Case 14 - Spine Flashcards

Question

What is osteomalacia and how is it treated

Answer 1

Rickets Vitamin D deficiency Reduced calcium storage Treat with vitamin D supplements

Answer 2

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

Answer 3

``` Breast Kidney Thyroid Prostate Lung ```

Answer 4

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

Answer 5

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

Answer 6

Spinal shut-down in response to injury | Usually resolves in 24 hours

Answer 7

Paralysis Inadequate ventilation Abdomen compromised Compartment syndrome

Answer 8

Anterior spine | Elderly patient

Answer 9

Unrelenting pain Painful at night Neurological compression causing deficits

Answer 10

``` Bone Tumour mass Direct pressure Kyphosis Pressure from intradural metastasis ```

Answer 11

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

Answer 12

``` Weight loss Anorexia Fatigue Smoking Coughing/passing blood ``` Spinal MRI required in 24 hours

Answer 13

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

Answer 14

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

Answer 15

Haematogenous Contiguous Direct implantation

Answer 16

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

Answer 17

Prolonged course of antibiotics Rest Brace to prevent deformity

Answer 18

Death Sepsis Pain Deformity

Answer 19

``` Disc prolapse Abuse Spondylolysis Infections Scoliosis ```

Answer 20

Abnormal curvature of spine in the coronal plane

Answer 21

Abnormal curvature of spine in the sagittal plane

Answer 22

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

Answer 23

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

Answer 24

Narrowing of the spinal canal

Answer 25

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.

Answer 26

Act on upper limb

Answer 27

Act on vertebral column

Answer 28

``` Vertebral body Spinous process Transverse process Laminae Pedicle Vertebral foramen ```

Answer 29

Foramen transversarium

Answer 30

Costal facets

Answer 31

Foramen transversarium | Costal facets

Answer 32

Tumours Disc prolapse Fractured vertebrae

Answer 33

``` Anterior longitudinal Posterior longitudinal Ligamentum flavum Interspinal ligament Supraspinal ligament ```

Answer 34

Anterior and posterior spinal arteries

Answer 35

Costocervical trunk

Answer 36

Posterior intercostal artery

Answer 37

Largest segmental artery | Lumbar and sacral arteries

Answer 38

Nucleus pulposus - jelly like central structure | Annulus fibrosis - fibrous outer layer

Answer 39

cervical - 7 thoracic - 12 Lumbar - 5

Answer 40

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

Answer 41

* 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

Answer 42

* Low mood * Depression/anxiety * Occupation * Family network

Answer 43

``` • Drowsy • Constipated • Nauseated • More likely to fall and break a bone Respiratory depression ```

Answer 44

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.

Answer 45

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

Answer 46

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.

Answer 47

* 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.

Answer 48

* 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

Answer 49

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

Answer 50

* 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.