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Semester 2- MJM > Clinical Applications of spinal anatomy > Flashcards

Clinical Applications of spinal anatomy Flashcards

1
Q

what is the function of the spine?

A

multidirectional mobile column linking the locomotion units (legs) and manufacturing appendages (arms) with the central processing unit (head)

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2
Q

what is bone strength of the VC increased by?

A

Requires adequate calcium intake
Strength ↑ by:
Exercise
Sunshine (vitamin D metabolism)
Moderate alcohol

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3
Q

what is bone strength of the VC decreased by?

A

Strength ↓ by the 5 T’s:
Time (aging)
Tobacco
Tippling (too much drinking)
Telly (inactivity)
Tablets (e.g. steroids)

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4
Q

what are the 3 different regions within the spinal canal?

A

Within the spinal cannel there are 3 different regions:
C1-T12 –> Spinal cord
T12-L1 –> Conus Medularis: Most distal end of the spinal cord
Contains cell bodies supplying the lower limb
L2 – Sacrum –> Cauda Equina: Collection of nerves at the end of the spinal cord
Contains nerve roots that supplies the lower limb.
Lesions above the Conus medularis will produce an upper motor neurone picture
Lesions below T12 will produce a lower motor neurone picture

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5
Q

what are the implications of level of neural compression?

A

The further down the spinal cord the compression –> smaller loss in motor and sensory function.
L5 and below:
Impaired sphincter and sexual function
Foot and ankle weakness
L5 – L2: decreasing leg function - Progressively less likely to walk
L1/2 – T1: can’t walk (paraplegia)
T1 – C5: decreasing arm function - Lower the injury the better the upper limb function
C5 –> quadriplegia
Above C4: Can’t breathe as diaphragm loses innervation
(C3, 4, 5 keeps the diaphragm alive)

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6
Q

what is myelopathy?
where does it usually occur?

A

Myelopathy: An injury to the spinal cord caused by severe compression.
It may be as a result of spinal stenosis, disc herniation, autoimmune disorders or other trauma (see later on)

Myelopathy usually occurs at the cervical level - weakness and sensory changes usually affecting the upper limb more than the lower limb

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7
Q

what is myelopathy characterised by?

A

It is characterised by:
development of Broad-based shuffling gait
Upper limb radiculopathy (symptoms due to pinching of nerve root)
E.g. Spastic paresis, increased tone, clonus (involuntary, rhythmic, muscular contractions and relaxations) of upper limb

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8
Q

what does myelopathy cause?

A

You get Brisk reflexes,
Extensor plantar reflex:
On stoking the sole of foot, the big toe will move up (extension) rather than down.
Myelopathy can rarely be accompanied with urinary symptoms
Retention, overflow and automatic bladder

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9
Q

what is Radiculitis?

A

Radiculitis: Inflammation of a nerve root
You will get nerve root pain (occurs in sclerotomal pattern) and nerve root tension

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10
Q

what is Radiculopathy?

A

Radiculopathy: Pinching of the nerve root in the spinal column
You will get nerve root dysfunction

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11
Q

what happens when there is pain and compression of the nerve root?

A

If there is compression/irritation of nerve root:
Pain will be experienced in sclerotomal distribution
Sensory disturbance occurs in a dermatomal distribution
Muscle weakness occurs in a myotomal distribution.

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12
Q

what happens when the L5 nerve root is irritated?
what would the patient experience?

A

Patient experiences:
Pain occurs in sclerotomal distribution: The L5 nerve supplies bones, ligaments and joints.
Therefore, patient will feel pain, in lateral aspect of thigh, lateral aspect of calf and dorsum of foot.
Sensory disturbance occurs in a dermatomal distribution:
L5 Dermatome: Lateral aspect of calf and dorsum of foot.
Muscle weakness occurs in a myotomal distribution:
Weakness of dorsi flexion of foot and great toe
May have difficulty in abducting of thigh away from the midline.

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13
Q

explain the vascular Supply of the Spine?

A

Principal spinal cord blood supply is from:
Anterior spinal artery
2 posterior spinal arteries
Supplemented by segmental vessels
Vulnerable regions (poor supply):
Upper thoracic T1-4
Thoraco-lumbar junction

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14
Q

what are the spinal cord columns?

A

Dorsal columns: Carry light touch, proprioception and vibration signals
Ventral columns: Carry pain, temperature and motor signals

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15
Q

how does a spinal cord syndrome occur?

A

Cord stroke: This occurs when the anterior spinal artery is obstructed.
This means there would be loss of pain, temperature and motor.
But preservation of light touch, proprioception and vibration.
Because the dorsal columns have a paired blood supply it is unusual to see an isolated loss of dorsal column function.

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16
Q

what kind of pathology could occur in the spine?

A

Spinal Deformity
Degenerative conditions
Neoplastic (tumour): primary, secondary
Infection
Inflammatory

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17
Q

what is spinal balance?

A

When the spine is in balance it is energy neutral –> comfortable
When the spine is imbalanced:
Muscle fatigue in the short term –> Postural Pain
Degenerative change in the long term –> mechanical pain

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18
Q

what are the types of spinal deformity?

A

Deformity in Sagittal plane
Kyphosis - excessive outward curve
Lordosis - excessive inward curve
Coronal plane deformity:
Left/right - Scoliosis
Deformity in Transverse plane
Rotation, usually associated with scoliosis

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19
Q

what are the physical signs of scoliosis?

A

Physical signs:
Visible curve (lordosis)
Scapula prominence
Hip prominence
Shoulder asymmetry
Waist asymmetry
Forward bend test: By performing a forward bend test the rib or lumbar hump becomes more prominent

20
Q

what are the causes of spinal deformity – component abnormality?

A

Spinal deformity can occur due to abnormalities in the bony components.
Abnormalities arise due to:
Failure vertebral formation
Failure of vertebral segmentation
These both result in bending of the spine.

21
Q

what are the causes of Spinal deformity - neutrally/muscle mediated?

A

Spinal deformity can also occur due to abnormalities in innervation or abnormalities in the muscle innervated.

Upper motor neurone abnormalities
When there in too much tone on one side of the body in comparison to the other - spine may be ‘pulled over’
This may occur in:
Cerebral palsy (CPU abnormality)
Cord abnormality

Lower motor neurone disorder
When there is Insufficient tone on one side in comparison to the other- spine may ‘fall over’
This may occur in:
Viral myelitis (polio)
Spinal muscular atrophy
Muscular dystrophies
Trauma

22
Q

how do you perform a scoliosis surgical correction?

A

A rod is connected to the spine by wires within the spinal canal.
These wires pull the spine onto the rod and straighten it.
You can also use pedicle screws.

23
Q

what is ‘Normal’ spinal degeneration?

A

Affects everyone
Prevalence increases with age
Age of onset determined genetically and by environmental influence
Degeneration can be seen particularly well using MRI
Variably symptomatic (symptoms don’t always occur)

24
Q

what are the types of normal spinal degeneration?

A

Disk Degeneration
Disk Protrusion
Facet degeneration
Annular Fissure

25
explain what the white, red anf dark disc is showing in this image?
White disc: Hydrated Dark disc: Not hydrated Red circle: Disc protrusion
26
what can cause nerve root tension?
Disc herniation can cause nerve root tension Nerve root tension can cause back pain or sciatica
27
what is the anatomy of nerve root tension depending on each part of the body? what tests do you do to examine each NRT?
Anatomy of nerve root tension: Sciatic nerve L4-S3 Perform sciatic stress test (Slight leg raise) If you get: Back pain, this indicates dural tension Leg pain, indicates Nerve root tension Femoral nerve L2-L4 Do femoral stress test (Lie prone, flex knee and extend hip) If you get: Back pain, this indicates dural tension Leg pain, indicates Nerve root tension
28
what is spinal stenosis?
(Can be congenital but usually degenerative) narrowing of the spinal canal. This can put pressure on the nerves that travel through the spine
29
Those with spinal stenosis have:
‘Simian’ posture: This ↑ effective volume of the spinal canal and takes pressure off the nerves Bicycle sign: They find it easier to ride a bike Shoelace sign: They find it hard to walk so have to bend down a lot as this provides relief
30
what are the characteristics of spinal stenosis?
Slow onset Age >50 years You usually get Numb, aching dysaesthetic leg pain Brought on by standing or walking Relieved by sitting or leaning forward Back pain is also present If severe you can get weakness and sphincter symptoms
31
what is the treatment for spinal stenosis?
Epidural injection (performed first) Can perform Targeted decompression: remove bone or ligament to allow spine through. (Performed if epidural injection is ineffective)
32
what is happening in this MRI scan?
Here the spinal cancel is good dimension at the lumbar-sacral level but it then narrows as you move up which results in compression of nerves.
33
what is Spondylolysis?
Spondylolysis: a stress fracture through the pars interarticularis of the lumbar vertebrae (uni or bilateral) Pars Interarticular: the part of a vertebra located between the inferior and superior articular processes of the facet joint.
34
when does it usually occur?
Usually occur between L3-L5, most commonly at L5 Probably a fatigue fracture More common in athletic individuals e.g. fast bowlers Never present in children who haven’t been on their feet (e.g. wheel chair bound for life)
35
what is the treatment for Spondylolysis?
Can heal without intervention but sometimes require internal fixation.
36
what is Spondylolisthesis?
Spondylolisthesis: When a vertebral body shifts anteriorly in relation to the vertebra immediately below it.
37
what are the causes of Spondylolisthesis?
Traumatic fracture Degenerative: occurs with aging Dysplastic: (congenital) Joints don’t form properly Lytic: acquired in youth Pathological
38
Degenerative spondylolisthesis can result in:
Narrowing of spinal canal --> spinal stenosis. Reduced AP diameter of central and lateral canal resulting in traction and compression of the nerve root AP: anterior-posterior
39
how do neoplastic (tumour) conditions lead to compression of spinal cord?
Majority of both primary and secondary tumours tend to be in the vertebral body (anterior) If tumour expands => compression of anterior aspect of cord which results in: Weakness Alteration of pain and temperature, without loss of fine touch and proprioception (dissociated sensory loss)
40
what is Spinal Metastases?
When a tumour spreads to the spine from cancer elsewhere in the body. This may result in compression of spinal cord and nerve roots - partial or complete paralysis.
41
what 2 mechanisms can compression be caused via? what is the treatment?
Direct Tumour compression: Treatment: DXR (radiotherapy) or chemotherapy Tumour causes pathological fractureof vertebral body resulting in bony compression of spinal cord and nerve roots Treatment: decompression and stabilisation Disc spaces are normally preserved
42
what is a spinal infection in a child?
Child – Discitis When a child is growing the intervertebral disc still has a blood supply. Bacteria in the blood supply may lodge into the intervertebral disc causing discitis
43
what is a spinal infection in an adult?
Adults – Vertebral osteomyelitis spondylodiscitis Bacterial inoculation usually occurs beneath vertebral end plate with involvement of disc and adjacent vertebral end plate. Disc is often involved in pyogenic and TB Infection In contrast to spinal tumour which spares the disc. Many patients with spinal infection have other underlying medical condition which compromises their immunity making them susceptible to infection e.g. diabetes.
44
name 2 inflammatory conditions of the spine?
Rheumatoid arthritis Ankylosing spondylitis
45
what is Rheumatoid arthritis?
Involves Cervical spine Effects synovial joints of the vertebrae C1/C2: Causes Atlanto-axial joint subluxation Sub-axial cervical spine: effect uncovertebral joints (not present in thoracic or lumbar spine) Anaesthetic implications
46
what is Ankylosing spondylitis?
Whole spine involvement Can result in spine being stiff and brittle. This means a relatively minor impact to the spine can result in fracture --> can result in displacement of SC --> Paralysis

Semester 2- MJM (12 decks)

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