clinical anatomy of back Flashcards
what is the Jefferson fracture
it is a fracture in the anterior and/or posterior arches of atlas (C1)
-results from axial loading injuries
what type of medical imaging is used to diagnose a Jefferson fracture
CT scan is best to see fracture as it is difficult to see in an x-ray
- if using x-ray it is best seen in an open mouth view (odontoid view)
what is Hangman’s fracture?
defect or fracture of the pars interarticularis (between the superior articular facet and inferior articular facet) of C2
- results from high force hyper-extension of the head on the neck
where is the pars interarticularis
space between the superior and inferior articular facets
what view can Hangman’s fracture best be seen in an x-ray
lateral view
what is a herniated intervertebral disc
it is when the central nucleus pulposus of the intervertebral disc protrudes past the anulus fibrosis into the vertebral canal which can compress spinal nerves or cauda equina
-can be caused by incorrect posture when lifting weights
why is herniations more likely to be posterolateral than posteriorly
because the posterior longitudinal ligament prevents it from escaping posteriorly
at what vertebral level does herniations commonly occur and how do you test for it?
mostly in lumbar region (L4-L5 or L5-S1)
- can compress L5 or S1 part of sciatic nerve which leads to sciatica (severe pain from lower back down to legs)
- straight leg test: raise the straight leg, if there is a pain then there might be cause for concern
what are some treatments for herniated disc
conservative treatment
- analgesia, non-steroidal anti-inflammatory drug
- active lifestyle rather than bed rest to avoid chronic back pain
- avoid activities which aggravate symptoms (lifting weights)
- steroid injection
- physiotherapy
- surgery as last resort
what is spondylolysis
defect or fracture in pars interarticularis (most commonly L5)
- usually due to repeated hyperextension
- common in young athletes (gymnast, diving)
- seen in oblique spine x-ray as the broken neck of Scotty dog
- often leads to spondylolisthesis
what is spondylolisthesis
- anterior slippage of superior vertebra over inferior vertebra
- most commonly affect L5/S1
- can be seen on lateral spine x-ray
what is spondylosis
degeneration of spinal column
what is facet joint syndrome
degeneration of the facet joint
-a common cause of back pain
- symptoms:
1. pain worse on lateral flexion and rotation
2. more common in cervical and lumbar regions as there is more movement that can happen there
what are vertebral fractures
- can be a compression fracture for elderly or burst fracture for young patients
when do you suspect vertebral fractures
- depends on their history of recent trauma relative to their age
- sudden severe central spinal pain which is relieved on lying down
- structural deformity of spine
- vertebral tenderness
what is a wedge compression fracture
a fracture that causes compression of the vertebra to make it appear like a wedge
what is spinal cancer and when do you suspect it?
spinal cancer is more often as a secondary cancer (metastasize to spine) than primary cancer
- can metastasize from:
1. renal
2. prostate
3. breast
4. lung
suspect when :
- patient is over 50
- gradual onset with no improvement after 4 to 6 weeks of conservative treatment
- severe back pain that remains when supine
- history of cancer
- vertebral tenderness
- disturbed sleep due to night pain
- pain aggravated when straining
what is the ‘winking owl sign’
normal : pedicles of vertebra looks like two eyes of an owl
cancer: cancer destroys the pedicle on one side and can cause it to look like a winking owl
what is discitis
infection of the intervertebral disc
- often presents together with vertebral osteomyelitis
- common cause is staphylococcus aureus
- risk factors increase when patients:
1. immunosuppression (HIV, immunosuppression drugs)
2. IV drug use
3. recent UTI
4. diabetes - symptoms :
1. back pain
2. fever
treatment : intravenous antibiotics
Diagnosis :MRI (better at imaging of soft tissue)
what is vertebral osteomyelitis
infection of the vertebral body
what is Pott’s disease
infection of spine by TUBERCULOSIS specifically
what is cauda equina syndrome and what are some causes
it is when the cauda equina is compressed
- causes include
1. herniation of the intervertebral disc
2. metastasis
3. vertebral fracture
4. infection leading to epidural abscess which can compress
5. spondylolisthesis
6. postoperative hematoma
what are some signs/symptoms of cauda equina syndrome
- bilateral sciatica
- severe or progressive bilateral motor weakness of lower limbs
- saddle anaesthesia
- bowel or urinary incontinence
- severe back pain
- laxity of anal sphincter (PR test)
how do you diagnose and treat cauda equina syndrome
MRI
- emergency- urgent surgical spinal decompression to relieve pressure on cauda equina
if not can result in :
- permanent paralysis
- permanent urinary/ bowel dysfunction
- sexual dysfunction
