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Locomotor 2 > Back Problems > Flashcards

Back Problems Flashcards

1
Q

how common is back pain

A

80% of adults will experience at least one episode

  • New cases added each year - around 1-4% of the population
  • 1:10 have some degree of chronic back pain
  • Cases have doubled over last 40 years
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2
Q

How much does the NHS spend on back problems

A

NHS spends more that £1 billion a year on back pain related costs

  • £512 million on hospital costs
  • £141 million GP consultations
  • £151 million physiotherapy

Private health care cost in addition to NHS = £565 million

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3
Q

how much does back pain relate to gross national product

A

Total costs = 1- 2% gross national product

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4
Q

how many working days are lost because of back pain

A

5 million working days lost because of back pain

- On any day 1% of working population is off work

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5
Q

what shape is the spinal cord

A

S shape

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6
Q

what are the two development curves in the spinal cord

A
  • primary and secondary
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7
Q

when are primary and secondary curves formed

A 
Primary = in utero 
Secondary = post fatally when you sit up and stand
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8
Q

What is kyphosis

A

increased thoracic curvature

  • also have kyphosis in the sacral region but the sacrum is fused so it does not move
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9
Q

What usually causes kyphosis

A

Erosion/fracture of anterior part of one or more vertebrae

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10
Q

what are abnormal curves due to

A
  • developmental anomalies or pathological conditions
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11
Q

how do you treat a kyphosis

A

Kyphoplasty (vertebroplasty, vertebral augmentation)

  • treatment for a collapsed vertebra
  • insert a balloon
  • and then fill with a support cast
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12
Q

What are the benefits of a kyphoplasty

A
  • safe
  • highly effective at providing pain relief
  • highly effective at preventing further collapse
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13
Q

What is another name for adolescent kyphosis

A

Sheuermann’s disease

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14
Q

what are the symptoms of adolescent kyphosis/sheuermann’s disease

A

Pain

difficulty breathing - trapping of the spinal nerve roots as they exit going to the intercostals

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15
Q

what happens in adolescent kyphosis

A
  • Epiphyseal growth plates of vertebral bodies are affected in one or more thoracic vertebrae
  • Schmorl’s nodes - these are protrusions of nucleus pulpous through the endplate into the vertebral body
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16
Q

What vertebra are commonly affected by adolescent kyphosis/sheuermann’s disease

A

T4-T6

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17
Q

How do you treat adolescent kyphosis/sheuermann’s disease

A
  • place into a brace - brace supports and straightens to keep the verbtra aligned
  • surgery if there is a large curve
  • Kyphoplasty (vertebroplasty, vertebral augmentation)
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18
Q

What is the two lordosis in the spine

A
  • cervical and lumbar
  • usually talking about the lumbar region
  • secondary curve
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19
Q

What is a lordosis

A

anterior rotation of pelvis produces increased lumbar curvature

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20
Q

What is a lordosis associated with

A

Associated with weakened trunk muscles. - so the core muscles

Can develop in late pregnancy or with obesity as you are carrying more weight anterior to the vertebral column - goes back after pregnancy or if you loose the weight

Or weakened hip flexors - ilopsoas - on anterior side as you have more pull on the pelvis that you have from the front

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21
Q

What are the symptoms of lordosis

A

Back ache

Sciatica - trapping the nerve roots, the intervertebral foramen are small for the size of the nerve roots that exit the lumbar region therefore can trap the nerve roots that go into the sciatic nerves

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22
Q

in a lordisos where is the weight shifted

A

Vertebral bodies designed for weight bearing but now weight is shifted onto posterior elements therefore the intervertebral disc is squished and this again reduces the size of the intervertrbal foramen

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23
Q

What is psoas dysunfcton

A

Chronic psoas shortening and weakness that leads to a lordosis

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24
Q

What is shortened in a psoasa dysfunction

A

Shortening of the thoraco-lumbar fascia and erector spinae muscles

psoas shortening and weakness

Stretching and weakness of abdominal muscles

Hamstring and gluteal muscles tightened and often hypertonic

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25
Q

How do you treat a psoas dysunfcton

A

stretching the psoas will relieve the tension as well as stretching the hamstrings

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26
Q

What muscles causes flat back syndrome

A

Tight musculature between ribs makes breathing shallow

Hamstrings tight therefore the knees flexed

Hip flexors weak – hip flexed (gravity)

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27
Q

what is flat back syndrome

A

Pelvis tilts backwards pulls vertebral column flat

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28
Q

what conditions cause flat back syndrome

A

Ankylosing spondylitis,

degenerative disc,

spinal fusion

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29
Q

What is scoliosis

A

abnormal lateral curvature

- Usually accompanied with rotation of the vertebrae

30
Q

who is scoliosis found in

A

Found in 3% of the population

- Mainly girls around puberty therefore could be hormonal related

31
Q

What is scoliosis as a result of

A
  • developmental defects
  • asymmetric muscle strength = if one side of paraspinals is more developed then the other side this can lead to an abnormal curvature
  • poor posture
  • idiopathic
32
Q

When does scoliosis become severe

A

when the curvature get 60 degrees when it restricts breathing, GI system and quite a severe deformity

33
Q

what is the goal in scoliosis

A

stabilisation

- always going to be some degree or curvature

34
Q

How do you treat scoliosis

A

Curves between 20-40 degrees
- Brace - can be worn 24 hours a day - prevents any more movement

Curves greater than 50o

  • Vertebral fusion
  • Harrington rods
  • Newer flexible rods attached to each vertebrae
35
Q

what does age do to the veretebra

A

Age affects both vertebrae and the disc causing:

- Back Pain

36
Q

how does age affect the IV disc

A
  • will dry out
  • gets thinner
  • tear and crack
37
Q

what do you look for in age related degenerative spine disorders

A

Osteophytes (syndesmophytes)

Loss of disc height

Loss or increase in curves

Spinal Stenosis

Ossification of vertebral ligaments

38
Q

what type of joint is the IV disc

A

cartilaginous joint (symphysis)

39
Q

What is the nucleus pulpous made out of

A

70-90% water

Proteoglycans

Avascular

No innervation

40
Q

What is the IV disc made out of

A

nucleus pulpous

annulus fibrousus

41
Q

What is the annulus fibrosis made out of

A

Alternating layers of collagen

Type I

Outer 1/3rd is innervated

Firmly attached to outer margin of vertebral body

42
Q

what happens to the IV discs after the age of 30 and the what is the result

A
  • After the age of 30 IV discs dry out – nucleus pulposus

- Result is loss of height

43
Q

describe what happens in a dry disc

A
  • Dry disc
  • Herinate and fibrocartilage layer to tears
  • When it tears the nucleus pulposis centre core will leak out
  • Usually happens in a lumbar region between L4/L5 and L5/S1 – the nucleus pulpous irritates the spinal nerve root and you get pain along the dermatome for these nerves
44
Q

What is caudal equina syndrome

A

If you have a sevre leaky this goes straight out posteriorly and press on the spinal cord or on the whole of the cadua and equaina

45
Q

what are the symptoms of caudal equina syndrome

A
  • Low back pain
  • Unilateral or bilateral sciatica
  • Saddle and perineal hypothesia or anaesthesia
  • Bowel and bladder disturbances
  • Lower extremity motor weakness and sensory deficits
  • Reduced or absent lower extremity reflexes
46
Q

What is the treatment of caudal equina syndrome

A

Discetomy
- take the disc out and fuse the vertebrae together giving the nerve roots room

laminectomy
- taken of the lamina and spinous process - this gives the nerve roots room

47
Q

What are burst fractures

A
  • have a disc above and below pushing and breaking the disc between them
48
Q

what are the late and immediate results of a burst fracture

A

Immediate

  • Compression of the spinal cord or nerve roots
  • instability

Late
- Hematoma/necrosis- vertebra has blood in it and this blood has to go somewhere therefore it goes into the IV disc which is usually avascular

49
Q

what is the most common complication in the vertebra

A

osteoarthritis

50
Q

what does osteoarthritis form on the vertebral column

A
  • Osteophytes (syndesmophytes) commonly develop around margins of vertebral body and zygapophysial joints
  • can fuse and lock together the vertebra
  • can compress vertebral arteries and can cause vertebral artery insufficiency
    this can reduce blood supply to the Brainstem, cerebellum and cerebrum
51
Q

what is arthritis to the spinal cord called

A

Spondylosis

52
Q

what happens in a vertebral-basilar artery insufficiency

A

Result of OA or degenerative disc disease

- osteophytes compress the cerebral arteries which supply the Brainstem, cerebellum and cerebrum

53
Q

what is diffuse idiopathic skeletal hyperostosis

A

Ossification of anterior longitudinal ligament this causes the vertebra to fuse together

54
Q

Who does diffuse idiopathic skeletal hyperostosis

A

50-75 year olds

55
Q

what ligament usually ossifies in diffuse idiopathic skeletal hyperostosis

A

Ossification of anterior longitudinal ligament

56
Q

describe what happens in diffuse idiopathic skeletal hyperostosis

A

might have osteophytes, they interlock down the side but they are not always present

Disc height maintained

Does not involve sacroiliac joint

57
Q

What is ankylosing spondylitis

A

Chronic inflammatory disorder - mainly involves axial skeleton
- linked to HLA B27

58
Q

what age is ankylosing spondylitis

A

19-25 year olds men primarily

- 3:1 male ratio

59
Q

What HLA is ankylosing spondylitis involved with

A
  • linked to HLA B27
    >95% of patients positive
    5% chance of developing AS
60
Q

what skeleton does ankylosing spondylitis affect

A

axial skeleton - main insertion point for ligaments

61
Q

How does ankylosing spondylitis affect the sacroiliac joint

A

Narrowing and sclerosis of both sacroiliac joints

62
Q

How does ankylosing spondylitis affect the vertebral column

A
  • Bamboo spine
  • Sclerosis and ankylosis of vertebral bodies with no loss of disc space
  • Bone formation extends across anterior and lateral margins of IV discs and down the posterior side eventually
63
Q

What is an Enthesopathy

A

Attachments of tendons and ligaments into bone

64
Q

give example of an Enthesopathy

A

ankylosing spondylitis

65
Q

describe the pathophysiology of ankylosing spondylitis

A
  • HLA B27 influences the composition of the endogenous gut flora
  • B27 flora is more damaging and tends to predispose people to a leaky gut and not a healthy set of bacteria
  • Leaky gut allows substances trigger cascades of inflammatory reactions = Toxins, microbial antigens, undigested food, waste or larger than normal macromolecules
  • these all can enter into the blood stream
  • effects the lamina propria
  • lamina propria start to produce things such as IL-17
  • these can then travel to the joint
66
Q

How can you prevent ankylosing spondylitis from starting

A
  • antibiotic therapy prevents spondylitis and colitis
67
Q

what are the synovial joints of the vertebral column

A

Zygapophysial joints (facet joints

C1 and C2 pivot synovial joint

68
Q

what type of joint does rheumatoid arthritis effect

A

synovial joints

69
Q

describe cervical spine involved in rheumatoid arthritis

A
  • dens is eroded
  • Neurological symptoms may be irreversible
  • Compression of vertebral arteries
  • Lower cervical - pannus may invade IV disc
70
Q

how many patients have cervical spine involved in rheumatoid arthritis

A

~90% of patients

Subluxations in about 32%

Atlantoaxial subluxation most common (~40%)

Locomotor 2 (30 decks)

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