Clin Med- Low Back I Flashcards
Spinal malignancy is multiple _________
myeloma
Spinal malignancy is a primary malignant tumor in the _______ ________
This is typically in ________ individuals
bone marrow; older
Spinal malignancy:
________ metastases is secondary and is the _____ MOST common serious spinal pathology
Spinal; 2nd
What are the most common tumors of the spine?
Spinal Mestastases
Spinal metastases is MOST often from __________, __________, prostate, _______, GI, and thyroid
breast; lung; kidney
__________ is the 3rd MOST common area of metastasis, behind lung and liver
bone
With bone metastasis, the ______ ______ is the MOST common structure involved and typically in the _______ portion… this leads to wedging (disc rarely involved)
vertebral body; anterior
With spinal malignancy, the _________ region is the MOST area involved (70%)
thoracic
With spinal malignancy, _____% created cord compression or myelopathy
20
With spinal malignancy risk factor:
97% of spinal tumors are the result of metastases, this means that _______ of _______ is the MOST useful indicator
PMH; cancer
With spinal malignancy, _______ bone is replaced by _______
healthy; tumor
Which imaging is the GOLD standard for spinal malignancy?
MRI
What should you mainly ask in the subjective self/family Hx for ANY patient?
Hx of cancer
Cancer S&S the pain is _______ and ________
local; referred
With cancer, it worsens as the tumor grows and enroaches on other ________ with more ________
tissue; inflammation
With cancer S&S, if someone wakes up at the same time every night it is due to what usually?
metabolic activity
As cancer worsens, it is often invariable with ______ or movement and may become constant
position
Additional cancer S&S?
N&V
Loss of appetite
unexplained weight loss ≥ 5-10% over a 3-6 month period
fever, chills, night sweats
swollen, non-tender lymph nodes
unusual malaise and fatigue
secondary infections (lowered immunity)
What S&S would likely be present due to the involvement of vertebral body? NOT spinal cord yet….
_____ segmental
______ S&S
_____ P!
______reflexive
multi
UMN
Spinal
Hyper
With spinal malignancy, the MOST common initial symptom is?
spinal P!
With spinal malignancy, there is a ________ and ______ P! that may become progressive and constant
unfamiliar; severe
With spinal maligancy, there could be possible bony alterations including ___ and subsequent ______ instability
fxs; joint
With spinal malignancy, thay be unable to lie ______ due to P!
flat
With spinal malignancy, there will most likely be __________ P! with scan and biomechanical exam components that stress the ______ ________ and lumabr will possibly be +
mechanical; verterbal body
With spinal malignancy, there will be a _______ referral to MD unless cord S&S you would want to immobilize for _________ referral
urgent; emergency
_______ myelopathy is slow, gradual, and often progressive compression of the cord
Lumbar
What level does the spinal cord end?
L1-L2
The ______ region is the 2nd MOST common area of spine for compression
lumbar
Lumbar myelopathy is ______ due to trauma
NOT
What is lumbar myelopathy MOST commonly due to _________ spinal changes
degenerative
With lumbar myelopathy and degenerative spinal changes, it has:
Lax and buckling _______ ________
Age-related joint _________ with enlarging and enroaching ______ bone aka stenosis
Age-related _______ disease with _________
______ ______ collapse
Pathalgical __________ such as spondylolithesis
Ligamentum Flavum
disease; athritic
disc; herniations
vertebral body
instability
With lumbar myelopathy and malignancy, 20% of the time only well validated RED flag being hx of _________
cancer
With lumbar myelopathy, there is rare ______ disc herniation
disc
With observation of lumbar myelopathy, it is NOT _____ and NOT likely to ______
acute; splint
With lumbar myelopathy and A/PROM- there will be extreme ______ pain with _________ reproduction with scan and biomechanical exam
spinal; mechanical
With lumbar myelopathy, A/PROM- there will be extreme spinal pain with mechanical reproduction with scan and biomechanical exam, possibly for:
_____-_______ changes
_______ body
Instability
age-related
vertebral
With lumbar myelopathy, _____ stress tests will be positive possibly or ______ symptoms
PA; neuro
With lumbar myelopathy:
DTRs ______reflexive
_______ myotomes
_______ bowel and bladder
Clonus and Babinski ________
Dural mobility _____
Superficial reflexes _______active
hyper
fatiguing
spastic/retentive
+
-
hypo
With lumbar myelopathy, it is a. _______ referral
urgent
With lumbar myelopathy, there will be _____ segmental numbness and ______/paralysis of lower extremities and trunk below level of injury likely leading to impaired balance
multi; weakness
________ _________ syndrome is compression on some degree of the 20 spinal nn. that originate from the end of spinal cord or conus medularris in the vertebral canal
Cauda Equina
Cauda Equina syndrome is ______ or _____ and below what segment?
acute; chronic; L1-L2
Cauda Equina syndrome is ____ with 2% of lumbar age-related ____ changes
rare; disc
Cauda Equina syndrome is PRIMARILY due to ____ to ______ lumbar age-related disc changes
mid; lower
Cauda Equina syndrome is SECONDARILY due to other _______ spinal changes and ________
degenerative; malignancy
What are the risk factors for Cauda Equina syndrome?
Mid to lower lumbar
- _______ IDD, central> postlat IDD
- ________ stenosis
- surgery
- < ______ years
- Obesity
Persistent
central
50
Cauda Equina syndrome clinical manifestations S&S Hx including (LMN):
____ _____ P!
Bowel and blader _________
_________ dysfunction
Possible _____ S&S if malignancy contributing
Low back
incontinence
sexual
cancer
With Cauda Equina syndrome, limited and worse with _____ and better with ______ activities
EXT; FLX
With Cauda Equina syndrome, there are progressive or even alternating LE/_______ findings due to movement of ______ ______
patchy; spinal nerves
With Cauda Equina syndrome, there are paresthesia’s and decreased sensation in multiple dermatomes in what areas?
saddle or groin area
With Cauda Equina syndrome, there a multiple ______ weaknesses and _____ abnormality
myotomial; gait
With Cauda Equina syndrome, there are ______active DTRs
hypo
Is dural moblity + for cauda equina syndrome?
yes
What kind of referral is Cauda Equina syndrome?
emergency
What imaging is the GOLD standard for Cauda Equina syndrome?
MRI
______ __________ is the infectious disease of spinal structures
spinal infections
Osteomyelitis is associated with _______ infections nad affects the ______
spinal; bone
Discitis means what?
disc infection
Spinal infections is uncommon in ________ countires but resurgence with longevity and IV drug use
wealthier
Discitis is more common in ______ spine
lumbar
Spinal infections etiology:
Primarily from _____ _______ bacteria
What is the secondary?
air born
staph bacteria
What are risk factors for spinal infection?:
________ suppression
_________ particularly of the spine and repeated procedures
_____ drug use
________ depravation
Hx of _____ or other recent infections
Immuno
Surgery
TB
With spinal infection, it may take days, _____ or ______ to spread to the spine
months
years
With spinal infections, it spreads to the disc MORE commonly in the ______ spine
lumbar
With spinal infection, it is NOT common but as abscess grows the following may occur:
____ ______ irritation
_______ ______ collapse/fx
______ compressionmay develop
nere root
vertebral body
cord
What is the MOST common presenting symptom for spinal infection?
age-related changes with back P!/stiffness
With spinal infections, there are __________ and ________ symptoms NOT common initially
constitutional; infection
What are the infection S&S?
_______ (MOST common early symptom)
Fever, _____, ______
N&V
Enlarged and likely ________ lymph nodes
_________ (maybe lymphangitis or streaks toward lymph nodes) abcess, _____, and or swelling
Malaise
chills; sweats
tender
Redness; heat
Spinal infection is usually ______ and ______ spinal P! that limits motion
localized; progressive
With spinal infections, it is likely _______ pain for disc > ______ _______ involvement with scan and biomechanical exam
mechanical; vertebral body
Spinal infection, infection S&S particuraly they would experience ______ fatigue and have a _____ since onset of back P!
abnormal; fever
If spinal infection is left untreated, it could lead to:
______ weight loss of ≥ 5-10% over a 3-6 month period with loss of appetite
_______ S&S influence LE and coordination as well with bowel and bladder ________
Loss of lumbar ______
unexplained
neurological; dysfunction
lordosis
Spinal infection is a _______ referral unless cord or Cauda equina S&S then _______ referral to MD
urgent; emergency
