clinical anatomy of back

Question 1

what is the Jefferson fracture

Answer 1

it is a fracture in the anterior and/or posterior arches of atlas (C1)
-results from axial loading injuries

Question 2

what type of medical imaging is used to diagnose a Jefferson fracture

Answer 2

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)

Question 3

what is Hangman’s fracture?

Answer 3

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

Question 4

where is the pars interarticularis

Answer 4

space between the superior and inferior articular facets

Question 5

what view can Hangman’s fracture best be seen in an x-ray

Answer 5

lateral view

Question 6

what is a herniated intervertebral disc

Answer 6

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

Question 7

why is herniations more likely to be posterolateral than posteriorly

Answer 7

because the posterior longitudinal ligament prevents it from escaping posteriorly

Question 8

at what vertebral level does herniations commonly occur and how do you test for it?

Answer 8

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

Question 9

what are some treatments for herniated disc

Answer 9

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

Question 10

what is spondylolysis

Answer 10

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

Question 11

what is spondylolisthesis

Answer 11

• anterior slippage of superior vertebra over inferior vertebra
• most commonly affect L5/S1
• can be seen on lateral spine x-ray

Question 12

what is spondylosis

Answer 12

degeneration of spinal column

Question 13

what is facet joint syndrome

Answer 13

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

Question 14

what are vertebral fractures

Answer 14

• can be a compression fracture for elderly or burst fracture for young patients

Question 15

when do you suspect vertebral fractures

Answer 15

• 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

Question 16

what is a wedge compression fracture

Answer 16

a fracture that causes compression of the vertebra to make it appear like a wedge

Question 17

what is spinal cancer and when do you suspect it?

Answer 17

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 :

1. patient is over 50
2. gradual onset with no improvement after 4 to 6 weeks of conservative treatment
3. severe back pain that remains when supine
4. history of cancer
5. vertebral tenderness
6. disturbed sleep due to night pain
7. pain aggravated when straining

Question 18

what is the ‘winking owl sign’

Answer 18

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

Question 19

what is discitis

Answer 19

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)

Question 20

what is vertebral osteomyelitis

Answer 20

infection of the vertebral body

Question 21

what is Pott’s disease

Answer 21

infection of spine by TUBERCULOSIS specifically

Question 22

what is cauda equina syndrome and what are some causes

Answer 22

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

Question 23

what are some signs/symptoms of cauda equina syndrome

Answer 23

1. bilateral sciatica
2. severe or progressive bilateral motor weakness of lower limbs
3. saddle anaesthesia
4. bowel or urinary incontinence
5. severe back pain
6. laxity of anal sphincter (PR test)

Question 24

how do you diagnose and treat cauda equina syndrome

Answer 24

MRI

1. emergency- urgent surgical spinal decompression to relieve pressure on cauda equina

if not can result in :

1. permanent paralysis
2. permanent urinary/ bowel dysfunction
3. sexual dysfunction

Question 25

what is excessive thoracic kyphosis

Answer 25

when the kyphosis curvature in thoracic region is increased

-usually in older people as bones are weaker so more curvature

Question 26

what is scoliosis

Answer 26

lateral curvature of the spine

- can be corrected by surgery in which rods are placed to straighten spine