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MS Clin Med > Disorders and Treatments of The Spine > Flashcards

Disorders and Treatments of The Spine Flashcards

1
Q

What are the functions of the Vertebral Column?

A

Supports the head and trunk, permits several types of movements, and protects the spinal cord in the vertebral canal.

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2
Q

How many bones are in the Vertebral Column of an infant and an adult?

A

33 separate bones in infants and 26 in adults.

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3
Q

What are the 4 curvatures of the Vertebral Column?

A

Cervical curvature (secondary), Thoracic curvature (primary), Lumbar curvature (secondary), Sacral curvature (primary).

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4
Q

What is the composition of the Vertebral Column?

A

7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
5 fused sacral vertebrae (Sacrum)
4 fused coccygeal (Coccyx)

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5
Q

What factors affect prognosis in spinal conditions?

A

1.Diagnosis is hard to identify

2.secondary gain
(work comp, MVA, interpersonal relationship),

3.psychosocial factors (tobacco, alcohol, education level, job satisfaction, depression).

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6
Q

What is the challenge of diagnosing spinal conditions?

A

Identifying the pain generator is nearly impossible; most back pain should be labeled as ‘non-specific’ in the absence of clearly discernable pathology.

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7
Q

What are indications for imaging studies for back pain?

A

Severe or progressive neurologic deficits

sudden back pain with spinal tenderness

trauma

serious underlying medical conditions.

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8
Q

What is the nomenclature for disc disease?

A

commonly used for herniated nucleus pulposus, prolapsed disc, ruptured disc, and torn annulus.

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9
Q

What characterizes a ‘normal’ disc?

A

Free of disease, trauma, and aging; however many ‘normal’ pain-free backs can have ‘abnormal’ discs.

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10
Q

What is an annular fissure?

A

Fissures in the annulus due to degeneration, aging, or trauma; seen in many people who do not have low back pain.

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11
Q

What is a bulging disc?

A

Generalized displacement of the disc tissue beyond the disc space

often a normal variant at L5/S1.
(bulging does not mean there will be symptoms)

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12
Q

What is a herniated disc?

A

Protrusion where the distance between the edges of the herniation is less than the distance at the edges at the base.

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13
Q

What is a herniated disc extrusion?

A

The distance between edges of herniation is greater than the distance at the base

often results in nerve root compression.

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14
Q

What is a herniated disc sequestration?

A

Displaced disc material has lost all connection with the disc of origin

may lead to leg pain only.

can also become reabsorbed

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15
Q

What is Schmorl’s node (intervertebral herniations)?

A

A portion of the disc projects through the vertebral end plate into the center of the vertebral body

common in minor degeneration of the aging spine.

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16
Q

What are major causes of Cauda Equina Syndrome?

A

Disc herniation, spondylosis

tumor

compression fractur

infection

ischemia

mechanical causes

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17
Q

What are degenerative diseases affecting the spine?

A

Disc degeneration, spondylosis, facet arthritis, stenosis, and spondylolisthesis.

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18
Q

What is spondylolisthesis?

A

The forward slippage of one vertebra over another.

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19
Q

What are the types of spondylolisthesis?

A

Isthmic (due to pars fracture or defect) common in adolescents

degenerative (most common in people over 65)-often grade 1 or 2

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20
Q

What are the grades of spondylolisthesis?

A

Grade 1: 0-25%,
Grade 2: 25-50%,
Grade 3: 50-75%,
Grade 4: 75-100%,

over 100% is spondyloptosis.

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21
Q

What is rheumatoid arthritis?

A

A systemic autoimmune disease diagnosed via blood tests; affects the synovial lining.

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22
Q

What are seronegative spondyloarthropathies?

A

Includes ankylosing spondylitis, psoriatic arthritis, and irritable bowel disease associated spondyloarthritis.

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23
Q

What is ankylosing spondylitis?

A

Reactive symptoms of sacroiliac joint pain and stiffness often begin during late adolescence or early adulthood.

diagnosed via xray and blood work

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24
Q

What is spondylolysis?

A

A congenital defect or non-displaced fracture of the pars interarticularis, usually at L5.

common in children and adolescents

often heals with rest

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25
Q

What are compression fractures?

A

The most common type of spinal fracture due to osteoporosis, trauma, or tumor.

often felt with a sudden onset of back pain that increases with standing or walking , pain decreases while lying on the back

most common in thoracic-lumbar spine

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26
Q

What is a Jefferson fracture?

A

A burst fracture of C1, often caused by axial loading; usually does not result in neurologic compromise.

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27
Q

What are common spinal surgery procedures?

A

Discectomy, artificial disc replacement, laminectomy, fusion, kyphoplasty, and vertebroplasty.

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28
Q

What is discectomy?

A

The most common procedure for herniated discs; involves removing a portion of or all of the disc.

an ambulatory surgery: avg time is 1-2 hours

29
Q

What is artificial disc replacement surgery?

A

An alternative to spinal fusion for disc disease or herniation

typically done for patients wuth disc disease at only one level

30
Q

What is spinal fusion?

A

Most commonly performed for spondylolisthesis; involves fusing vertebrae together.

31
Q

What are kyphoplasty and vertebroplasty?

A

Minimally invasive techniques to treat compression fractures;

kyphoplasty involves balloon insertion and cement filling.

vertebroplasty is bone cement injected under high pressure

32
Q

What are common conservative treatments for back pain?

A

Education, medication, physical therapy, and bracing.

33
Q

What are common medications for back pain?

A

OTC analgesics and NSAIDs
prescription NSAIDs
muscle relaxants
neuromodulating medications.

34
Q

What are targeted injections used for?

A

Pain relief, identifying pain generator, and promoting active rehabilitation.

35
Q

What is radiofrequency ablation?

A

Used to treat painful facet joints by cauterizing the medial branch nerve.

36
Q

What are the two types of curves?

A

lordsosis ( secondary)
kyphosis (primary)

37
Q

What are common symptoms of Spondylosis?

A

Episodic back pain and stiffness in the morning.

Painful spinal joint movements

38
Q

What is observed in X-rays of Spondylosis?

A

Spinal joint deformity.

39
Q

What age group is most affected by Spondylosis?

A

Very common in ages 50 and older.

40
Q

What are Spondylotic changes?

A

Loss of disc height and dehydration.

facet hypertrophy

hypertrophy of the posterior longitudal ligament

bone spurs

narrowing of foramen and or spinal canal

41
Q

What is spinal stenosis?

A

Degenerative narrowing of the spinal canal, most often occurring after age 60.

42
Q

What are the symptoms of spinal stenosis?

A

Symptoms include low back pain and neurogenic claudication (weakness and cramping in legs).

symptoms better with flexed postures

43
Q

What causes claudication in spinal stenosis?

A

Claudication is due to decreased blood flow to lumbar/sacral nerve roots.

44
Q

What are early signs of RA?

A

low grade fever, muscle aches, fatigue

45
Q

risk factors of ankylosing Spondylitis?

A

testing positive for the HLA-B27 marker

family hx of AS

frequent gastrointestinal infections

46
Q

How is ankylosing Spondylitis treated?

A

with medication and PT

47
Q

What aggrevates spondylolysis

A

extension and standing

48
Q

how is spondylolsysis diagnosised

A

angle x ray

bone scan

CT

MRI

49
Q

who is at highest risk of compression fractures?

A

osteoporotic females older than 50

females are 4x more likely than men

50
Q

How are compression fractures treated?

A

bracings, meds, PT, surgery

51
Q

What causes jefferson fracture?

A

axial loading, diving injuries, and MVA

52
Q

How is jefferson fracture treated?

A

halo brace

53
Q

What are Odontoid (Dens) Fractures?

A

Most common type of C2 fracture; accounts for 10-15% of all cervical fractures.

54
Q

In which patients are Odontoid fractures commonly seen?

A

Seen in young patients and elderly as a result of hyperflexion or hyperextension injury.

55
Q

What are the symptoms of an Odontoid fracture?

A

neck pain and possibly difficulty swallowing due to hematoma; neuro signs not common.

56
Q

How are Odontoid fractures treated?

A

Treated with bracing and/or surgery.

57
Q

How is an Odontoid fracture diagnosed?

A

Best viewed via open mouth x-ray.
CT helpful to determine type of fracture.
MR indicated when neurological findings are present.

58
Q

What is a Hangman’s Fracture?

A

Traumatic Spondylolisthesis of C2 due to hyperextension injury.

59
Q

In what situations are Hangman’s fractures common?

A

Common in diving accidents, falls, and MVAs.

60
Q

How are Hangman’s fractures typically treated?

A

Most often treated with stabilization vs. surgery.

61
Q

what are some surgical considerations before operating on the spine ?

A

these surgeries are elective

use least invasive procedure that will accomplish goals

do the benefits outweigh the risks?

62
Q

What is an indication for emergency spine surgery?

A

progressive neurologic deficit in the presence of a surgically correctable lesion

63
Q

What is decompression surgery?

A

typically indicated for spinal for spinal stenosis but is also done for herniated discs

involves removal of laminae

64
Q

types of spinal fusions?

A

Anterior Lumbar Interbody Fusion (ALIF) Posterior Lumbar Interbody Fusion (PLIF) Transforaminal Lumbar Interbody Fusion (ALIF)

65
Q
A
66
Q

What is the Future of Regenerative Medicine?

A

moving towards prolotherapy, platelet rich plasma injections, and stem cell treatment

67
Q

What is Prolotherapy?

A

Prolotherapy is the injection of an irritant solution used to trigger a healing response.

68
Q

What are Platelet-Rich Plasma (PRP) Injections?

A

PRP Injections involve the injection of the patient’s platelets to stimulate healing.

Commonly used for tendons, muscles, ligaments.

69
Q

What are Stem-cell treatments?

A

Stem-cell treatments involve the injection of stem cells to promote healing.

MS Clin Med (3 decks)

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