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MSK Cramming > Lumbar and Cervical Spine > Flashcards

Lumbar and Cervical Spine Flashcards

1
Q

Function of the posterior spine

A

Restricts movement of the spine to protect the spinal cord, and acts as a tension band during movement

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2
Q

Spinal stenosis

A

Cord foramen diameter

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3
Q

Primary movement of the C1/Occipital joint

A

Flexion and extension

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4
Q

Primary movement of the C1/C2 joint

A

Rotation

Some flexion/extension

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5
Q

Primary movement of the lower cervical spine

A

Flexion/ Extension

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6
Q

Primary movement of the thoracic spine

A

Lateral bending and rotation

Ribs limit flexion

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7
Q

Primary movement of the lumbar spine

A

Lateral bending and flexion/extension

Pelvis limits rotation

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8
Q

Type of collagen in vertebral discs

A

Type II

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9
Q

Vertebral endplates

A

thin edges of cortical bone at vertebral articulations with discs. Diffusion across the endplates keeps cartilage healthy

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10
Q

Normal MRI changes seen in vertebral discs with aging

A

Loss of hydration (and thus T2 signal)
Loss of disc height
Endplate edema

these findings are found in pathological and nonpathological persons

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11
Q

Activities that increase risk for vertebral disc problems

A

Vibrational equipment
Repeated heavy loading
SMOKING
Genetic colalgen diseases

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12
Q

Ways to prevent IVD disease

A

Little can be done

Regular exercise
Ergonomics/ proper lifts
Good core strength

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13
Q

Referral of axial neck pain

A

Referred to the posterior neck in the correct dermatome

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14
Q

Structures that may be damaged in whiplash syndrome

A 
Anterior neck muscles (hyperextension)
Disc herniation
Cervical radiculopathy
Facet joint impaction
SYMPATHETIC PLEXUS (horner's)
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15
Q

Imagining that should be ordered with any patient presenting immediately after acute spinal trauma

A

CT
Can visualize posterior spine better than MRI

If patient is presenting weeks later, can get XR instead

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16
Q

Predictor of spinal trauma prognosis after trauma

A

Severity of symptoms, NOT speed of impact

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17
Q

Factors that increase risk of disabling pain in patients with spinal trauma

A

High pain with initial contact
Social isolation
Poor coping skills
History of chronic pain or drug abuse

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18
Q

Motor, sensory and reflex abnormalities seen with a C5 impingement

A

WEAKNESS: Deltoid, bicep
SENSORY: Lateral arm, shoulder
REFLEX LOSS: Bicep

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19
Q

Motor, sensory and reflex abnormalities seen with a C6 impingement

A

WEAKNESS: Bicep, wrist extension, pronation
SENSORY: Arm, thumb, index finger (6 shooter)
REFLEX LOSS: Bicep

20
Q

Motor, sensory and reflex abnormalities seen with a C7 impingement

A

WEAKNESS: Triceps
SENSORY: Index and long fingers (mostly long)
REFLEX LOSS: Triceps

21
Q

Motor, sensory and reflex abnormalities seen with a C8 impingement

A

WEAKNESS: Intrinsic muscles of the hand
SENSORY: Ulnar digits
REFLEX LOSS: None

22
Q

Spurlings test

A

Flexion and compression of the cervical spine to elicit pain on the flexed side with the compressed disc

(like giving them spurs in their neck)

23
Q

Imaging studies used on a suspected disc herniation

A

None, unless pain persists for >6 weeks or gets worse

24
Q

Typical treatments for an acute radiculopathy

A

Pain management >75% recover without need for surgery

25
Q

Indications for surgery in radiculopathies

A

Persistent, disabling pain
Involvement of bowel or bladder
Pain that worsens while being treated

26
Q

Treatment for cervical myelopathy

A

SURGERY, spinal ischemia can occur due to compression of the spinal cord

27
Q

Hoffman sign

A

Flexion of the fingers when flicking the nail bed
Flexion is a positive (normal test)
If Flexion is absent, suspect a cervical myelopathy (UMN problem)

28
Q

Spinal diseases that elicit pain with forward flexion

A

Lumbar disc herniation

29
Q

Spinal diseases that elicit pain with extension

A

Spondylolisthesis (pushes vertebral body further anterior)

30
Q

Motor, sensory and reflex abnormalities seen with a L4 impingement

A

Quadriceps weakness
Absent patellar reflex
Absent sensation to anterior thigh

31
Q

Motor, sensory and reflex abnormalities seen with a L5 impingement

A

Foot dorsiflexion and hallux extension weakness
Loss of sensation to lateral thigh and calf
Loss of sensation to dorsum of foot
No reflex losses

32
Q

Motor, sensory and reflex abnormalities seen with a S1 impingement

A

Foot plantarflexion weakness
Loss of sensation to Most lateral aspect of foot and small toe
Loss of achilles reflex

33
Q

Imaging ordered for lumbar nerve impingement

A

MRI ONLY if pain persists for 2-3 months

34
Q

Typical treatment options for lumbar herniated disc

A

Same as cervical: Pain treatment
Surgery only if pain is debilitating, chronic, progressive, or involves bowel/bladder

McKenzie’s extension exercises have proven effective

35
Q

Risk factors for developing spinal stenosis

A

Woman

Obese

36
Q

Spinal diseases in which pain is relieved by forward flexion

A 
Spinal stenosis (also helped with sitting)
Spondylolisthesis
37
Q

Most common causes of spinal stenosis

A 
Degeneration of the facet joints --> bone spurs and ligamentum thickening
Disc herniation
Compression fracture
Spondylolisthesis
Vertebral cysts
38
Q

Clinical presentation of Spinal Stenosis

A

Back, buttock, or leg pain
Heaviness with standing or walking
Pain relieved by sitting or flexing trunk (pulls on SC)

39
Q

Treatment options for patients with spinal stenosis

A

Similar to spondylolisthesis
Pain management
Surgery only if pain worsens, becomes chronic, or if slip becomes worse

40
Q

Spondylolysis

A

Stress fracture occurring in the pars interarticularis of the spine (most often L5) a principal factor in developing spondylolisthesis

41
Q

spondylolisthesis

A

Anterior shifting of the vertebral body after spondylolysis-, leading to a myelopathy

42
Q

Physical exam findings for patients with spondylolithesis

A 
Forward stooping (flexion relieves pain)
Negative straight leg raise (not a radiculopathy)
Palpable "step off" in lumbar spine
43
Q

Treatment of spondylolisthesis

A

Similar to spinal stenosis
Pain management
Surgery only if pain worsens, becomes chronic, or if slip becomes worse

Rest and core strengthening are also essential to healing the stress fracture

44
Q

Surgical approach to spondylolisthesis

A

Typically a fusion of L5 to the sacrum

45
Q

Clinical presentation of actue back pain

A

Sudden onset pain
Non-radiating (not radiculopathy)
Lack of numbness or weakness
Subsides in 3-5 days with RICE

46
Q

Clinical presentation of Chronic Back pain

A

Often patients are obese, or have poor lifting ergonomics or posture
Only effective treatment is exercise, and core strengthening
Weight loss is essential

MSK Cramming (9 decks)

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