Clinical correlations of Back disorders Flashcards
Scoliosis
Primary and secondary curves
most likely occurring in prepubescent girls
causes:
- wedged vertebrae
- shorter leg
- neuromuscular disease
- post menopausal women
harrington rods
surgical rods used to correct scoliosis
impact of scoliosis
may affect breathing
abdominal organs
intervertebral discs
Cervical spine compression/burst fracture
all pressure onto a certain vertebral body causing the whole vertebral body to shatter
vertebroplasty
using polymer injection into vertebral body to “pump” it back up
can’t do this if there is a disk that is blown out
MUST HAVE INTEGRITY of IV DISK
Pathological fracture
fracture due to underlying disease (such as osteoporosis)
Metastases to bone from: Breast Ovary Prostate Hodgkin’s lymphoma
osteoporosis
Lack of dense matrix in trabecular bone
in progressive stage of osteoporosis vertebrae can become biconcave, flat, wedge, planar
ALSO their spine becomes kyphotic
b/c when you get compression fractures from stepping off a curve they are going to have an anterior compression fracture
Metastases to bone
go through vertebral venous plexus***
no valves so meaning pressure changes in abdomen/thorax leads blood to wherever it wants to go that is why there is usually spread of cancer to spine!
function of vertebral venous plexus during inspiration and expiration
in normal inspiration–> pressure is reduced, blood splits its way back into the thorax by passing into intervertebral plexus
during expiration, pressure is high, little blood comes in, larger amount of blood goes into vertebral venous plexus
forced expiration pressure is Really high, blood mainly flows into vertebral venous plexus
what is the most commononly fractured/dislocated vertebrae?
C6
simply b/c of space in this area
Jefferson (Burst) fracture of CV1
fracture of the anterior and posterior arch of the atlas
Hangman’s fracture
C2/C3 spondylolysthesis
so fracture of the pars interarticularis
fracture of the dens (cv2-axis)
can walk around and not know this has happened
transverse ligament of the atlas intact
can lead to vascular necrosis b/c lose blood supply to the dens
disarticulation of the dens
CV1/CV2
the atlas is collaring the dens so compressing the spinal cord!! very bad–> if you survive this you are quadriplegic
tear transverse ligament of the atlas***
rupture of the alar ligament the “owl” ligament
Pre load the alar ligament (so the head is already flexed) and then turn and then it will rupture
(think of a football player whose head is in a turn)
spondyloysis
unilateral fracture of the pars interarticularis
sitting right at the lamina so much closer to the lamina than the pedicle
spodylolisthesis
bilateral fracture
tend to have these in areas where there are high mobility (cervical and lumbar)
most common at L5 and S1 b/c it is at an angle that wants to slide forward
as it slides forward it stretches the nerves of the cauda equina (if in the lumbar region)
grading spondylolisthesis
grade 1 slides a little bit
grade 4 just getting ready to fall off
Batson’s plexus
inside and outside vertebral column
those plexus inside are immune to pressures that the outside venous plexuses are NOT immune to
so when there are changes in pressure in the abdomen and thorax the outer vertebral plexuses are the ones that are being drained in to…
Spina bifid occulta
happens at L5-S1 more than anywhere else
defect of lamina
can be overlayed with a fat pad, or tuft of hair
in order to see the dens…
go through the mouth
Case 26 year old male hurt neck while water skiing …
vertical fracture of the dens??
no it is spina bifida of the atlas!! incomplete fusion of lamina
how many views are needed to confirm diagnosis
2
cervical spondylosis
degenerative changes between the body and the disk
spinal stenosis
in the intervertebral canal (spinal cord) (can be caused by growth of articular processes/facets)
OR
intervertebral foramen at the spinal nerve (degenerative disk)
these both will give you different symptoms
spinal stenosis in vertebral canal
upper motor neurons lesions
spinal stenosis in intervertebral foramen
lower motor neurons lesions
osteoarthritis (effects vertebral bodies and facet joints)
degeneration of disks and disk spaces
extension of the vertebral column
spinal column doesn’t move as well
also have involvement of zygopophyseal joints
can cause pressure on spinal nerves –> leads to radiculopathy –> lower motor neuron lesions
what indicates osteophytic vertebrae
narrowed vertebral foramen
biconcave “Lip” of body
laminectomy
to fix spinal stenosis
foraminotomy
opening intervertebral foramen
take off portion of lamina
posterior longitudinal ligamen
serrated to keep IV disk in place
Mild hyperextension
Whiplash
can cause tear in the anterior longitudinal ligament
avulsion fracture
worse case scenario–> tear the disk, lose integrity, now have to fuse vertebrae
whiplash muscle spasms
pull the cervical column into a more kyphotic curve
ankylosing spondylitis
“bamboo” spine
spine is fused due to inflammation of synovial joints and ligaments
X-ray shows inflammation and calcium formation
Disk pathologies
degenerated
bulging
herniated- happens more in cervical and lumbar (L4-L5, L5-S1)
thinning
disc degeneration with osteophyte formation
posterior herniation
towards the cauda
effects a much larger span of nerves
posterolateral herniation
goes toward spinal nerve
stages of intervertebral disk herniation
disc degeneration
prolapse
extrusion
sequestration
acute pain of herniation
tear of the IV
chronic pain
disk pushing on the nerve and mechanically stimulating it over time
ischemic paralysis of the spinal cord
lose segmental arteries
loss of blood supply to vertebrae
lumbar puncture
.
epidural (transsacral)
.
Tension headache
greater occipital nerve is entrapped in muscles and fascial layers
so if you are constantly using these muscles (trapeziums, semispinalis) then this nerve will be impinged/compressed and cause headache
