbances
- lower extremity motor weakness and sensory deficits
- reduced/absent lower extremity reflexes
What is the treatment of cauda equina syndrome?
- laminectomy = cut through lamina to pedicles
- discectomy = remove disk to suck it out
What are some immediate burst fracture complications?
- compression of spinal cord or nerve roots
- instability
What are some late burst fracture complications?
- hematoma/necrosis
- disc cannot function
- blood clot unable to be cleared out so get necrosis
What are the significance of osteophytes?
- develop around margins of vertebral body and zygapophyseal joints
- in spondylosis/OA
When may you get vertebral-basilar artery insufficiency?
- OA or degenerative disc disease
What is diffuse idiopathic skeletal hyperostosis?
- 50-75 year olds
- ossification of anterior longitudinal ligament
- may or may not have osteophytes
- disc height maintained
- sacroiliac joint not involved
What is ankylosing spondylitis?
- chronic inflammatory disorder
- mainly involves axial skeleton
- enthesopathy = attachment of tendons and ligaments into bone and get ossified on anterior longitudinal ligament
- 19-25 year olds
- more males
- only autoimmune disease affecting more men
What are the x-ray features of ankylosing spondylitis?
- bamboo spine
- narrowing and sclerosis of sacroiliac joints
- sclerosis and ankylosing
- bone formation extends across anterior/lateral margins
What is the significance of HLA-B27?
- most ank spon patients are positive
What are the synovial joints of the vertebral column?
- zygapophysial joints (facet joints)
- C1 and C2 pivot synovial joint
How does RA affect the spine?
- commonly involves cervical spine
- subluxations
- atlantoaxial subluxation most common = irreversible neurological symptoms as joint presses on brainstem
- pannus invasion in lower cervical IV discs
