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OITE > Cervical and Thoracic Spine > Flashcards

Cervical and Thoracic Spine Flashcards

1
Q
  1. Where do you most commonly get degeneration in the spine?
  2. You also commonly get what here?
A
  1. Uncovertebreal region in which degeneration occurs.
  2. This is where you get the osteophytes.
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2
Q

What are the lines pointing to?

A
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3
Q
  1. Nerve root exits above the pedicle with what number in the cervical spine?
  2. C8 root exits above the ____ pedicle?
  3. Nerve root exits below the pedicle with what number in the thoracic and lumbar spine?
A
  1. the same
  2. T1
  3. the same
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4
Q

Do we become more kyphotic or lordotic as we age?

A

Life is a kyphosing event. We lose lordosis.

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5
Q

Axial Pain Generator

Pain fibers located where?

5

A
  1. Annulus
  2. Joint – uncovertebral, facet
  3. Ligaments
  4. Periosteum
  5. Muscle/Fascia
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6
Q

Radicular Pain Generator

  1. Nerve root mediated how? 2
  2. Quality? 3
  3. Associated with what? 2
A

1.

  • Compression
  • Chemical/ inflammatory

2.

  • Dermatomal sharp pain,
  • numbness,
  • parasthesia

3.

  • weakness,
  • hyporeflexia
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7
Q
  1. What is Referred Pain?
  2. Cause?
  3. Quality?
  4. Associated with?
A
  1. Axial or external pain localized to a site remote from location of nocioceptors
  2. Probable activation of contiguous cerebral cortex
  3. Dull, achy, nondermatomal pain
  4. Associated with axial pain
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8
Q

What areas are the following nerve roots associated with:

  1. C2-C3?
  2. C3-4?
  3. C 4-5?
  4. C 5-6?
  5. C6-7?
A
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9
Q

Pathophysiology/ Normal Aging

  1. Normal aging results in a degenerative cascade that may result in a what?
  2. what triggers the degenerative cascade?
A
  1. pathologic state
  2. Intervertebral disc biologic aging
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10
Q

Intervertebral Disc

  1. _______ is metabolically active, hydrostatic proteoglycans, shock absorber effect?
  2. Nucleus is vascular in childhood via what?
  3. Beginning at adolescence nutrition is via _______ only
  4. ___________ degenerate, loose H2O content(dehydrate)
  5. Alters biomechanical properties of the disc and the motion segment – loss of what?
A
  1. Nucleus
  2. annular arteries
  3. diffusion
  4. Proteoglycans
  5. shock absorber
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11
Q
  1. What happens to the quality of the disc as you age? 2
  2. There is also increased strain on the annulus? 3
A

1.

  • Disc dehydration,
  • disc narrowing
    2. Increase strain on annulus
  • Diffuse bulging annulus
  • Annulur tears
  • Focal disc herniation
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12
Q

Normal Aging

  1. Stress transfer to where? 2
  2. What does this lead to? 2
A

1.

  • uncovertebral
  • facet joints

2.

  • Arthrosis (bone spurs), stiffness
  • Instability
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13
Q

Pathological States

DDx for Axial neck pain? 4

A
  1. Facet , uncovertebral joint arthritis
  2. Loss of lordosis resulting in muscular pain
  3. Instability
  4. Discogenic pain
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14
Q
  1. What is radiculopathy?
  2. Examples? 2
  3. What is myelopathy?
  4. Examples? 3
A
  1. Radiculopathy – pressure related nerve root disfunction (peripheral nerves)

2.

  • Disc herniation
  • Uncovertebral, facet joint spurs
    3. Myelopathy – pressure related spinal cord disfunction (cord)

4.

  • Large disc herniation
  • Spurs
  • Congenitally narrow canal
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15
Q

Which nerve roots are involved with the following Disc Space levels:

A
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16
Q

In lumbar spine the nerve part that is injured is which part of the nerve?

A

transverse portion/nerve that’s getting ready to exit

17
Q
  1. For palpation on PE what bones do you want to make sure to palpate for the spine? 4
  2. Muscles? 4
A
  1. Bones –
    - occiput,
    - spinous processes,
    - scapula,
    - ribs
  2. Muslces-
    - paraspinal,
    - trapezius,
    - scapular elevators,
    - sternocleidomastoid
18
Q

Neurologic Exam

Motor Levels

What do the following do:

C5? 2

C6? 2

C7? 1

C8? 1

T1? 1

A

C5: deltoid shoulder, external rotators

C6: wrist extension, pronator teres

C7: triceps

C8: finger flexors

T1: interosseous

19
Q

Neuro Exam

Describe the 5 levels of the Motor Scale

A

Motor Scale

5/5 normal

4/5 weak

3/5 > gravity- can bring arm up against gravity

2/5 less than gravity- can move side ways but not up and down

1/5 trace- twicth

0/5 absent

Some people may lose a lot more strength without noticing. Weakness of the phyiscal exam

20
Q

For sensation on the spinal exam what should we test? 4

A
  1. Light touch
  2. Pin prick
  3. Vibration
  4. Temperature
21
Q

DTR

Levels

  1. C5?
  2. C6?
  3. C7?
  4. If they are Hyporeflexic think?
  5. If they are Hyperreflexic think?
A
  1. biceps
  2. brachioradialis
  3. triceps
  4. – root lesion- radiculopathy
  5. – cord lesion- myopathy
22
Q

Describe the C5 motor function, reflex and sensation

23
Q

Describe the C6 motor function, reflex and sensation

24
Q

Describe the C7 motor function, reflex and sensation

25
Q

Describe the C8 motor function, reflex and sensation

26
Q

Describe the T1 motor function, reflex and sensation

27
Q

Physical Exam

Long tract signs? 5

A
  1. Hyperreflexia
  2. Clonus
  3. Spasticity, increase tone
  4. Gait, coordination, rectal tone
  5. Hoffman(UE), Babinski(LE)

Hoffman is an abnormal reflex- may have a myopathy

28
Q

Physical Exam

Provacative Tests

3

A
  1. Spurlings – ipsilateral lateral bending + extension
  2. Reverse Spurlings – contralateral bending
  3. L’Hermitte
29
Q

PE: Associated Systems? 6

A
  1. Vascular
  2. Cranial nerves
  3. Shoulder and other UE joints
  4. Peripheral nerves
  5. Lymphatic
  6. Pulmonary
30
Q

What does the adson test indicate?

31
Q

Axial DD:

  1. Spinal? 3
  2. Soft Tissue? 2
  3. Tumor/Infection? 2
  4. Inflammatory? 1
A
  1. Spinal
    - Bone: fracture, instability
    - Disc: degeneration, central HNP
    - Joint: arthritis, instability
  2. Soft tissue: sprain, fibromyalgia
  3. Tumor/Infection: primary, metastatic
  4. Inflammatory: R.A.
32
Q

Axial Diagnostics Tests:

  1. Spinal
    - bone? 2
    - disc? 3
    - Joints? 3
  2. Soft tissue? 2
  3. Tumor infection? 3
  4. Inflammatory? 1
A
  1. Spinal
    - Bone: x-ray, bone scan
    - Disc: MRI, myelo/CT, discography
    - Joints: bone scan, F/E x-rays, facet injection
  2. Soft Tissues: MRI, diagnosis of exclusion
  3. Tumor/Infection: labs, bone scan, MRI
  4. Inflammatory: labs
33
Q

Tx Basics:

  1. Non-operative? 6
  2. Operative?
A
  1. Non - operative
    - PT,
    - NSAID,
    - narcotics,
    - MR,
    - education, activity modification, reassurance
    - Pain management: injection, RFA,
  2. Operative

Fusion

34
Q

Differential Diagnosis

Extremity pain:

  1. Nerve Root (radiculopathy)? 6
  2. Spinal Cord (myelopathy)? 9
  3. Peripheral Nerves? 4
  4. Joints? 3
A

1.

  • HNP,
  • spondylosis,
  • instability,
  • tumor,
  • infection,
  • fracture

2.

  • HNP,
  • stenosis,
  • instability,
  • cord lesions,
  • medical,
  • trauma,
  • tumor,
  • syrinx,
  • CNS

3.

  • entrapment,
  • neuropathy,
  • plexopathy,
  • RSD

4.

  • rotator cuff,
  • tennis
  • elbow
35
Q

Dx tests

Extremity

  1. Nerve root? 4
  2. Spinal cord? 3
  3. Peripheral nerves? 1
  4. Joints? 1
A
  1. Nerve Root:
    - MRI,
    - myelo/CT,
    - EMG,
    - SNRB
  2. Spinal Cord:
    - MRI,
    - myelo/CT,
    - SSEP
  3. Peripheral Nerves:
    - NCV
  4. Joints:
    - orthopedic evaluation
36
Q

Tx Basics

Extremity

  1. Nonoperative? 6
  2. Operative? 1
A
  1. Non - operative
    - NSAID,
    - narcotics,
    - steroid injection,
    - traction,
    - collar
    - Myelopathy: more urgent W/U
  2. Operative
    - Decompression +/- fusion

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