Back problems

Question 1

What is kyphosis?

Answer 1

Increased thoracic curvature

Question 2

What can cause kyphosis?

Answer 2

Erosion or fracture of anterior part of one or more vertebrae
*dowager’s hump = wedging of the vertebral bodies in the thoracic vertebrae
can be due to developmental anomalies or pathological conditions (missing half vertebrae + osteoporosis)

Question 3

How can kyphosis be treated?

Answer 3

With kyphoplasty

1. insert tube into vertebral body
2. inflate balloon
3. inject bones cement into balloon
   - help restore the size and stability of the vertebral body
   - reduce compression of nerves exiting and therefore reduce pain

Question 4

What is Scheuermann’s disease?

Answer 4

Adolescent kyphosis (affects 1% of children)

• epiphyseal growth plates of vertebral bodies are affected in one or more thoracic vertebrae
• causing wedging of the bone and exaggerated kyphosis

Question 5

What are Smorl’s nodes?

Answer 5

occurs in Scheuermann’s disease

due to protrusions of nucleus pulposus through end plate into vertebral body

Question 6

What are the symptoms of Scheuermann’s disease (severe cases)?

Answer 6

pain
difficulty breathing

*due to trapping of nerves

Question 7

What is lordosis?

Answer 7

Increased curvature

Question 8

What causes lordosis?

Answer 8

due to anterior rotation of the pelvis
this can be due to weakened trunk muscles or weakened hip flexors

can also develop in late pregnancy or obesity (carrying more weight anterior to vertebral column)

Can also be due to psoas dysfunction

• muscle shortening and weakness
• increased lumbar lordosis
• shortening of the thoraco-lumbar fascia and erector spinae muscles
• stretching and weakness of abdominal muscles
• hamstring and gluteal muscles are tightened and often hypertonic

Question 9

What is flat back syndrome + how is it caused?

Answer 9

tight musculature between ribs (breathing will be shallow)
hamstrings are tight and so knees are flexed
hip flexors are weak (hips are flexed due to gravity)
the pelvis tilts backwards (pulls vertebral column flat)

*often seen in ankylosing spondylitis, degernative disc, spinal fusion

Question 10

What is scoliosis and how does it occur?

Answer 10

it is abnormal lateral curvature , and is usually accompanied with rotation of the vertebrae 
it can be the result of:
- developmental defects
- asymmetric muscle strength 
- poor posture 
- idiopathic

Question 11

At what degree of curvature does scoliosis become a problem and why?

Answer 11

60 degrees

will restrict breathing and impact the GI tract

Question 12

how can scoliosis be treated?

Answer 12

AIM: stabilisation
- use a brace for 20-40 degrees of curvature
- curvature >50 degrees: vertebral fusion, Harrington rods
try and get curvature to 0-15 degrees

Question 13

Where do herniated or prolapsed discs usually occur? What is the effect of this?

Answer 13

Most commonly occurs in the IV disc between L4/5 or L5/S1
nucleus polposus irritates and/or compresses the spinal nerve root
- pain felt along distribution of the compressed/irritated nerve root

Question 14

What is cauda equina syndrome? How does it present?

Answer 14

It is a serious neurological condition - can lead to necroses of nerves
presents with:
- low back pain
- unilateral or bilateral sciatica
- saddle and perineal hypothesia or anaethesia
- bowel and bladder disturbances
- lower extremity motor weakness and sensory deficits
- reduced/absent lower extremity reflexes

Question 15

How should cauda equina syndrome be treated?

Answer 15

Discectomy: take out disc and fuse vertebral bodies
Laminectomy: take out lamina and spinous process

Question 16

What are the early and late complications of burst fractures? How are they treated?

Answer 16

Early/immediate: compression of the spinal cord or nerve roots + instability
Late: haematoma/necrosis

*surgical intervention is required for stabilisation; blood clots can form in IVD if blood from vertebral body leaks out - can cause contigual damage

Question 17

How does vertebral-basilar artery insufficiency occur?What are the effects of this insufficiency?

Answer 17

It is a result of OA + degenerative disc disease
vertebral arteries become kinked and must take a more circuitous route around the osteophytes
could mean that the arteries become occluded when you turn your head –> reduce blood flow to the brain which can result in fainting

Question 18

What is diffuse idiopathic skeletal hyperostosis?

Answer 18

hyperostosis = excessive bone growth
usually occurs in 50-75 y/os
due to ossification of anterior longitudinal ligament
can occur with or without presence of osteophytes
disc height is maintained

Question 19

What is ankylosing spondylitis? Who is most likely to develop it?

Answer 19

• chronic inflammatory disorders - mainly involves axial skeleton
• usually narrowing and sclerosis of both sacroiliac joints
• sclerosis and ankylosing of vertebral bodies with NO LOSS of disc space
• bone formation extends across anterior and lateral margins of IVDs

commonly in 19-25 y/o men with HLA-B27

Question 20

How does ankylosing spondylitis usually present?

Answer 20

Insidious onset 
Morning stiffness 
Pain around sacroiliac joints 
stiffness and pain improve with exercise 
associated with iritis + conjunctivitis 
symptoms lasting longer than 3 months

Question 21

How will ankylosing spondylitis look on AP and lateral x-rays?

Answer 21

Bamboo spine - spine becomes encased in calcified ligaments

Question 22

How is ankylosing spondylitis treated?

Answer 22

conventional analgesia/NSAID

physiotherapy to maintain flexibility