Back & Vertebral Column - Clinical Flashcards
what is dowager’s hump?
exaggerated posterior curvature of the thoracic kyphosis - also called hyperkyphosis
how does disc degeneration contribute to the development of thoracic hyperkyphosis?
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
what spinal region is often affected by hyperlordosis?
lumbar spine region
why does hyperlordosis often resolve postpartum in women who developed it during pregnancy?
after childbirth, centre of gravity shifts back to normal & compensatory lumbar hyperlordosis is reduced
in scoliosis, why might secondary compensatory curves develop in regions of the spine not initially affected?
to maintain the centre of gravity over the feet - preserve balance despite primary curvature
why is osteoporosis a particularly significant cause of hyperkyphosis in older adults?
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
what spinal regions are often affected by scoliosis?
thoracic or lumbar
what anatomical and pathological differences distinguish hyperkyphosis from scoliosis?
hyperkyphosis - exaggerated posterior thoracic curvature due to wedge-shaped vertebrae from wedge fractures
scoliosis - exaggerated lateral spinal curvature & potential rotation of vertebral column
why are adolescents more prone to idiopathic scoliosis compared to other age groups?
growth spurts during adolescence may lead to imbalances in spinal development - underlying cause often idiopathic/unknown
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?
(adolescent idiopathic) scoliosis - cause unknown
why is maintaining a healthy abdominal muscle tone critical in preventing hyperlordosis?
strong abdominal muscles counteract excessive lumbar curvature - provide anterior support to the spine
what happens in a disc prolapse?
nucleus pulposus protrudes through a weakened/torn annular fibrosus - often during spinal flexion under load
why are lumbar disc prolapses most common between L4-S1?
- L4-S1 bears the most amount of weight
- thinner annular fibrosus
- less support from the posterior longitudinal ligament
symptoms caused by a lumbar disc prolapse?
lower back pain
paraesthesia/ tingling
muscle weakness
sciatica- pain radiating down the leg
what nerve root would be compressed in an L4/L5 disc prolapse? why?
L5 - lumbar spinal nerve roots descend down before exiting the spinal canal (spinal nerve exiting one level below the disc prolapse is compressed)
what is the difference between posterolateral and directly posterior lumbar disc prolapse?
posterolateral compresses nerve roots & causes localised pain and sciatica
directly posterior compresses the cauda equina - causes cauda equina syndrome
key symptoms of cauda equina syndrome?
severe neurological problems, loss of bladder control, permanent sensory & motor damage
what would a directly posterior lumbar disc prolapse lead to?
cauda equina syndrome - compression of the cauda equina nerve roots
where do cervical disc prolapses commonly occur? why?
C5-C7 - due to traumatic hyperflexion (e.g. car accidents)
symptoms associated with cervical disc prolapse?
upper limb pain
paraesthesia in arms/hands
muscle weakness in the upper limb
compare the symptoms of lumbar disc prolapse, cauda equina syndrome & cervical disc prolapse
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
which root is affected by a C5/C6 disc prolapse?
affects C6 nerve root
what is spinal stenosis? causes?
narrowing of the intervertebral foramen - leads to compression of the exiting spinal nerve roots
causes: age-related disc dehydration, osteoporosis
what is the role of osteophytes in the pathology of spinal stenosis?
osteophytes are laid down in response to joint degeneration - further narrow the intervertebral foramen, further compress nerve roots & contribute to symptoms
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?
S1 nerve root - nerve roots descend before exiting the spinal canal
A patient with cauda equina syndrome presents with bowel incontinence and numbness in the perineal area. What is the likely cause?
cause: directly posterior lumbar disc prolapse
how does disc degeneration contribute to spinal stenosis?
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