Lumbar and Cervical Spine Flashcards
Function of the posterior spine
Restricts movement of the spine to protect the spinal cord, and acts as a tension band during movement
Spinal stenosis
Cord foramen diameter
Primary movement of the C1/Occipital joint
Flexion and extension
Primary movement of the C1/C2 joint
Rotation
Some flexion/extension
Primary movement of the lower cervical spine
Flexion/ Extension
Primary movement of the thoracic spine
Lateral bending and rotation
Ribs limit flexion
Primary movement of the lumbar spine
Lateral bending and flexion/extension
Pelvis limits rotation
Type of collagen in vertebral discs
Type II
Vertebral endplates
thin edges of cortical bone at vertebral articulations with discs. Diffusion across the endplates keeps cartilage healthy
Normal MRI changes seen in vertebral discs with aging
Loss of hydration (and thus T2 signal)
Loss of disc height
Endplate edema
these findings are found in pathological and nonpathological persons
Activities that increase risk for vertebral disc problems
Vibrational equipment
Repeated heavy loading
SMOKING
Genetic colalgen diseases
Ways to prevent IVD disease
Little can be done
Regular exercise
Ergonomics/ proper lifts
Good core strength
Referral of axial neck pain
Referred to the posterior neck in the correct dermatome
Structures that may be damaged in whiplash syndrome
Anterior neck muscles (hyperextension) Disc herniation Cervical radiculopathy Facet joint impaction SYMPATHETIC PLEXUS (horner's)
Imagining that should be ordered with any patient presenting immediately after acute spinal trauma
CT
Can visualize posterior spine better than MRI
If patient is presenting weeks later, can get XR instead
Predictor of spinal trauma prognosis after trauma
Severity of symptoms, NOT speed of impact
Factors that increase risk of disabling pain in patients with spinal trauma
High pain with initial contact
Social isolation
Poor coping skills
History of chronic pain or drug abuse
Motor, sensory and reflex abnormalities seen with a C5 impingement
WEAKNESS: Deltoid, bicep
SENSORY: Lateral arm, shoulder
REFLEX LOSS: Bicep
Motor, sensory and reflex abnormalities seen with a C6 impingement
WEAKNESS: Bicep, wrist extension, pronation
SENSORY: Arm, thumb, index finger (6 shooter)
REFLEX LOSS: Bicep
Motor, sensory and reflex abnormalities seen with a C7 impingement
WEAKNESS: Triceps
SENSORY: Index and long fingers (mostly long)
REFLEX LOSS: Triceps
Motor, sensory and reflex abnormalities seen with a C8 impingement
WEAKNESS: Intrinsic muscles of the hand
SENSORY: Ulnar digits
REFLEX LOSS: None
Spurlings test
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)
Imaging studies used on a suspected disc herniation
None, unless pain persists for >6 weeks or gets worse
Typical treatments for an acute radiculopathy
Pain management >75% recover without need for surgery
Indications for surgery in radiculopathies
Persistent, disabling pain
Involvement of bowel or bladder
Pain that worsens while being treated
Treatment for cervical myelopathy
SURGERY, spinal ischemia can occur due to compression of the spinal cord
Hoffman sign
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)
Spinal diseases that elicit pain with forward flexion
Lumbar disc herniation
Spinal diseases that elicit pain with extension
Spondylolisthesis (pushes vertebral body further anterior)
Motor, sensory and reflex abnormalities seen with a L4 impingement
Quadriceps weakness
Absent patellar reflex
Absent sensation to anterior thigh
Motor, sensory and reflex abnormalities seen with a L5 impingement
Foot dorsiflexion and hallux extension weakness
Loss of sensation to lateral thigh and calf
Loss of sensation to dorsum of foot
No reflex losses
Motor, sensory and reflex abnormalities seen with a S1 impingement
Foot plantarflexion weakness
Loss of sensation to Most lateral aspect of foot and small toe
Loss of achilles reflex
Imaging ordered for lumbar nerve impingement
MRI ONLY if pain persists for 2-3 months
Typical treatment options for lumbar herniated disc
Same as cervical: Pain treatment
Surgery only if pain is debilitating, chronic, progressive, or involves bowel/bladder
McKenzie’s extension exercises have proven effective
Risk factors for developing spinal stenosis
Woman
Obese
Spinal diseases in which pain is relieved by forward flexion
Spinal stenosis (also helped with sitting) Spondylolisthesis
Most common causes of spinal stenosis
Degeneration of the facet joints --> bone spurs and ligamentum thickening Disc herniation Compression fracture Spondylolisthesis Vertebral cysts
Clinical presentation of Spinal Stenosis
Back, buttock, or leg pain
Heaviness with standing or walking
Pain relieved by sitting or flexing trunk (pulls on SC)
Treatment options for patients with spinal stenosis
Similar to spondylolisthesis
Pain management
Surgery only if pain worsens, becomes chronic, or if slip becomes worse
Spondylolysis
Stress fracture occurring in the pars interarticularis of the spine (most often L5) a principal factor in developing spondylolisthesis
spondylolisthesis
Anterior shifting of the vertebral body after spondylolysis-, leading to a myelopathy
Physical exam findings for patients with spondylolithesis
Forward stooping (flexion relieves pain) Negative straight leg raise (not a radiculopathy) Palpable "step off" in lumbar spine
Treatment of spondylolisthesis
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
Surgical approach to spondylolisthesis
Typically a fusion of L5 to the sacrum
Clinical presentation of actue back pain
Sudden onset pain
Non-radiating (not radiculopathy)
Lack of numbness or weakness
Subsides in 3-5 days with RICE
Clinical presentation of Chronic Back pain
Often patients are obese, or have poor lifting ergonomics or posture
Only effective treatment is exercise, and core strengthening
Weight loss is essential
