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Clin Med IV Exam 1 > Cervical and Lumbar Spine Injuries > Flashcards

Cervical and Lumbar Spine Injuries Flashcards

1
Q

How many vertebrae are in the human body

A

33

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2
Q

How many cervical vertebrae/nerves?

A 
V = 7
N= 8
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3
Q

How many thoracic vertebrae/nerves?

A

V= 12

N=12

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4
Q

How many lumbar vertebrae/nerves?

A 
V= 5
N= 5
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5
Q

How many sacral vertebrae/nerves?

A 
V= 5
N= 5
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6
Q

How many coccyx vertebrae?

A

4

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7
Q

Where does the spinal cord end?

A

L2

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8
Q

What are the cervical spine x-ray views?

A 
AP
Lateral
Odontoid --> C1-C2 clear space
Obliques
Fuchs
Swimmer's --> C6-C7
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9
Q

What are the lumbar spine x-ray views?

A

AP
Lateral
Coned-down (spot)–> L4 and L5
Obliques–> scotty dog

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10
Q

Which vertebrae does the odontoid fracture impact?

A

C2

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11
Q

What is an odontoid fracture?MOI?

A
  • aka pegs or dens fx
  • fx through odontoid process of C2
  • from flexion or extension w/ or w/o compression
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12
Q

Type I Odontoid Fx

A

fx upper part of odontoid peg
potentially unstable
rare

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13
Q

Type II Odontoid Fx

A

fx base of odontoid
unstable
high risk non-union

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14
Q

Type III Odontoid Fx

A

through odontoid & into lateral masses of C2

best prognosis of healing

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15
Q

Which type of odontoid fx has best prognosis of healing?

A

Type III

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16
Q

What are some associated injuries of odontoid fx?

A

Atlas (c1) fx (jefferson fx)
Transverse ligament rupture
Pharangeal injury

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17
Q

Imaging of choice for odontoid fx?

A

CT scan

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18
Q

Tx odontoid fx

A

Conservative
-halo brace 3mo (<50yo, <5mm displacement, reduction maintained)

Operative
-posterior atlantoaxial arthrodesis w/ wire & bone graft (pt >50yo, C1 intact)

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19
Q

Which vertebrae does cervical spondylosis most commonly impact?

A

C5-C6 > C6-C7

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20
Q

What is cervical spondylosis–DDD?

A
  • combo of degenerative disc dz (DDD) & osteophyte formation
  • age 40-50yo
  • may lead to radiculopathy

basically arthritis of the neck

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21
Q

Would you get an MRI for cervical spondylosis?

A

Only if intervention is being done (ESI, surgery)

If not, plain films only

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22
Q

When would surgery be indicated for cervical spondylosis?

A
  • Intractable pain
  • Progressive neurological deficit
  • Severe deltoid or wrist extensor weakness
  • Myelopathy
  • Discectomy of affected disc
  • Fusion of vertebrae affected
  • C5-C6 disc herniation w/ anterior cervical disc fusion
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23
Q

What are some conservative mgmt that could be done for cervical spondylosis?

A
  • Pain control
  • Oral steroids
  • PT
  • Light activity
  • Epidural steroid injections
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24
Q

What is a Herniated Nucleus Pulposis (HNP)?

A

disc herniation

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25
Q

HNP presentation

A
  • neck pain w/ RADIATING pain and/or numbness to arm
  • radicular pain w/ compression of neural structures
  • extremity numbness & weakness
  • appear stiff
  • pain worse w/ FLEX/EXTENSION of spine
  • myelopathy
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26
Q

What special test is positive for HNP?

A

Spurlings

-turn pt head to affected side while extending and applying downward pressure to top of pt’s head (axial load to head)

27
Q

What sort of imaging would you get for HNP?

A

MRI

CT myogram

28
Q

What vertebrae does hangman’s fx impact?

A

C2 (pars interarticularis)

29
Q

MOI of hangman’s fx

A
  • post traumatic neck pain after high-velocity hyperextension injury
  • high speed MVC
  • invovles pars interarticularis of C2
30
Q

What x-ray features indicate a hangman’s fx?

A
  • bilateral lamina & pedicle fx at C2

- assoc w/ anterolithesis of C2 on C3

31
Q

What spinal vertebrae does a jefferson fx impact?

A

C1

32
Q

MOI of Jefferson Fx

A
  • burst fx of C1
  • 3 part fracture w/ 2 part fx through anterior and posterior arches
  • axial loading along axis of c-spine w/ occipital condyles being driven into lateral masses of C1
  • ex. diving head 1st in to shallow water
  • vertebral artery injury
  • extra-cranial nerve injury
33
Q

What kind of view on x-ray would you want for jefferson fx?

A. AP
B. Oblique
C. Lateral
D. Odontoid

A

Odontoid! –gives clear visualization of C1-C2

  • will see displacement of lateral masses away from dens
  • distance >6mm –> suspect ligamentous injury
34
Q

What vertebrae are most commonly impacted for low back pain?

A

L4-L5

35
Q

If low back pain radiates past knee, what other injury might there be?

A

Disc problem; radicular sx

36
Q

What are Waddell’s Signs?

A

Exam findings that correlate w/ non-organic low back pain

  1. Tenderness–pain w/ light touch, nonanatomic, widespread deep pain
  2. Simulation–pain w/ light compression of skull or light twisting of pelvis
  3. Distraction–no pain w/ distracted straight leg raise test
  4. Regional–nonanatomic or inconsistent
  5. Overreaction
37
Q

Where would a HNP most commonly be seen in the lumbar spine?

A

L4-L5

L5-S1

38
Q

HNP L-spine presentation

A

-low back pain w/ or w/o radiation of pain and/or numbness
-pain w/ flexion or prolonged sitting; WANT TO STAND
-radicular pain
-varying lvl of pain
-pain worse w/ flex/extension of spine
+SLR on affected side

39
Q

What sx might be indicative of cauda equina syndrome?

A

Perianal numbness or bowel or bladder incontinence

40
Q

What sx might be indicative of Sciatica?

A

electric shock-like pain radiating down posterior aspect of leg; often below knee

41
Q

Which vertebrae is spondylolysis commonly located in the lumbar region?

A

L5

42
Q

Presentation of spondylolysis

A
  • can be asymptomatic
  • pain w/ extension and/or rotation of lumbar spine
  • common cause of low back pain in ADOLESCENTS
43
Q

MOI of spondylolysis

A

-defect in pars interarticularis portion of neural arch that connects superior & inferior articular facets
-caused by repeated microtrauma, resulting in stress fx
-high energy trauma w/ hyperextension of lumbar spine
(football tackling, sled, swimmers)

44
Q

What x-ray view do you want for spondylolysis and what will you see?

A

Oblique view
Want to look at scotty dog
Scotty dog has a collar (fracture)

45
Q

Spondylolysis Tx

A

Conservative –> activity limitation (6-8mo)
Bracing –> if sx persist in spite of activity modification
Surgery –> painful and not responding to orthosis after 6-8mo, if L5 pars defect, decompression required only for focal neuro deficit

46
Q

What vertebrae are most commonly impacted by Spondylolisthesis?

A

L5-S1

47
Q

MOI of spondylolisthesis

A
  • Displacement of vertebral body in relation to inferior vertebrae
  • anterolisthesis (anterior displacement)
  • retrolisthesis (posterior displacement)
  • Synonymous w/ anterolisthesis

D/t spondylolysis (pars interarticularis defect)

48
Q

Grading of Spondylolisthesis

A 
I <25% displacement
II 25-50%
III 50-75%
IV 75-100%
V Spondyloptosis
49
Q

Spinal stenosis presentation

A

-pain worsens w/ extension
-reproducible single or bilateral leg sx worse after walking several mins; relieved by sitting
-pain worse w/ back extension & relieved by leaning forward
-present w/ neurogenic claudication sx w/ walking
+SLR on affected side

50
Q

What pt population in spinal stenosis commonly seen in?

A

Elderly
>50yo
Hx of osteoarthritis

51
Q

What is the study of choice for spinal stenosis?

A

MRI

but get plain films 1st!

52
Q

Tx Spinal Stenosis?

A 
Pain control
Oral steroids
PT
Light activity
Facet or epidural injections
Surgery

Surgery > Conservative Tx
(Spinal decompression, nerve root decompression, spinal fusion, multi-lvl spinal fusion)

53
Q

Which vertebrae is a wedge fracture commonly seen in?

A

T12-L1

54
Q

MOI of wedge fx

A
  • Hyperflexion injuries to vertebral body resulting from axial loading
  • YOUNG PT
  • d/t insufficiency fx secondary to osteoperosis
55
Q

What is seen on imaging for wedge fx?

A

CT/MRI –> cortical disruption w/ impacting of antero-superior endplate; “wedge appearance”

Antero-inferior endplate & posterior vertebral body remain unaffected

56
Q

Tx wedge fx

A

TSLO brace

57
Q

Which vertebrae is a compression fx commonly seen in?

A

T7-8

T12-L1

58
Q

MOI of compression fx

A
  • Osteoperotic fx occurring after fall from standing height or less
  • OLDER PT
  • vertebral compression fx most common type
59
Q

Radiographic features of compression fx

A

loss of height in anterior, middle or posterior dimension of vertebral body >20%

60
Q

How can you tell if the compression fx is acute or chronic?

A

If acute, x-ray will show cortical breaking or impaction of trabeculae

Chronic fx will not see this

61
Q

Tx Compression Fx

A

Require tx is symptomatic

Non-surgical:

  • observation/TSLO brace
  • bisphosphonate

Surgical
-vertebroplasty

62
Q

17yo pt presents with lumbar pain w/ extension. The pt noticed the pain getting progressively worse after each football practice. On an oblique x-ray, a defect is seen in the pars interarticularis. What injury may this be?

A. Spondylosis
B. Spondylolysis
C. Spondylolithesis
D. Spinal Stenosis

A

B. Spondylolysis!

Key words;

  • Defect in parts interarticularis
  • 17yo (young pt)
  • pain w/ extension (hyperextension)
  • common in football players, sled, swimmers
63
Q

65yo pt is presenting with back pain that worsens w/ extension and when walking. Pain is relieved w/ sitting and leaning forward. Pt finds that when grocery shopping, they need to lean on the shopping cart to relieve the pain. +SLR on exam. What injury may this be?

A. Spondylolysis
B. Spondylolithesis
C. Spinal Stenosis
D. Compression Fx

A

Spinal Stenosis!

Key words:

  • older pt
  • pain w/ extension
  • pain relieved w/ sitting and learning forward
64
Q

70yo pt presents with low back pain. On x-ray, loss of height in anterior and posterior dimension of T7-T8 is noted along with cortical breaking of the trabeculae.
What injury may this be?

A. Herniated Nucleus Pulposis
B. Wedge Fracture
C. Spondylolisthesis
D. Compression Fx

A

Compression Fx!

Key words:
-loss of height of anterior, middle or posterior dimensions
-T7-T8 common
-cortical breaking of trabeculae 
-seen in elderly!!
Wedge fx --> young pt

Clin Med IV Exam 1 (9 decks)

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