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
