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MSK 2023 > Clinical spine > Flashcards

Clinical spine Flashcards

1
Q

How to identify spine sections on X ray

A 
for AP:
Owls face
Eyes of owls = pedicles
Owls beak = spinous process
Vertebral body = head
Transverse processes stick out to side
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2
Q

Imaging for spine:

A

X-ray (AP and Lateral)
CT
MRI for ligaments

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3
Q

Common to least common lumbar pathology

A 
Mechanical back pain
Prolapsed intervertebral disc
Spinal Stenosis
Spondylolisthesis 
Spinal infection/tumour
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4
Q

Causes of mechanical back pain

A

Bad posture (can be from poorly designed seating)
Little exercise
Obesity
Incorrect manual handling

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5
Q

Mechanical back pain characterised by

A

Pain when the spine is loaded
Worse with exercise
Relieved by rest

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6
Q

What happens as spine ages?

A

Loss of height of disc = disc bulging
Osteophytes (syndesmophytes from marginal osteophytosis)
Facet joint OA

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7
Q

What occurs when facet joints get OA?

A

PAIN (innervated by meningeal branch of spinal nerves)

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8
Q

Ultimate result of decreased disc height, OA in facet joints?

A

Intervertebral foramina decrease in size = compression of spinal nerves

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9
Q

Pain caused by compression of spinal nerve

A

Radicular / Nerve pain

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10
Q

What occurs during herniation of disc?

A

‘slipped disc’

Nucleus pulposus protrudes and compresses spinal nerve

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11
Q

4 stages of disc herniation

A

Disc degeneration
Prolapse
Extrusion
Sequestration

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12
Q

Disc degeneration

A

ageing = chemical changes

discs dehydrate and bulge

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13
Q

Prolapse

A

Protrusion of nucleus pulposus slightly into spinal canal

*Still contained within annulus fibrosus

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14
Q

Extrusion

A

Nucleus pulposus breaks through annulus fibrosus but still contained within disc space

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15
Q

Sequestration

A

Nucleus pulposus seperates from main body of disc and enters spinal canal

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16
Q

Most common sites for slipped disc

A

L4/5
L5/S1
(from mechanical loading)

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17
Q

When are nerve roots most vulnerable?

A

Crossing intervertebral disc paracentrally

When they exit spinal canal via intervertebral foramina

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18
Q

Paracentral prolapse

A

most common (96%)
Posterolaterally (PLL prevents straight posterior)
TRAVERSING nerve root affected

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19
Q

Other prolapse

A 
Far lateral (2%)
Central (2%) towards spinal cord (risk of cauda equina syndrome)
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20
Q

Exiting root

A

Nerve that exits spinal canal at same level as disc

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21
Q

Traversing root

A

Nerve root that emerges level below the disc

Affected in paracentral prolapse

22
Q

If paracentral herniation occured at L4/5 which root would be affected?

A

L5 as its traversing

23
Q

What is sciatica?

A

Pain caused by irritation or compression to one of the spinal nerves contributing to the sciatic nerve

(L4 L5 S1 S2 S3)

24
Q

Where is pain usually experienced in sciatica?

A

Back and buttock

radiates to dermatome supplied by that root (follows path)

25
Q

L4 sciatica pain

A

Anterior thigh, anterior knee and medial leg

26
Q

L5 sciatica pain

A

Lateral thigh, lateral leg, dorsum of foot

27
Q

S1 sciatica pain

A

Posterior thigh, posterior leg, heel, sole of foot

28
Q

Where is parasthesia experienced in sciatica?

A

ONLY in affected dermatome (not full path)

29
Q

Cauda equina syndrome possibly

A

Prolapsed intervertebral disc filling spinal canal

30
Q

Other causes Cauda equina syndrome

A 
Tumours
Infection/abscess
Spinal stenosis (from OA)
Fracture in vertebrae
Spinal haemorrhage
Late stage Ankylosing spondylitis
31
Q

RED FLAG for Cauda equina

A 
Bilateral Sciatica
Perianal numbness
Painless retention of urine
Urinary/faecal incontinence
Erectile dysfunction
32
Q

Treatment Cauda equina syndrome

A

Surgical decompression urgently

(otherwise: chronic neuropathic pain, self catheterisation, faecal incontinence, loss of sensation/weakness in lower limb = WHEELCHAIR)

33
Q

Spinal canal stenosis

A

Abnormal narrowing of spinal canal compresses spinal cord or nerve roots

34
Q

Who and why spinal stenosis?

A

Elderly

Disc prolapse, Facet OA, Ligamentum flavum hypertrophy

35
Q

Other not so common causes of spinal stenosis

A

Compression fractures of vertebral bodies
Spondylolisthesis
Trauma

36
Q

Symptoms of spinal stenosis

A 
Pain when standing 
Discomfort in shoulder/arm/hand (cervical) or lower limb (lumbar)
Numbness at and below stenosis
Weakness at and below 
Neurogenic claudication
37
Q

Neurogenic claudication - what does it feel like

A

symptom
pain/pins and needles in the legs after prolonged standing/walking
radiating sciatica distribution

38
Q

Claudication meaning

A

Latin for limb

cramping/weakness in legs = limp

39
Q

Neurogenic claudication cause

A

Compression of spinal nerves as they emerge from lumbosacral spinal cord/cauda equina

40
Q

What happens to neurogenic claudicated nerved during exercise?

A

Venous engorgement
Reduced arterial inflow
Arterial ischaemia = pain/paraesthesia

41
Q

How is neuroclaudication relieved?

A

Rest
Change in position
Flexion of spine (open canal)

42
Q

Spondylolisthesis

A

Anterior displacement of vertebrae above relative to vertebrae below

43
Q

How is spondylolisthesis spotted on x ray?

A

Scotty dog outline on oblique xray of spine
If dog wearing collar = stress fracture (spondylolysis)
If dogs head detatched from body = spondylolisthesis

44
Q

Spondylolysis

A

Fracture in pars interarticularis

between superior and inferior articulating processes

45
Q

Lumbar puncture

A

Withdrawal of fluid from subarachnoid space of lumbar cistern (filled with CSF)

46
Q

Patient position lumbar puncture

A

Patient on side
back and hips flexed (knees to chest)

=Spreads apart vertebral lamina and spinous processes and stretches ligamentum flavum

47
Q

Where is lumbar puncture needle inserted?

A

Midline between spinous processes of L3 and L4

or L4 and L5

48
Q

How can this lumbar location be located?

A

Plane transecting highest points of iliac crest (supracristal plane)

no danger damaging spinal cord here

49
Q

What happens during lumbar puncture?

A 
Passes 4-6cm in adults (through skin and subcutaneous fat)
needle 'pops' through ligamentum flavum
epidural fat and veins
punctures dura mater
punctures arachnoid mater
enters lumbar cistern
50
Q

Layers of mater

A 
Epidural space
Dura mater
Arachnoid mater
CSF
Pia mater at base

MSK 2023 (55 decks)

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