Clinical Anatomy of the Back

Question 1

What is a Jefferson fracture?

Answer 1

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

Question 2

What is the best way to view a Jefferson fracture?

Answer 2

On the open mouth

Question 3

What is a hangman’s fracture?

Answer 3

Fracture in pars interarticularis of C2 resulting from high force hyper-extension of the head on the neck eg. car accident

Question 4

What is the best way to view a hangman’s fracture?

Answer 4

Lateral view

Question 5

What nerve is compressed in a herniated disc?

Answer 5

Part of the sciatic nerve-sciatica

Question 6

What test for a herniated disc?

Answer 6

Straight leg raise

Question 7

Diagnosis of herniated disc?

Answer 7

Clinical diagnosis

MRI

Question 8

Treatment of a herniated disc

Answer 8

Analgesia, nonsteroidal anti-inflammatory drug
Keep active
Avoid activities that aggregate symptoms
Physiotherapy
Steroid injection
Surgery as a last resort

Question 9

What is spondylolysis?

Answer 9

Defect or stress fracture in pars interarticularis most commonly affecting L5 and caused by repetitive hyperflexion

Can lead to spondylolithesis

Question 10

What is spondylolisthesis?

Answer 10

Anterior slippage of the superior vertebra over the inferior vertebrae commonly affecting L5 and S1

Question 11

Treatment for spondylolysis and spondylolisthesis?

Answer 11

Analgesia
Avoid activities which aggregate injury
Physiotherapy
Brace
Surgery for high degree of slippage/instability/failed conservative treatment

Question 12

Facet joint syndrome

Answer 12

Degeneration of facet joint
Common cause of back pain
Pain worse on lateral flexion/rotation
More common in cervical and lumbar spine

Question 13

What is a vertebral fracture?

Answer 13

Compression fracture in elderly fracture/burst fracture in young patient

Question 14

When to suspect a vertebral fracture?

Answer 14

History of trauma related to patient’s age
Sudden severe central spinal pain relieved by lying down
Vertebral tenderness

Question 15

Common cancers that metastasis to the spine

Answer 15

Protstate
Breast
Lung
Renal

Question 16

When to suspect spinal cancer?

Answer 16

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

Question 17

What is discitis?

Answer 17

Infection of the vertebral disc often associated and can coexist with vertebral osteomyelitis

Question 18

Common cause for discitis?

Answer 18

Staphylococcus aureus

Question 19

What are risk factors discitis?

Answer 19

IV drug use
Immunosuppression
Diabetes
Recent UTI

Question 20

Symptoms of discitis?

Answer 20

Severe back pain and fever

Question 21

Imaging used for diagnosing discitis?

Answer 21

MRI

Question 22

Treatment for discitis?

Answer 22

IV antibiotics

Question 23

What is Pott’s disease?

Answer 23

Infection of the spine by TB

Question 24

What causes cauda equina syndrome?

Answer 24

Herniated invertebral disc
Metastasis
Infection causing epidural abscess
Spondylolisthesis
Vertebral fracture
Postoperative haematoma

Question 25

Red flags for cauda equina syndrome

Answer 25

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

Question 26

Diagnosis and treatment of cauda equina syndrome?

Answer 26

MRI

emergency care- urgent surgical spinal decompression

Question 27

untreated cauda equina sydrome

Answer 27

Permanent paralysis
Bladder/bowel dysfunction
Sexual dysfunction