cervical and lumbar spine (adult) Flashcards
what causes cervical spine instability
down’s syndrome
rheumatoid arthritis
what does cervical spine instability cause in Down’s
there is a risk of developing atlanto-axial instability with subluxation potentially causing spinal cord compression
what is the treatment of cervical spine instability in down’s
minor instability = no high impact sports
major instability = surgical stabilisation
what does cervical spine instability cause in rheumatoid arthritis
atlanto-axial subluxation due to destruction of the synovial joint between atlas and dens, and rupture of the transverse ligament
what is the treatment of cervical spine instability in rheumatoid arthritis
minor = collar to prevent flexion major = surgical fusion
what are the symptoms of cervical spondylosis
slow onset stiffness
neck pain which can radiate to shoulder
what is the treatment of cervical spondylosis
physio
analgesics
what nerves are usually involved in cervical disc prolapse
lower root nerve (e.g. if C6/C7 disc is affected then it will be C7)
what can a large central cervical disc prolapse cause
myelopathy with upper motor neurone symptoms
what are the symptoms of cervical disc prolapse
shooting neuralgic pain with dermatomal distribution
weakness
loss of reflex
what should be done before any treatment in cervical disc prolapse
MRI which should match clinical findings
what is the treatment of cervical disc prolapse
asymptomatic = leave alone symptomatic = surgery
what is osteoporotic crush fracture, in what condition do they occur
spontaneous crush fracture of the vertebral body which occurs in severe osteoporosis
what are the symptoms of osteoporotic crush fracture
acute back pain
kyphosis
chronic pain if spinal mechanisms altered
what is the treatment of osteoporotic crush fracture
conservative
what is the treatment of chronic pain in osteoporotic crush fracture
balloon vertebroplasty
what is caudal equina syndrome
a large central disc prolapse which compresses all nerve roots of the caudal equina
what nerve roots are effected in caudal equine syndrome
sacral nerve roots
mainly S4/S5
what are nerves S4 and S5 involved in
defecation and urination
what are the symptoms of caudal equine syndrome
bilateral leg pain
numbness (saddle)
altered urinary function
faecal incontinence and constipation
what investigations are done in caudal equine syndrome
PR exam
urgent MRI
what is the treatment of caudal equine syndrome
urgent surgery
what is spinal stenosis
spondylosis + a bulging disc/bulging ligamentum flavum/osteophytosis which decreased the space held by the caudal equina
what are the symptoms of spinal stenosis
pain on walking (burning not cramps. worse uphill)
claudication distance is inconsistence
persevered pedal pulses
what is the cause of bony nerve root entrapment
OA of the facet joints which results in osteophytes impinging on nerve roots
what is the treatment of bony nerve root entrapment
surgical decompression + trimming of the impugning osteophytes
what is radiculopathy
pinched nerve
what is the cause of sciatica and radiculopathy
disc tear which allows the nucleus pulposis to herniate/prolapse through the tear and impinge on a nerve
what are the symptoms of sciatica and radiculopathy
pain (burning/tingling) beyond knee
altered sensation
reduced reflexes
what is the treatment of sciatica and radiculopathy
analgesia (gabapentin)
maintain mobility
physio
what are the symptoms of L3/4 prolapse
pain to medial ankle
reduced knee jerk
loss of quadratic power
what are the symptoms of L4/5 prolapse
pain to dorsum of foot
reduced power of extensor halves longs and tibias anterior
what are the symptoms of L5/S1 prolapse
pain to sole of foot
reduced power plantar flexion
reduced ankle jerk
what causes discogenic back pain
an acute tear in the outer annulus fibrosis of the invertebral disc
heavy lifting
what are the symptoms of discogenic back pain
severe pain with acute onset
pain worse on coughing
what is the treatment of discogenic back pain
painkillers
physio
what is mechanical back pain
recurrent, relapsing and remitting back pain with no neurological symptoms
what are the causes of mechanical back pain
obesity poor posture lack of activity degenerative disc prolapse facet joint OA spondylosis
what is spondylosis
invertebral discs lose water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA
what are the symptoms of mechanical back pain
pain is worse with movement and better on rest
no red flags
what is the treatment of mechanical back pain
painkillers
physio
