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anatomy of the spine > General Pathology > Flashcards

General Pathology Flashcards

1
Q

Position of spine in normal balance

A

Balanced over the pelvis in frontal plane/balanced over the femoral heads in the sagittal plane

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2
Q

Position of spine in imbalance

A

Affected in the sagittal balance and moves towards the front of the body, head posture is anterior to instead of balanced over the hips

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3
Q

Which planes are affected by adolescent idiopathic scoliosis?

A

Thoracic, left or right and sagittal plane

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4
Q

List the four broad categories of etiologies of scoliosis

A

1) neuromuscular curves
2) congenital curves
3) Curves resulting from a specific disorder i.e. disease, tumor, trauma
4) Idiopathic curves

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5
Q

Neuropathic disorders

A

Polio, cerebral palsy, spinocerebellar Dysfunction

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6
Q

Myopathic disorders

A

Arthorgryposis and Muscular dystrophy

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7
Q

What are the three main categories of idiopathic scoliosis in children?

A

Infantile – birth to three years
Juvenile – 3 to 10 years
Adolescent- 10 to 17 years

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8
Q

What are the steps in the evaluation process of scoliosis?

A 
Family and general health history
Physical examination
Radiographic evaluation
Classification of curve
Cobb angle measurement
Risk of progression
Determination of skeletal maturity
Treatment by observation
Non-operative treatment
Operative treatment
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9
Q

Describe a structural curve/major curve

A

Will not bend out on forced bending x-rays, generally at least 10° greater than a minor curve

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10
Q

Describe a non-structural curve/minor curve/compensatory curve

A

Generally do bend out on x-rays, appear to develop an attempt to keep balance in coronal plane. Often resolved once the major curve has been corrected

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11
Q

Describe how a bending film is taken and what it shows

A

Left and right side bending x-rays taken in the supine position to show maximum amount of spinal column flexibility

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12
Q

How do you identify the end vertebrae for a Cobb angle measurement

A

End vertebrae are the last vertebrae on each end of the curve that are tilted into the concavity of the curve

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13
Q

What planes does the king classification relate to and what region of the spine does it describe

A

Thoracic scoliosis, type one to type five, type one deformity is often a true double major curve

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14
Q

Which planes do the Lenke classification system relate to and what region of the spine does it describe

A

Sagittal planes and lumbar curves, made from long P-A lateral and dual side bending x-rays. There are three components: Lumbar spine modifier, curve type and thoracic sagittal plane modifier

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15
Q

What are the five main indicators to help determine the risk of curve progression

A 
Gender of the patient
Magnitude of the curve
Curve pattern
Age at onset of the curve
Skeletal maturity of the patient
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16
Q

How is the Risser sign used?

A

Sections which have been fused, score of five would mean sections 1 through 4 have fused and the patient is scheduled to leave mature. Based upon sacrum joint.

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17
Q

List and describe the three basic treatment options for adolescent idiopathic scoliosis

A

Observation
Non-operative treatment with observation
Surgical intervention

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18
Q

Differentiate between casting and orthotics

A

Casting not performed as frequently today. Requires patient interaction on special frame prior to application of the cast mainly reduce his scoliosis as much as possible but has had limited success

Orthotics/braces, numerous ones, and have two functions. One should improve the deformity initially and two it should prevent curve progression

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19
Q

Difference between patients who have adult idiopathic scoliosis under 40 versus over 40

A

Under 40 is a continued progression or cosmetic appearance of their curve.

Over 40 is present because of back pain, significant degenerative disease process and a pre-existing curve otherwise known as adult scoliosis

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20
Q

For indications for treatment of adult scoliosis

A

Progression of the deformity
Unrelieved pain
Decreased pulmonary function
Cosmesis

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21
Q

What is DeNovo scoliosis

A

Degenerative scoliosis is the onset of a scoliotic curve in a previously straight spine

Spinal stenosis, foraminal stenosis of a concave side, disc degeneration, Motion segment instability, rotatory subluxation of lateral listhesis, and osteoporosis w compression fractures

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22
Q

What is the difference between a postural and structural kyphosis?

A

Postural-When bended forward spine forms a smooth curve. Generally can correct with consciousness

Structural-When bent forward the angular gibbus can be seen as a sharp angular pattern

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23
Q

What are the normal degrees of sagittal curvature in the cervical, thoracic and lumbar curves of the spine?

A

20 to 40°, 20 to 40°, 30 to 50°

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24
Q

What is Scheuermann’s disease?

A

Kyphotic deformities most common form of primary hyperkyphosis

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25
Q

Describe the difference between a curve with a smooth radius and a curve with an angular radius

A

The greater the radius, the smoother the curve. Curves that are more angular have a greater risk of progression

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26
Q

Spondylosis

A

Degenerative changes in the vertebrae and articulation points i.e. disc and facet

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27
Q

Soondylolysis

A

Refers to a defect in the vertebrae, usually in the area of the pars

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28
Q

Spondyloptosis

A

Spondy, where L5 vertebral body has fallen below the horizontal line across the top of the sacrum

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29
Q

Most vertebral slips are the result of a defect in the?

A

Pars area of the lamina

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30
Q

Wiltse’s Classification system

A

Types of spondylolistheis (type I to type VI)

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31
Q

What is low dysplastic spondylolisthesis?

A

Translational shift of one vertebrae

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32
Q

What is high dysplastic spondylolisthesis?

A

Significant segmental kyphosis associated with the translational shift

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33
Q

What is Marchetti & Bartolozzi’s Classification system for spondylolisthesis?

A

Classifies them as developmental or acquired categories i.e. high and low dysplastic forms

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34
Q

What type of x-ray will you see Napoleon’s hat?

A

AP x-ray

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35
Q

What type of x-ray will you see the Scottie dog sign?

A

Oblique view

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36
Q

Meyerding’s grading system

A 
Grade I -less than 25%
Grade 2–25 to 49 percent
Grade 3–50to74 percent
Grade 4–75 to 99 percent
Grade 5 – spondyloptosis
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37
Q

Describe tilt

A

Measured from the anterior inferior corner of the vertebrae, perpendicular to the line of the anterior surface of the sacrum

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38
Q

Describe slip

A

Measured from the posterior inferior angle of the body perpendicular to the sacral end plate line

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39
Q

Osteoarthritis

A

Inflammation of the bones and cartilage of a joint due to a degenerative process

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40
Q

What is the motion segment?

A

Human spine Dash each motion segment has three joints, two facet joints and the intravertebral disc

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41
Q

What makes up the three joint complex?

A

To facet joints and intervertebral disc

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42
Q

The intravertebral disc acts as…

A

Shock absorber and pivot point

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43
Q

The nucleus pulposus Is the central telogen a substance that accounts for about _____ of the IVD?

A

40

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44
Q

Which has more water and proteoglycan content, The nucleus or the anulus?

A

Nucleus – 90 percent at birth, 70 percent after 50

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45
Q

Which carries the smallest portion of the compress upload – the cortical shell or the spongy trabecular bone?

A

Cortical

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46
Q

The end plate is composed of how many layers?

A

Two layers – an inner bony layer and an outer cartilaginous layer

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47
Q

The cartilaginous layer is highly porous and nutrition diffuses across this service from the _____ layer.

A

Bony

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48
Q

The facet joins are important in stabilizing the spine. Their ______ _______ and _________ affect the mobility of each spinal region.

A

Anatomic position and orientation

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49
Q

The facet joints in the lumbar region are oriented in the _____ plane and limit the ________ ___ _______ in rotation

A

Sagittal/range of motion

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50
Q

Ligaments have many functions including….

A

Provide stability for the spine, allow for normal spinal motion, protect the spine and neurological structures, prevent the motion segment from exceeding its physiological range of motion

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51
Q

List the seven ligaments that attach the motion segment together

A

Anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, facet capsular ligament, intertransverse ligament, interspinous ligament, supraspinous ligament

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52
Q

Muscles are the _____ that produce _________ through __________ and ________ across a ____ or _______. Muscles also provide significant ________ and _______ to the spinal column. They resist ______ placed on the body through _________.

A

Active structures/spinal movements/bending movements/torque/joint/motion segment/dynamic stability/stiffness/external leads/isometric forces

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53
Q

What are the two most negative affects of sclerosis on the motion segment

A

Sclerosis of bone and formation of osteophytes

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54
Q

What is another name for attractions Spurs

A

Osteophytes

55
Q

Major trauma or repetitive minor trauma may lead to ____________

A

A nonspecific synovitis

56
Q

The articular processes begin to override each other as the joint capsules become stretched. This results in…

A

Malalignment of the joints and abnormal biomechanical function of the motion segment

57
Q

How do spinal ligaments show the effects of aging?

A

Partial rupture’s, necrosis, and calcification of fibers

58
Q

List seven changes to the motion segment that may occur due to degenerative disc disease

A

Complete resorption of the desk, marked sclerosis/end plates and osteophytes, encroachment into the spinal canal, Significant over writing of the articular surface is with osteophytes, development on both superior and inferior margin’s, infolding and redundancy of the ligamentum flavum and Compromising space and the intravertebral foramen.

59
Q

What are the most frequently affected levels of degenerative disc disease?

A

L4-L5, L5-S1 and C5-C6

60
Q

What does stenosis mean?

A

Narrow/pathological condition/Narrowing of a tube

61
Q

What is the most common form of spinal stenosis?

A

Acquired degenerative type (lower cervical and lumbar areas)

62
Q

What is neurogenic claudication and how can it be relieved?

A

Brought on by and intensified by walking and standing upright. Relieved when one flexes Ford and open up more of the spinal canal, which relieves pressure. Sitting or lying down can also help

63
Q

What is the difference between neurogenic claudication and vascular claudication?

A

Vascular is caused by narrowing of the major arteries supplying blood to the legs

64
Q

What kind of radiographic studies are most commonly used when evaluating lumbar spinal stenosis?

A

Myelography combined with a CT scan and MRI can also be done

65
Q

What are some of the conservative treatments for mild degenerative lumber stenosis?

A

Stretching exercises that increase their flexion motion. Biking, water walking and swimming are excellent activities

66
Q

What is the most common cause of spinal stenosis in the cervical region?

A

Degeneration of the three joint facets and intervertebral disc

67
Q

What is radiculopathy?

A

Progressive deterioration of a nerve root

68
Q

What is myelopathy?

A

Deterioration of the spinal cord

69
Q

Surgical treatment for degenerative cervical stenosis is generally given to what kind of patients?

A

Ones with myelopathy or ones with significant deformity or instability

70
Q

Describe surgical approaches and techniques used for decompression in the cervical region

A

Laminectomy and laminoplasty

71
Q

What is a laminectomy?

A

Partial or complete removal of the posterior elements, allowing increase space for the neural structures

72
Q

What is laminoplasty

A

Surgical reconstruction of the posterior elements that allow for increased canal space but maintains the posterior arch

73
Q

What are the most frequent discs to herniate in the cervical and lumbar regions of the spine?

A

Cervical: C5 to C6, C6 to C7, C4 to C5

Lumbar: L4-L5, L5-S1 and L3-L4

74
Q

What is sciatica?

A

Posterior leg pain from disc herniations, where protrusion occurs. Usually follows the distribution of the sciatic nerve

75
Q

What are the most common symptoms with an S1 radiculopathy?

A

Posterior thigh and calf And lateral aspect of the bottom of the foot from heel to last two toes

76
Q

What are the most appropriate radio graphic studies done for evaluating herniated lumbar discs?

A

MRI and CT scans

77
Q

What are the most common surgical procedures for lumbar disc herniation?

A

Laminectomy with this ectomy, micro discectomy, endoscopic discectomy and ablation (Removal of a body part or destruction of function)

78
Q

What are the most appropriate radiographic studies for evaluating herniated cervical discs?

A

MRI and plain films, CT scan and cervical myelogram may be used.

79
Q

What are the most common surgical procedures for cervical disc herniation?

A

Anterior posterior surgical procedures/fusion

Anterior discectomy without fusion, partial anterior discectomy, discectomy with fusion, posterior laminectomy, posterior laminotomy and posterior laminoplasty

80
Q

What is instability?

A

Loss of normal relationship between anatomic structures with a resulting alteration of natural function

81
Q

What are the primary problem is that concern surgeons and spinal trauma?

A

Mechanical instability of the vertebral column and actual or potential neurologic injury

82
Q

What is a dislocation?

A

Misalignment of the normal structure of anatomic components a.k.a. disruption of soft tissue

83
Q

Axial force

A

Pushes material fibers together in a Christian manner. Pier axial load is rare such as at diving injury and facture vertebrae in multiple pieces

84
Q

Distraction force

A

Force In which the primary mechanism is pulling apart at the disc or bony soft tissue elements

85
Q

Extension force

A

Axial severe backward bending of neck or trunk. Fractures of spinous processes or lamina

86
Q

Flexion force

A

Distraction- a severe forward bend of neck or trunk. Most frequently force associated with neurological damage wedge or teardrop fracture to the vertebral body

87
Q

Shear force

A

Force parallel results in translation or subluxation movement of the shared component. Usually anterior or lateral

88
Q

Rotational force

A

Rotational tension on the tissue fibers. Associated with axial loading force

89
Q

What is a major fracture?

A

Involving the vertebral body, pedicles or lamina and are more serious injuries

90
Q

What is a minor fracture?

A

Involve the transverse, spinous and articular processes not as serious but may be painful

91
Q

What is a stable fracture?

A

No significant displacement of or deformity to the bony or soft tissue. Spine can withstand but patient may have pain

92
Q

What is an instable fracture?

A

Spine may not be able to carry normal loads without risk of causing new or additional neurological damage/injury. Significant deformity and incapacitating pain

93
Q

What is Cauda equine syndrome?

A

Neurological injury below L1 – drama to spinal nerves may result in a complete or incomplete loss of neurological function of affected levels

94
Q

How many pairs of spinal nerves are found in the spinal column?

A

31

95
Q

Describe Frankel’s classification of neurological impairment?

A

Complete loss of motor and sensory function, only sensory function remains, motor function present but have no practical use, motor function impaired, no neurological impairment noted

96
Q

What is a craniovertebral junction injury?

A

Base of the skull (C0), the atlas (C1) and/or axis (C2)

97
Q

Occipito-Atlantal dislocation

A

Rare fatal dislocation where the head is struck and the occiput is subluxed over C1

98
Q

Jefferson’s fracture

A

Burst fracture of the ring of C1; caused by axial loading combined with extension and rotation

May not result in neurological loss if bone fragments do not compromise the spinal canal

99
Q

Hangman’s fracture

A

Posterior arch of C2, caused by hanging, sudden force of hyperextension of head and neck; results in complete neurological loss

100
Q

Odontoid process fractures

A

Type one – generally stable

Type two and three – not stable

101
Q

Atlantoxial joint subluxation

A

Rotatory distractive force, causes the atlas to rotate around odontoid. Results in partial dislocation of lateral articular mass of C1 on C2. May not be any neurological symptoms

102
Q

Subaxial injury

A

Traumas of the cervical spine below C2.

103
Q

Compression fracture

A

Cost by pure Flexion, generally stable, looks like a teardrop or wedge shaped fracture

104
Q

Flexion/axial load injury

A

Fracture/dislocation at C-5 C from diving. Very unstable with three column involvement and significant neurological damage/deficit

105
Q

Extension/axial load injury

A

Multiple level laminae fractures, much lower incidence of neurological involvement. Any middle column involvements results in unstability

106
Q

Facet dislocation

A

Occurs with or without a fracture. Potentially serious, anterior translation of the superior level

107
Q

Three types of thoracolumbar injuries

A

Burst, Flexion/compressive fractures, and Flexion/distraction

108
Q

Two types of lower lumbar injuries

A

Flexion/distraction and compression/torsion/translational

109
Q

Neoplasm

A

Tumors, new growth

110
Q

Primary tumors

A

Benign or malignant – originate within the vertebrae and aren’t coming

111
Q

Secondary tumor’s

A

Originate within another organ and then metastasize to the vertebrate

112
Q

Metastasis

A

Spread of a neoplasm from one part of the body to another

113
Q

Most patients with spine tumors present to the position with _______

A

Back pain

114
Q

Five types of primary benign tumors

A

Aneurysmal bone cyst or ABC, giant cell tumor or GCT, Hemangioma, Osteoid osteoma and osteoblastoma

115
Q

Three types of primary malignant tumors

A

Chardoma, Osteosarcoma, Chondrosarcoma

116
Q

Four types of round cell tumor’s

A

Plasmacytoma, multiple myeloma, lymphoma and Ewing’s sarcoma

117
Q

Where is the most common site for metastasis in the skeleton

A

Vertebral column

118
Q

What is the five-year survival rate for all forms of lung cancer

A

Less than 10 percent

119
Q

What is the five-year survival rate for breast cancer

A

Exceed 75 percent

120
Q

What is the five-year survival rate for patients with global metastasis of prostate cancer

A

20 percent

121
Q

What is osteoporosis

A

Decrease in skeletal bone mass

122
Q

What factors may influence osteoporotic bone loss?

A

Racial and genetic, menopause, decrease of estrogen, park calcium intake, cigarettes, excessive drinking and inactive lifestyle

123
Q

Describe the conservative treatment for compression fractures

A

Bed rest, pain medication and bracing

124
Q

Describe the treatment for secondary osteoporosis

A

Treating the underlying Malady or discontinuing the offending agent/drug treatment

125
Q

What is Paget’s disease

A

Chronic, usually localized, skeletal disorder resulting from the rapid metabolism of new bone

126
Q

What is osteomalacia

A

Decrease in mass of chemically normal bone; similar to osteoporosis

127
Q

What are the most common causes of osteomalacia

A

Vitamin D deficiency (nutritional intake or inadequate sunlight exposure) or acquired disorders of vitamin D metabolism (kidney failure)

128
Q

What is the clinical presentation of tuberculosis infections of the spine

A

Weight lost, general malaise, night sweats, and intermittent fever. Back pain with spine patients, kyphotic deformity and neurological deficit in long-standing cases. Thoracic spine as most common

129
Q

What is the treatment of choice for spinal TB

A

Multiple drug treatment – surgical intervention one bone collapse is significant and deformity when spinal cord is compressed is evident or when there is a para spinal abscess formation

130
Q

What is osteomyelitis of the spine

A

Inflammation of the bone marrow of the vertebral body and the adjacent cortical bone due to an infection

131
Q

About half of all the osteomyelitis infections in the spine occur in which region of the spine?

A

Lumbar region

132
Q

What is discitis?

A

Infection in the disc

133
Q

What is the most frequent treatment of spinal osteomyelitis

A

IV drug therapy with broad-spectrum antibiotics – oral antibiotics. Evidence of spinal instability or potential or actual neurological compromise, surgical intervention may be had/done. Anterior approach is option performed

anatomy of the spine (2 decks)

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