Clinical Anatomy of the Back Flashcards
What is a Jefferson Fracture? How does it arise? Whats the best view for looking at it?
Fracture in the anterior and/or posterior arch of the atlas.
It results from axial loading injuries (diving head first)
Best seen on the open mouth view.
What is a Hangman’s fracture? How does it occur? What is the best view for looking at it?
- Fracture in the pars interarticularis of C2 (axis)
- Results from hyper-extension of the neck (car accidents)-Best seen on a lateral view
What is a herniated disc and how do they occur?
- When the nucleus pulposus prolapses. Can occur from lifting heavy objects incorrectly
Where are the most common areas for a herniated disc to occur? What can occur from compression in one of these areas?
- Most common in the lumbar regions (L4-L5 and L5-S1)
- Herniated disc in L5-S1 can compress the sciatic nerve causing sciatica
How can you diagnose a herniated disk?
Clinical diagnosis (straight leg test) MRI scanning (not often needed but the most sensitive investigation)
What is the treatment for herniated disks?
- Analgesia and nonsteroidal anti-inflammatory drugs (ibuprofen)
- Keeping active not resting
- Avoid activities that aggregate symptoms
- Physiotherapy
- Steroid injection
- Surgery but this is the last resort
What is Spondylolysis? What is it caused by and what does it often lead to?
- A defect or stress fracture in the pars interarticularis (most common in L5)
- Usually due to repetitive hyperexternsion (more common in young athletes)
- Often leads to spondylolisthesis
What is spondylolisthesis? Where is it most common and where can is be readily seen?
- Anterior slippage of superior vertebra over inferior vertebra.
- Most common between L5 and S1
- Readily seen on lateral spine X-rays
What can be used to treat spondylolysis and spondylolisthesis?
- Analgesia
- Avoiding activities that aggregate injury
- Physiotherpy
- Brace but there is debate over the effectiveness of these
- Surgery (only for high degree of slippage or failure of conservative treatment)
What is spondylosis?
Degeneration of the spinal column
What is facet joint syndrome? Where is it most common?
Degeneration of the facet joint (intervetebral foramen).
Most common in cervical and lumbar spine regions as they are more mobile (for rotation and lateral flexion)
When should you suspect a vertebral fracture? What does treatment of vertebral fractures depend on?
- When there is a history of significant trauma relative to patients age
- Sudden severe central spinal pain that is relieved on lying down
- Structural deformity of spine
- Vertebral tenderness
The treatment of vertebral fractures depend on the type of fracture and its stability
What is a wedge compression fracture?
Fracture in the vertebral body that causes it to have a wedge like appearance on an X-ray
What is the most common reasons for cancers in the spine?
Due to metastasis rather than a primary cancer
What are the most common cancers that metastasis to the spine?
Prostate, Breast, Renal and Lung
When should you suspect spinal cancer?
- Age overs 50
- Gradual onset with no improvement after 4-6 weeks of conservative treatment
- Severe pain that remains on supine
- Pain that desturbs sleep
- Pain aggravated by straining
- Thoracic pain
- Unexplained weight loss
- History of cancer
- Vertebral tenderness
How can you visualise spinal cancer?
Scan of the vertebrate - the “winking owl sign”
What is Discitis? and what is associated with?
- Infection of the intervertebral disc. It often co-exists with vertebral osteomyelitis (Infection of vertebral body)
What is the most common causative organism of Discitis?
Staphylococcus Aureus
What are the risk factors, diganosis choice and tratments for discitis?
Risk factors = IV drug user, immunosuppression, diabetes and recent UTI’s.
Diagnosis = MRI scan
Treatment = IV antibiotics
What is Pott’s Disease?
Infection of the spine by TB
What are some of the causes of cauda equina syndrome?
Compression of the cauda equina by the following pathologies;
- Herniated intervertebral disc
- Metastasis
- Infection leading to an epidural absess
- Spondylolisthesis
- vertebral fracture
- Postoperative haematoma
What are the Cauda Equina Syndrome red flags?
- Bilateral sciatica
- Bilateral neurological deficits in the legs
- Difficulty initiating micturition which can lead to irreversible urinary retention and overflow urinary incontinence
- Loss of sensation of rectal fullness which can lead to irreversible faecal incontinence
- Saddle anaesthesia
- Laxity of anal sphincter (test by rectal examination)
Describe the diagnosis, treatment of cauda equina syndrome and the consequences if left untreated
Diagnosis - MRI scanning
Treatment - Emergent surgical spinal decompression
Consequences - If left untreated can result in paralysis, bladder/bowl incontinence and sexual dysfunction
What is excessive thoracic kyphosis?
When the thoracic region of the back curves out far too much
What is a more unusual cause of back pain
An abdominal aortic aneurysm
