Back & Vertebral Column - Clinical Flashcards

1
Q

what is dowager’s hump?

A

exaggerated posterior curvature of the thoracic kyphosis - also called hyperkyphosis

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2
Q

how does disc degeneration contribute to the development of thoracic hyperkyphosis?

A

disc degeneration leads to uneven load distribution across the vertebrae - especially the anterior region

leads to reduced bone mineral density & weakening of the anterior vertebral body - causes anterior wedge fractures

wedge-shaped vertebrae stacked on top of each other = thoracic hyperkyphosis

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3
Q

what spinal region is often affected by hyperlordosis?

A

lumbar spine region

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4
Q

why does hyperlordosis often resolve postpartum in women who developed it during pregnancy?

A

after childbirth, centre of gravity shifts back to normal & compensatory lumbar hyperlordosis is reduced

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5
Q

in scoliosis, why might secondary compensatory curves develop in regions of the spine not initially affected?

A

to maintain the centre of gravity over the feet - preserve balance despite primary curvature

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6
Q

why is osteoporosis a particularly significant cause of hyperkyphosis in older adults?

A

osteoporosis reduces bone mineral density - vertebrae are more prone to anterior vertebral fractures, creating wedge-shaped vertebrae

these wedge-shaped vertebrae stacked on top of each other = exaggerated posterior curvature/ hyperkyphosis

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7
Q

what spinal regions are often affected by scoliosis?

A

thoracic or lumbar

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8
Q

what anatomical and pathological differences distinguish hyperkyphosis from scoliosis?

A

hyperkyphosis - exaggerated posterior thoracic curvature due to wedge-shaped vertebrae from wedge fractures

scoliosis - exaggerated lateral spinal curvature & potential rotation of vertebral column

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9
Q

why are adolescents more prone to idiopathic scoliosis compared to other age groups?

A

growth spurts during adolescence may lead to imbalances in spinal development - underlying cause often idiopathic/unknown

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10
Q

during a routine check-up of a 14-year-old girl, an S-shaped lateral deviation of the spine is observed. What is the most likely diagnosis and its cause?

A

(adolescent idiopathic) scoliosis - cause unknown

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11
Q

why is maintaining a healthy abdominal muscle tone critical in preventing hyperlordosis?

A

strong abdominal muscles counteract excessive lumbar curvature - provide anterior support to the spine

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12
Q

what happens in a disc prolapse?

A

nucleus pulposus protrudes through a weakened/torn annular fibrosus - often during spinal flexion under load

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13
Q

why are lumbar disc prolapses most common between L4-S1?

A
  1. L4-S1 bears the most amount of weight
  2. thinner annular fibrosus
  3. less support from the posterior longitudinal ligament
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14
Q

symptoms caused by a lumbar disc prolapse?

A

lower back pain
paraesthesia/ tingling
muscle weakness
sciatica- pain radiating down the leg

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15
Q

what nerve root would be compressed in an L4/L5 disc prolapse? why?

A

L5 - lumbar spinal nerve roots descend down before exiting the spinal canal (spinal nerve exiting one level below the disc prolapse is compressed)

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16
Q

what is the difference between posterolateral and directly posterior lumbar disc prolapse?

A

posterolateral compresses nerve roots & causes localised pain and sciatica

directly posterior compresses the cauda equina - causes cauda equina syndrome

17
Q

key symptoms of cauda equina syndrome?

A

severe neurological problems, loss of bladder control, permanent sensory & motor damage

18
Q

what would a directly posterior lumbar disc prolapse lead to?

A

cauda equina syndrome - compression of the cauda equina nerve roots

19
Q

where do cervical disc prolapses commonly occur? why?

A

C5-C7 - due to traumatic hyperflexion (e.g. car accidents)

20
Q

symptoms associated with cervical disc prolapse?

A

upper limb pain
paraesthesia in arms/hands
muscle weakness in the upper limb

21
Q

compare the symptoms of lumbar disc prolapse, cauda equina syndrome & cervical disc prolapse

A

lumbar disc prolapse - lower limb paraesthesia, lower back pain, lower limb muscle weakness & sciatica

cervical disc prolapse - upper limb paraesthesia, pain & muscle weakness

cauda equina syndrome - severe neurological symptoms, loss of bladder control & permanent sensory/ motor damage

22
Q

which root is affected by a C5/C6 disc prolapse?

A

affects C6 nerve root

23
Q

what is spinal stenosis? causes?

A

narrowing of the intervertebral foramen - leads to compression of the exiting spinal nerve roots

causes: age-related disc dehydration, osteoporosis

24
Q

what is the role of osteophytes in the pathology of spinal stenosis?

A

osteophytes are laid down in response to joint degeneration - further narrow the intervertebral foramen, further compress nerve roots & contribute to symptoms

25
Q

A patient has lower back pain, muscle weakness, and tingling in the leg. An MRI shows a disc prolapse at L5/S1. Which nerve root is likely affected, and why?

A

S1 nerve root - nerve roots descend before exiting the spinal canal

26
Q

A patient with cauda equina syndrome presents with bowel incontinence and numbness in the perineal area. What is the likely cause?

A

cause: directly posterior lumbar disc prolapse

27
Q

how does disc degeneration contribute to spinal stenosis?

A

disc dehydration causes uneven load distribution across vertebral bodies

load shifts posteriorly to facet joints & posterior region of vertebral body - causes joint degeneration –> promotes osteophyte formation which further narrows the intervertebral foramen & compresses nerve roots