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C21 Phase 1 > Case 14 - Spine > Flashcards

Case 14 - Spine Flashcards

1
Q

Indications for spinal x-ray

A

Trauma
Surgical planning
Alignment assessment
Post-op assessment

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2
Q

When is spinal x-ray not indicated

A

Chronic back pain
Cauda Equina
Spinal cord pathology

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3
Q

How do you assess a lateral c-spine x-ray

A 
A - adequacy/alignment
B - bone
C - cartilage
D - dens
E - extra-axial soft tissue
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4
Q

How do you assess AP view c-spine

A 
Alignment
Vertebral bodies
Lateral mass
Unconvertable joint
Spinous processes
Discs
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5
Q

What is an open mouth x-ray taken to view

A

C1-C2

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6
Q

Indications for spinal CT

A

trauma
malignancy
surgical planning
inflammation

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7
Q

Spinal MRI contraindications

A 
Ferrous metallic objects
Patient size
Claustrophobia
Pregnancy
Contrast allergy
Renal allergy
Pacemaker
Cochlear implants
Bullets
Aneurysm clips
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8
Q

What does the endoneurium surround

A

Neuron

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9
Q

What does the epineurium surround

A

Surrounds nerve fibre

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10
Q

What does the perineurium surround

A

Fascicles

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11
Q

How do non-depolarising agents work as anaesthetics

A

Competitive antagonists

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12
Q

How do non-depolarising agents work as anaesthetics

A

Competitive agonists

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13
Q

Causes of nerve injury

A 
Pressure
Laceration
Traction
Chemical
Thermal
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14
Q

What is neuropraxia

A

Loss of myelin

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15
Q

What is axonotmesis

A

Loss of axon + myelin

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16
Q

What is neurotmesis

A

Complete severance of nerve

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17
Q

What is Wallerian Degeneration

A

Nerve and myelin breakdown and start releasing proteases

Nerve cell bodies breakdown by apoptosis

Phagocytosis of waste

Nerves regrow towards broken axon

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18
Q

What is a neuroma

A

nerve bundle due to nerve growing back incorrectly

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19
Q

Why must motor nerves repair within 12-24 months

A

Muscle fibres will die without innervation

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20
Q

How does bone tissue attempt to return to homeostasis in hypocalcaemia

A

Parathyroid hormone secreted which increases calcium reabsorption and decreases phosphate

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21
Q

How does bone tissue attempt to return to homeostasis in hypercalcaemia

A

Calcitonin secreted causing osteoclast inhibition

Decreased Ca2+

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22
Q

What occurs in primary bone healing

A

No callus

Comparable to bone remodelling in non-fractured bone

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23
Q

What occurs in secondary bone healing

A

Inflammation
Repair
Remodelling

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24
Q

What is osteoporosis and how is it treated

A

More osteoclast than osteoblast
Decreased bone density
Treated with biphosphoriates

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25
Q

What is osteomalacia and how is it treated

A

Rickets

Vitamin D deficiency
Reduced calcium storage
Treat with vitamin D supplements

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26
Q

What is Paget’s disease

A

Increased turnover of bone tissue
Weaker bone tissue
Causes bone pain, pathological fractures
Increased cardiac output due to increased calcium

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27
Q

Which cancers usually develop bone metastasis

A 
Breast
Kidney
Thyroid
Prostate
Lung
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28
Q

Treatment goals in spinal trauma

A 
Protection of spinal cord
Detection of injury
Optimize conditions for rehab
Maintain/restore spinal alignment
Minimize loss of spinal mobility
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29
Q

Why is adrenaline given with anaesthetic and when is it not given

A

Adrenaline makes the anaesthetic last longer and reduces the likelihood of toxicity as the uptake is slower

Not given in peripheries as it can permanently constrict end-arteries causing ischaemia

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30
Q

What is spinal shock

A

Spinal shut-down in response to injury

Usually resolves in 24 hours

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31
Q

What type of curvature occurs in the lumbar and cervical spine

A

Lordosis

32
Q

What type of curvature occurs in the thoracic spine

A

Kyphosis

33
Q

Acute consequences of spinal cord injury

A

Paralysis
Inadequate ventilation
Abdomen compromised
Compartment syndrome

34
Q

What two features make a spinal mass more likely to be cancerous

A

Anterior spine

Elderly patient

35
Q

Presentation of bone cancer

A

Unrelenting pain
Painful at night
Neurological compression causing deficits

36
Q

Causes of spinal cord compression

A 
Bone
Tumour mass
Direct pressure
Kyphosis
Pressure from intradural metastasis
37
Q

Pathophysiology of bone metastasis

A

Gets into bloodstream or lymph (Azygous venous system - thoracic spine mets, or pelvic venous plexus - lumbar mets)

Direct infiltration

38
Q

Red flags for spinal injury

A 
Weight loss
Anorexia
Fatigue
Smoking
Coughing/passing blood

Spinal MRI required in 24 hours

39
Q

Indications for spinal tumour surgery

A 
Progressive/impending neurological deficit
Paralysed less than 24 hours
Spinal instability/collapse
Unbearable pain
Growing tumour resistant to treatment
Deterioration during radiotherapy
40
Q

What is the difference between a primary bone tumour and a primary tumour in bone

A

Primary bone tumour - tumour arises from bone tissue

Primary tumour in bone - tumour within the boundary of bone, not of bone tissue

41
Q

How do spinal infections spread

A

Haematogenous
Contiguous
Direct implantation

42
Q

Groups at risk of spinal infections

A 
D - diabetics/drug users
I - immunosuppressed/immigrant
S - steroids/surgery
G - Genitourinary
R - renal failure/rheumatoid
A - adolescents
C - cardiac issues
E - elderly
43
Q

Treatment for spinal infections

A

Prolonged course of antibiotics
Rest
Brace to prevent deformity

44
Q

Complications of spinal infections

A

Death
Sepsis
Pain
Deformity

45
Q

Causes of lower back pain in children

A 
Disc prolapse
Abuse
Spondylolysis
Infections
Scoliosis
46
Q

What is scoliosis

A

Abnormal curvature of spine in the coronal plane

47
Q

What is kyphosis

A

Abnormal curvature of spine in the sagittal plane

48
Q

What is spondylolysis

A

Spondylolysis is a bony defect or fracture within the pars interarticularis of the vertebral arch in the spinal column. The vast majority of spondylolysis occur in the lumbar vertebrae, however it can also be seen in cervical vertebrae

49
Q

What is spondylolisthesis

A

Spondylolisthesis is where one of the bones in your spine, known as a vertebra, slips out of position. It’s most common in the lower back, but it can also happen in the mid to upper back or at the top of the spine at the back of your neck

50
Q

What is spinal stenosis

A

Narrowing of the spinal canal

51
Q

What is spinal claudication

A

Spinal claudication refers to symptoms caused by nerve compression in the spinal canal brought on during strain. The symptoms are felt as lower limb pain, numbness or fatigue, but back pain that becomes worse under stress is also common.

52
Q

What do the extrinsic muscles of the back do

A

Act on upper limb

53
Q

What do the intrinsic muscles of the back do

A

Act on vertebral column

54
Q

Features found on all vertebrae

A 
Vertebral body
Spinous process
Transverse process
Laminae
Pedicle
Vertebral foramen
55
Q

Additional feature of vertebrae in c spine

A

Foramen transversarium

56
Q

Additional feature of vertebrae in thoracic spine

A

Costal facets

57
Q

Additional feature of vertebrae in lumbar spine

A

Foramen transversarium

Costal facets

58
Q

Indications for laminectomy

A

Tumours
Disc prolapse
Fractured vertebrae

59
Q

Ligaments of the spine

A 
Anterior longitudinal
Posterior longitudinal
Ligamentum flavum
Interspinal ligament
Supraspinal ligament
60
Q

What is the blood supply of C1-C6

A

Anterior and posterior spinal arteries

61
Q

What is the blood supply of C7-T1

A

Costocervical trunk

62
Q

What is the blood supply of T2-T9

A

Posterior intercostal artery

63
Q

What is the blood supply of T8-conus medularis

A

Largest segmental artery

Lumbar and sacral arteries

64
Q

What is a spinal disc made of

A

Nucleus pulposus - jelly like central structure

Annulus fibrosis - fibrous outer layer

65
Q

How many cervical, thoracic and lumbar vertebrae are there

A

cervical - 7
thoracic - 12
Lumbar - 5

66
Q

What is ankylosing spondylitis

A

this causes pain and stiffness that’s usually worse in the morning and improves with movement

67
Q

Spinal red flags

A
  • Severe or progressive bilateral neurological deficit of the legs, such as major motor weakness with knee extension, ankle eversion, or foot dorsiflexion.
  • Recent-onset urinary retention (caused by bladder distension because the sensation of fullness is lost) and/or urinary incontinence (caused by loss of sensation when passing urine).
  • Recent-onset faecal incontinence (due to loss of sensation of rectal fullness).
  • Perianal or perineal sensory loss (saddle anaesthesia or paraesthesia).
  • Unexpected laxity of the anal sphincter.
  • Being under 20 or over 50
  • Unexplained weight loss
  • Fever
  • Tuberculosis, or recent urinary tract infection
68
Q

Spinal yellow flags

A
  • Low mood
  • Depression/anxiety
  • Occupation
  • Family network
69
Q

Short term side effects of opioids

A 
•	Drowsy
•	Constipated
•	Nauseated
•	More likely to fall and break a bone
Respiratory depression
70
Q

What is radicular pain

A

Commonly described as electric shock-like or searing, radicular pain follows the path of the spinal nerve as it exits the spinal canal. This type of pain is caused by compression and/or inflammation to a spinal nerve root. In the lower back (lumbar spine), radicular pain may travel into the leg. Other terms for radicular pain are sciatica or radiculopathy (when accompanied by weakness and/or numbness). It can be caused by conditions such as a herniated disc, spinal stenosis, or spondylolisthesis.

71
Q

What is referred pain

A

Often characterized as dull and achy, referred pain tends to move around and vary in intensity. As an example in the lower back, degenerative disc disease may cause referred pain to the hips and posterior thighs

72
Q

What is axial pain

A

Also called mechanical pain, axial pain is confined to one spot or region. It may be described a number of ways, such as sharp or dull, comes and goes, constant, or throbbing. A muscle strain is a common cause of axial back pain as are facet joints and annular tears in discs.

73
Q

Risk factors for back pain

A
  • Age. Back pain is more common as you get older, starting around age 30 or 40.
  • Lack of exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
  • Excess weight. Excess body weight puts extra stress on your back.
  • Diseases. Some types of arthritis and cancer can contribute to back pain.
  • Improper lifting. Using your back instead of your legs can lead to back pain.
  • Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
  • Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.
74
Q

Symptoms of a slipped disc

A
  • lower back pain
  • numbness or tingling in your shoulders, back, arms, hands, legs or feet
  • neck pain
  • problems bending or straightening your back
  • muscle weakness
  • pain in the buttocks, hips or legs if the disc is pressing on the sciatic nerve
75
Q

What is the sciatic nerve formed of

A

The sciatic nerve is formed from the L4 to S3 segments of the sacral plexus

76
Q

Symptoms of cauda equina

A
  • sciatica on both sides
  • weakness or numbness in both legs that is severe or getting worse
  • numbness around or under your genitals, or around your anus
  • finding it hard to start peeing, can’t pee or can’t control when you pee – and this isn’t normal for you
  • you don’t notice when you need to poo or can’t control when you poo – and this isn’t normal for you
  • Cauda equina syndrome requires emergency hospital admission and emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence.

C21 Phase 1 (45 decks)

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