clinical correlations Flashcards
What is the most common spinal deformity
scoliosis
What population does scoliosis most often affect
pre-pubescent girls
What are the causes of scoliosis
idiopathic congenital (wedge shaped segment) short leg neuromuscular (cerebral palsy, muscular dystrophy) degenerative (osteoporosis)
What is the primary curve vs secondary in scoliosis
primary is the way you initially bend and the secondary curve is the compensatory bend
In scoliosis which way do the spinous processes rotate
towards the center of the curve
What is the treatment for scoliosis
bracing and internal fixation
What can cause compression fractures
trauma. or because of previous condition- osteoporosis and neoplastic metastasis
Which area of the vertebral column is most prone to dislocation
cervical vertebrae
Which segment of cervical vertebra is most prone to dislocation
CV6
What is the fracture nature of CV1 Atlas
the occipital condyles push down with force and the lateral masses of atlas are pushed laterally- forcing arches to fracture.
Describe fractures of CV2
~40% cervical fractures
hangmans fracture
and forceful hyperextension resulting in bilateral fracture though pars interarticularis
Describe the fracture of dens- odontoid process
complete fracture results in avascular necrosis
does not impinge on the cord if transverse ligament is attached but there is slight added tension of cord on posterior arch
Describe problems of rupturing transverse ligament of atlas
atlas moves freely in AP direction- so the spinal cord gets pinched between dens and posterior arch- quadriplegia or death
what ligament is missing or relaxed in downs syndrome
transverse ligament of atlas
What happens if you rupture alar ligaments
increased rotation of skull and CV1 on CV2 ~30 degrees unilaterally.
can be caused by increased flexion with rotation of the skull
What is spondylolysis
defect in the pars interarticularis
spondylolisthesis
bilateral spondylolysis. vertebral column above fractures shifts forward
Spina bifida occulta
neural arch defect at LV5 or SV1
can be complete or partial- usually spinous process is absent
tuft of hair on skin can indicate area of defect
what happens with degeneration of articular cartilage (Osteoarthritis)
inflammation and bone spur formation (osteophyte) which leads to a narrowing of the intervertebral foramina and impinges spinal nn
Radiculopathy
pain distributed along path of a dermatome
Spinal stenosis
Narrowing of the spinal canal and or intervertebral foramen
What are the two procedures for radiculopathy
laminectomy and foramintomy- enlarge intervertebral foramina
What happens with osteoarthritis of the zygopophyseal joints
narrowing of intervertebral foramina
What causes injury to the anterior longitudinal lig
rapid hyperextension like in whip lash injuries
Describe progression of ankylosing spondylitis
inflammation of sacroiliac and all spinal ligaments osteophytic bone growth into the log the spine fuses and so no arm swing most common in 30-50 yr old men HLA B27 marker "bamboo" spine
What is a ruptured disk? Herniated disk?
ruptured is tearing annulus fibrosis
herniated is tearing annulus fibrosis AND protrusion of nucleus pulposus
Where do most herniated disks occur
posterolaterally and impinge nerves
in the lumbar L4-S1 regions where the bodies are greatest so flexion has greatest overall excursion
Acute pain from intervertebral disk suggests what
tear in annulus fibrosis
regional inflammation around intervertebral disk suggests what
herniated nucleus
Chronic pain associated with disk herniation suggests what?
compression of spinal nerve root- continuous low grade depolarization that results in patient “feeling” pain in the receptive field of the compressed n
Herniations affect which spinal nerves
in cervical region same level spinal nn
in lumbar regions affect spinal n one or more segments lower than disk level
what are signs of interference in the supply of blood provided by segmental arteries?
paresthesia and/or paraplegia
Describe the location of lumbar puncture
suarachnoid space ofund between ligamentum flavum as patient flexes
placed between LV3 and LV4 or LV4 and LV5
location of spinal tap in neonate
LV4-LV5 because spinal cord is almost full length of column
Describe location of epidural anesthetic
through sacral hiatus into sacral canal to deliver anesthesia to the surface of cauda equina
to remove pelvic pain without removing motor function because that occurs in higher cord levels.
