Important Spine Concepts Flashcards
What is the nomenclature for disc disease?
commonly used for herniated nucleus pulposus, prolapsed disc, ruptured disc, and torn annulus.
What characterizes a ‘normal’ disc?
Free of disease, trauma, and aging; however many ‘normal’ pain-free backs can have ‘abnormal’ discs.
What is an annular fissure?
Fissures in the annulus due to degeneration, aging, or trauma; seen in many people who do not have low back pain.
What is a bulging disc?
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)
What is a herniated disc?
Protrusion where the distance between the edges of the herniation is less than the distance at the edges at the base.
What is a herniated disc extrusion?
The distance between edges of herniation is greater than the distance at the base
often results in nerve root compression.
What is a herniated disc sequestration?
Displaced disc material has lost all connection with the disc of origin
may lead to leg pain only.
can also become reabsorbed
What is Schmorl’s node (intervertebral herniations)?
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.
What are major causes of Cauda Equina Syndrome?
Disc herniation, spondylosis
tumor
compression fractur
infection
ischemia
mechanical causes
What are degenerative diseases affecting the spine?
Disc degeneration, spondylosis, facet arthritis, stenosis, and spondylolisthesis.
What is spondylolisthesis?
The forward slippage of one vertebra over another.
What are the types of spondylolisthesis?
Isthmic (due to pars fracture or defect) common in adolescents
degenerative (most common in people over 65)-often grade 1 or 2
What are the grades of spondylolisthesis?
Grade 1: 0-25%,
Grade 2: 25-50%,
Grade 3: 50-75%,
Grade 4: 75-100%,
over 100% is spondyloptosis.
What is rheumatoid arthritis?
A systemic autoimmune disease diagnosed via blood tests; affects the synovial lining.
What are seronegative spondyloarthropathies?
Includes ankylosing spondylitis, psoriatic arthritis, and irritable bowel disease associated spondyloarthritis.
What is ankylosing spondylitis?
Reactive symptoms of sacroiliac joint pain and stiffness often begin during late adolescence or early adulthood.
diagnosed via xray and blood work
What is spondylolysis?
A congenital defect or non-displaced fracture of the pars interarticularis, usually at L5.
common in children and adolescents
often heals with rest
What are compression fractures?
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
What is a Jefferson fracture?
A burst fracture of C1, often caused by axial loading; usually does not result in neurologic compromise.
What is discectomy?
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
What is artificial disc replacement surgery?
An alternative to spinal fusion for disc disease or herniation
typically done for patients wuth disc disease at only one level
What is spinal fusion?
Most commonly performed for spondylolisthesis; involves fusing vertebrae together.
What are kyphoplasty and vertebroplasty?
Minimally invasive techniques to treat compression fractures;
kyphoplasty involves balloon insertion and cement filling.
vertebroplasty is bone cement injected under high pressure
What are common conservative treatments for back pain?
Education, medication, physical therapy, and bracing.
What are targeted injections used for?
Pain relief, identifying pain generator, and promoting active rehabilitation.
What are common symptoms of Spondylosis?
Episodic back pain and stiffness in the morning.
Painful spinal joint movements
What is observed in X-rays of Spondylosis?
Spinal joint deformity.
What age group is most affected by Spondylosis?
Very common in ages 50 and older.
What are Spondylotic changes?
Loss of disc height and dehydration.
facet hypertrophy
hypertrophy of the posterior longitudal ligament
bone spurs
narrowing of foramen and or spinal canal
What is spinal stenosis?
Degenerative narrowing of the spinal canal, most often occurring after age 60.
What are the symptoms of spinal stenosis?
Symptoms include low back pain and neurogenic claudication (weakness and cramping in legs).
symptoms better with flexed postures
What causes claudication in spinal stenosis?
Claudication is due to decreased blood flow to lumbar/sacral nerve roots.
What are early signs of RA?
low grade fever, muscle aches, fatigue
risk factors of ankylosing Spondylitis?
testing positive for the HLA-B27 marker
family hx of AS
frequent gastrointestinal infections
How is ankylosing Spondylitis treated?
with medication and PT
What aggrevates spondylolysis
extension and standing
how is spondylolsysis diagnosised
angle x ray
bone scan
CT
MRI
who is at highest risk of compression fractures?
osteoporotic females older than 50
females are 4x more likely than men
How are compression fractures treated?
bracings, meds, PT, surgery
What causes jefferson fracture?
axial loading, diving injuries, and MVA
How is jefferson fracture treated?
halo brace
What are Odontoid (Dens) Fractures?
Most common type of C2 fracture; accounts for 10-15% of all cervical fractures.
In which patients are Odontoid fractures commonly seen?
Seen in young patients and elderly as a result of hyperflexion or hyperextension injury.
What are the symptoms of an Odontoid fracture?
neck pain and possibly difficulty swallowing due to hematoma; neuro signs not common.
How are Odontoid fractures treated?
Treated with bracing and/or surgery.
How is an Odontoid fracture diagnosed?
Best viewed via open mouth x-ray.
CT helpful to determine type of fracture.
MR indicated when neurological findings are present.
What is a Hangman’s Fracture?
Traumatic Spondylolisthesis of C2 due to hyperextension injury.
In what situations are Hangman’s fractures common?
Common in diving accidents, falls, and MVAs.
How are Hangman’s fractures typically treated?
Most often treated with stabilization vs. surgery.
what are some surgical considerations before operating on the spine ?
these surgeries are elective
use least invasive procedure that will accomplish goals
do the benefits outweigh the risks?
What is an indication for emergency spine surgery?
progressive neurologic deficit in the presence of a surgically correctable lesion
What is decompression surgery?
typically indicated for spinal for spinal stenosis but is also done for herniated discs
involves removal of laminae
types of spinal fusions?
Anterior Lumbar Interbody Fusion (ALIF) Posterior Lumbar Interbody Fusion (PLIF) Transforaminal Lumbar Interbody Fusion (ALIF)
What is Prolotherapy?
Prolotherapy is the injection of an irritant solution used to trigger a healing response.
What are Platelet-Rich Plasma (PRP) Injections?
PRP Injections involve the injection of the patient’s platelets to stimulate healing.
Commonly used for tendons, muscles, ligaments.
What are Stem-cell treatments?
Stem-cell treatments involve the injection of stem cells to promote healing.
