Clinical Anatomy of the Back Flashcards
What is a Jefferson fracture?
Fracture in the anterior or posterior arches of C1 caused by an axial loading injury eg. diving into a pool and hitting your head first
What is the best way to view a Jefferson fracture?
On the open mouth
What is a hangman’s fracture?
Fracture in pars interarticularis of C2 resulting from high force hyper-extension of the head on the neck eg. car accident
What is the best way to view a hangman’s fracture?
Lateral view
What nerve is compressed in a herniated disc?
Part of the sciatic nerve-sciatica
What test for a herniated disc?
Straight leg raise
Diagnosis of herniated disc?
Clinical diagnosis
MRI
Treatment of a herniated disc
Analgesia, nonsteroidal anti-inflammatory drug Keep active Avoid activities that aggregate symptoms Physiotherapy Steroid injection Surgery as a last resort
What is spondylolysis?
Defect or stress fracture in pars interarticularis most commonly affecting L5 and caused by repetitive hyperflexion
Can lead to spondylolithesis
What is spondylolisthesis?
Anterior slippage of the superior vertebra over the inferior vertebrae commonly affecting L5 and S1
Treatment for spondylolysis and spondylolisthesis?
Analgesia Avoid activities which aggregate injury Physiotherapy Brace Surgery for high degree of slippage/instability/failed conservative treatment
Facet joint syndrome
Degeneration of facet joint
Common cause of back pain
Pain worse on lateral flexion/rotation
More common in cervical and lumbar spine
What is a vertebral fracture?
Compression fracture in elderly fracture/burst fracture in young patient
When to suspect a vertebral fracture?
History of trauma related to patient’s age
Sudden severe central spinal pain relieved by lying down
Vertebral tenderness
Common cancers that metastasis to the spine
Protstate
Breast
Lung
Renal
When to suspect spinal cancer?
Over 50 Gradual onset with no improvement after 4-6 weeks of conservative treatment Severe pain in supine Pain disturbs sleep Pain aggravated by straining Thoracic pain Unexplained weight loss History of cancer Vertebral tenderness
What is discitis?
Infection of the vertebral disc often associated and can coexist with vertebral osteomyelitis
Common cause for discitis?
Staphylococcus aureus
What are risk factors discitis?
IV drug use
Immunosuppression
Diabetes
Recent UTI
Symptoms of discitis?
Severe back pain and fever
Imaging used for diagnosing discitis?
MRI
Treatment for discitis?
IV antibiotics
What is Pott’s disease?
Infection of the spine by TB
What causes cauda equina syndrome?
Herniated invertebral disc Metastasis Infection causing epidural abscess Spondylolisthesis Vertebral fracture Postoperative haematoma
Red flags for cauda equina syndrome
Bilateral sciatica
Severe/progressive bilateral neurological deficit of the legs such as motor weakness with knee extension, ankle eversion or foot dorsiflexion
Difficulty urinating/ impaired sensation of urinary flow
Facecal incontinence
Perianal, perineal or genital sensory loss
Laxity of anal sphincter
Diagnosis and treatment of cauda equina syndrome?
MRI
emergency care- urgent surgical spinal decompression
untreated cauda equina sydrome
Permanent paralysis
Bladder/bowel dysfunction
Sexual dysfunction
