In the clinic - The back Flashcards
Spina bifida
Two sides of the vertebral arches (usually lower vertebrae) fail to fuse, therefore opening the vertebral canal
Spina bifida occulata
Defect in LV or SI, over 10% of individuals have it and it results in failure of the posterior arch to fuse in the midline
Spina bifida mening / myelomeningocele
Failure of fusion of the posterior acth at the lumbosacral junction with a large outpouching of the meninges
So you can have a meningocele (filled with cerebrospinal fluid)
You can also have a myelomeningocele (which has a portion of the spinal cord)
Causes neurological defects including walking and bladder function
Herniation of the nucleus pulposus
Degenerative changes in the anulus fibrosus (the outer ring of the intervertebral disc) can cause it to weaken and tear. When this happens, the nucleus pulposus (the soft, gel-like center) can herniate or protrude through the damaged area.
A posterolateral herniation is the most common type, where the nucleus pulposus pushes backward and to the side, often compressing the spinal nerves as they exit the intervertebral foramen. This can lead to symptoms like pain, numbness, and weakness, depending on which spinal nerve is affected.
Hangman’s fracture
A Hangman’s fracture is a fracture of the pars interarticularis of the C2 vertebra (axis). It typically results from hyperextension and distraction of the cervical spine, often seen in high-impact trauma such as car accidents or hanging (hence the name).
This fracture can lead to instability in the cervical spine and, in severe cases, compression of the spinal cord, which may cause neurological damage or even death. However, in many cases, the spinal cord is not immediately affected because the fractured vertebra can still maintain alignment.
THE DENS IS USUALLY INTACT FUNNILY ENOUGH
Vertebral cancer
The vertebra is a common site for metastatic disease
Because cancer interrupts normal bone cell turnover which leads to either bone destruction or formation, therefore destroying its mechanical properties.
Therefore this can lead to vertebral collapse
It can be found with nuclear imaging
Vertebrae that contain extensive metastatic disease may extrude fragments of tumor into the vertebral canal, compressing both the nerves and the spinal cord.
Osteoporosis
Pathophysiologic condition
Normal bone quality but deficient on bone quantity
Metabolic so occurs in the 50s /60s for women and in the 70s for men
Affected by estrogen levels in women and genetic predetermination and activity (USE IT OR LOSE IT)
“Crush” vertebral body fractures, distal fractures or, radius and hip fractures
Because aging leads to more susceptible to fracture. With impaired healing
Can be identified with DXA scanning.
Vertebral fractures
Can occur anywhere
Usually will heal under certain circumstances.
The related damage to contents are worrying
1 column destruction
Manageable
2 column
Unstable requires immobilization
3 column
Significant neurological defect.
Anterior column
Vertebral bodies and anterior longitudinal ligament
Middle column
Vertebral body and posterior longitudinal ligament
Posterior column
Ligamenta flava, interspinous ligaments, supraspinous ligaments & ligamentum nuchae.”
Fracture in the cervical area
Craniocervical junction if incident disrupts craniocervical stability then chances of spinal cord injury are HIGH
Can lead to quadriplegia.
C3-C5 paralysis (phrenic nerve) = respiratory function.
Hypotension can result from central disruption of sympathetic autonomic division of the nervous system.
Mid & lower cervical column disruption can limit limbs but respiratory tract is ok
Fracture in the dorsal area
LUmbar column injuries
RARE
Abdominal organs and the rest of skeleton must be assessed for visceral rapture because you need lots of force for lumbar to be hurt.
Unifacetal and bifacetal cervical vertebral dislocations that occur in hyperflexion injuries
Showing that vertebral injuries can involve supporting tissue.
Pars interarticularis fractures
Superior and inferior facet (zygapophysial) joints
Susceptible to trauma fo athletes
Fractures that occur here then the vertebral body may compress the vertebral canal
Common in LIV and LV
If the slip occurs and it doesn’t have a pars interarticularis fracture then its called spondylolisthesis
