Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Mini Symposium - Spine > Flashcards

Mini Symposium - Spine Flashcards

1
Q

What are orthopaedic causes of unsteady gait?

A

Myelopathy (slipped disc)
L5 radiculopathy
Antalgic gait caused by sciatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can you pick up unsteady gait/problems with balance?

A

Dynamic Romberg’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What spinal segments maintain continence?

A

S234 supply the doors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Distinguish between an upper motor neuron problem and a lower motor neuron problem

A

UMN - in spinal cord

LMN - in peripheral nerve after it’s left spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features of an L5 radiculopathy?

A

High stepping gait (compensatory high lifting of leg to prevent foot dragging as there is weakness of dorsiflexion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is sciatica?

A

Pain/tingling/numbness/weakness in back, bottom of legs, feet/toes that is usually worse on physical activities

Not just back pain!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can cause sciatica?

A

Degenerative disc disease and herniation
Tumour
Trauma
Infection
Trapped nerve
–> compression of sacral nerves/sciatic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can you test for L4 and 5 function?

A

Get patient to walk on heel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can you test the gastrocnemius and soleus function (S1)?

A

Walk on tiptoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can you test for sciatica?

A

Straight leg raise will recreate sciatica pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What two differentials must you exclude when people present with seemingly orthopaedic spine problems?

A 
Vascular problems (check pulses) 
Hip arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can you test for protrusions at L2-3 and L3-4?

A

Femoral stretch test - passively flex knee to thigh and extend hip
+ve if anterior thigh pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause focal bony tenderness?

A

Trauma
Tumour
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where does muscle attach on to vertebrae?

A

Spinous processes and transverse processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the lordoses and kyphoses of the spine?

A

Lumbar and cervical lordoses

Thoracic and sacral kyphoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of the lordoses and kyphoses are most mobile?

A

Lordoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the majority of spinal surgery for?

A

Releasing a trapped nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What movements occur at the spine?

A

Depends where it is

Flexion, extension, lateral flexion, rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How many vertebrae are there?

A 
33 in total
7 cervical
12 thoracic
5 lumbar 
5 sacral 
variable coccygeal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the coronal alignment of the spine?

A

Should be straight

If not - ?scoliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the long group of muscles on the back?

A

Erector spine - consists of spinalis, longismus, iliocostalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the function of the erector spinae muscles?

A

Erect the spine and maintaining the spine in the erect position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where do spinal nerves leave the spine?

A

Via foramen BELOW the corresponding pedicle (apart from C8 - as only 7 lumbar vertebrae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where does the spinal cord end?

A

As conus medullaris at L1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define dermatome

A

Sensory area of skin supplied by a single spinal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the L2 dermatome?

A

Speedo region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define myotome

A

Group of muscle supplied by one spinal segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the upper limb myotomes?

A 
C5 - shoulder abduction (deltoid) 
C6 - biceps (elbow flexion) 
C7 - wrist extension (triceps)
C8 - finger flexion (FDS and FDP)
T1 - finger abduction (interossei)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the lower limb myotomes?

A 
L2 - hip flexion (iliopsoas) 
L3/4 - knee extension (quadriceps) 
L4 - ankle dorsiflexion (anterior tibialis) 
L5 - big toe extension (EHL) 
S1 - ankle plantarflexion (gastroc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a useful rhyme to remember the myotomes associated with different reflexes in the limbs?

A

1, 2 buckle my shoe (ankle jerk - S1, 2)
3, 4 kick the door (patellar tendon L3-4)
5, 6 pick up sticks (brachioradialis/biceps - C5-6)
7, 8 close the gait (triceps C7-8)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

15% of people with fractures or dislocations of the spine will have what?

A

Spinal cord injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

In what gender and age group do SCI occur more often?

A

Males

Peak is 20-29 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the most common causes of SCI?

A 
Degenerative orthopaedic causes
Tumours
Spinal cord stroke
Transverse myelitis
Thoracoabdominal aortic aneurysm 
FALLS MOST COMMON
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the difference between a complete and an incomplete SCI?

A

Complete = complete loss of sensation and motor function below SCI (no anal squeeze, acral sensation or chance of recovery)

Incomplete = lesions of ascending/descending spinal tract where some function is present below site of lesion - better prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can cause an incomplete spinal lesion?

A

Trauma
Spinal compression
Occlusion of spinal arteries

E.g.s - central/anterior/posterior cord syndrome and brown sequard syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What must you be aware of when diagnosing complete or incomplete SCI?

A

Patient may be in spinal shock - acute physiological loss or depression of spinal cord function for hrs-weeks after SCI) - lose all sensorimotor functions below level of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the ASIA classification?

A

Used to measure severity of SCI

Grade A - complete spinal injury (no sensory/motor function in S4-5)

Grade B - incomplete; sensory but no motor function below SCI (extending to S4-5)

Grade C - incomplete; motor function preserved below SCI, maj key muscles grade <3 (active RoM without gravity)

Grade D - incomplete; motor function preserved below SCI; maj key muscles grade >3 (full active RoM with gravity)

Grade E - normal sensation and motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is tetra/quadriplegia?

A

Partial/total loss of use of all four limbs and the trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is quadriplegia normally due to?

A

Cervical spine injury, e.g. cervical fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why would you be really concerned about damaging C3, 4 or 5 nerve roots?

A

As they make up the phrenic nerve which supplies the diaphragm and therefore are responsible for breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What may you also see in quadriplegia?

A

Spasticity and other UMN signs if the damage is above L1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is paraplegia?

A

Total/partial use of the lower limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the clinical features of paraplegia?

A 
Arm function spared 
Possible involvement of trunk 
Motor/sensory impairment in thoracic/lumbar/sacral segements 
Spasticity if above L1
Bowel/bladder affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What may cause paraplegia?

A

Thoracic/lumbar fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is central cord syndrome?

A

Injury to the central region of the spinal cord

Tends to be cervical central tracts affected

46
Q

In which group of people is central cord syndrome more common?

A

Elderly with pre-existing degenerative changes (e.g. arthritic neck)

47
Q

What is the aetiology of central cord syndrome?

A

Degenerative spine dx, traumatic disc herniation, various hyperextension injuries (e.g. whiplash)

48
Q

Does central cord syndrome affect the arms or legs more?

A

More arms
(can still walk)
Still have perianal sensation and lower extremity power

49
Q

What is anterior cord syndrome?

A

Damage to the anterior 2/3rd of spinal cord

50
Q

What tends to cause anterior cord syndrome?

A

Reduced BP/occlusion of anterior spinal artery (e.g. arteriosclerosis, vasculitis, thrombosis)

Other causes: trauma (e.g. penetrating trauma), anterior compression fracture, hyperflexion injury w. vertebral instability, pathological compression (e.g. tumours)

51
Q

What are the signs and symptoms of anterior cord syndrome?

A

Fine touch and proprioception preserved by profound weakness

52
Q

What is brown sequard syndrome?

A

Damage to a hemisection of the cord

53
Q

What are the aetiologies of brown sequard syndrome?

A

Tends to be penetrating injuries or disc herniation

54
Q

What are the signs and symptoms of brown sequard syndrome?

A

Ipsilateral loss of proprioception, vibration, tactile discrimination below level of lesion

Contralateral loss of pain, temperature sensation below level of lesion

55
Q

How do you manage SCI?

A

Prevent secondary injury - avoid HTN, hypovolaemia, inadequate BS, blood loss, immobilise patient, do ATLS resus, give appropriate Rx/surgical care

56
Q

What is involved in the ABCD/ATLS of SCI?

A

Airway and C spine control
Breathing (ventilation and oxygenation)
Circulation - IV fluids, consider neurogenic shock
Disability - assess neurologic function, include PR and perianal sensation, log roll and document
ASIA assessment

57
Q

What is neurogenic shock?

A

Response of the body to a spinal cord injury that leads to the disruption of the sympathetic system

58
Q

What are the signs of neurogenic shock?

A

Hypotension
Bradycardia
Hypothermia

59
Q

What can cause neurogenic shock?

A

Injuries above T6

60
Q

What kinds of imaging can be used to diagnose SCI?

A

Xray
CTS good for bony anatomy
MRI - if neurological deficit or children

61
Q

What are the clinical features of spinal shock?

A

Transient depression of cord function below level of injury

–> flaccid paralysis, areflexia

62
Q

What are causes of broken spinous processes?

A

Tends to be car accidents, fall or hyperflexion injuries

63
Q

How do you manage broken spinous processes?

A

Surgical fixation for unstable fractures (mostly done from posterior with pedicle screws)

64
Q

What are the long term managements for SCI?

A 
SCI unit 
Physio
OT 
Psychological support
Urological/sexual counselling
65
Q

What kind of joint is the IV disc?

A

Secondary cartilaginous

66
Q

Hoes the IV disc get its nutrient?

A

Its avascular so relies on end plates of bone on either side

67
Q

What is the structure of an IV disc?

A

Outer tough, cartilaginous annulus fibrosis

Inner, gelatinous nucleus pulposis (88% water, collagen and proteoglycans)

68
Q

What is the purpose of the annulus fibrosis? How does its structure compensate for this?

A

Resists rotational movements as fibres run obliquely and alternatively between the layers

69
Q

Define disc protrusion

A

Pressure on vertebrae causes nucleus pulposus to move and press against annulus fibrosis

This bulge can compress a spinal nerve and cause pain

70
Q

Define disc herniation/prolapse

A

A tear in annulus fibrosis allows extrusion of nucleus pulposus and potential compression of spinal nerve

71
Q

In what direct do discs tend to herniate and why?

A

Posteriolaterally due to the thin posterior longitudinal ligament

72
Q

What can result from disc herniation?

A

Pressure on nerve root (radiculopathy)

Pressure on the central canal (myelopathy)

73
Q

Define disc extrusion

A

Through annulus but in continuity

74
Q

Define sequestration

A

Desicated disc material free in canal

75
Q

What are the most common symptoms of disc disease?

A

Radicular pain in dermatome of compressed nerve root, muscle weakness and loss of deep tendon reflexes

76
Q

How can you diagnose a lumbar disc prolapse?

A

MRI will confirm diagnosis

77
Q

What is involved in the normal ageing process of the IV discs?

A

Water content decreases
Disc space narrows
Degenerative changes on XRay (sclerosed, dehydrated)
Degenerative changes in the facet joint (can become misaligned)

78
Q

What things will aggravate the normal ageing process of the IV discs?

A

Smoking, genetic predisposition, heavy manual work etc.

79
Q

Define spondylolysis

A

Lytic defect in pars interarticularis, permitting forward slippage of superior vertebrae

80
Q

Define spondylolisthesis

A

Vertebral body slips forward/backwards in relation to the vertebral body above it

81
Q

How do you manage spondylolisthesis?

A

Conservative, lifestyle changes, surgery for persistent pain/nerve root entrapment

82
Q

What is nerve root pain?

A

Pain/weakness/numbness in the nerve root distribution (radiculopathies) due to compression of the nerve root

83
Q

What is the most common cervical disc prolapse?

A

C5/6

84
Q

What are the least common disc prolapses?

A

Thoracic (most T11-12 in thoracic region, however)

85
Q

What is the management for thoracic disc prolapses?

A

Don’t do much unless impeding paralysis - in which case remove it

86
Q

What are the most common lumbar disc prolapses?

A

L4/5 or L5/S1

87
Q

L5/S1 IV disc prolapse affects what nerve and leads to what symptoms and signs?

A

S1

Sensory loss over little toe and sole of foot, weakness in plantarflexion of foot and reduced/no ankle jerk

88
Q

L4/5 IV disc prolapse affects what nerve and leads to what symptoms and signs?

A

L5
Sensory loss over great toe and first dorsal webbed space
Weakness in EHL

89
Q

L3/4 IV disc prolapse affects what nerve and leads to what symptoms and signs?

A

Sensory deficit in medial aspect of lower leg
Motor weakness in quads
Knee jerk diminished/absent

90
Q

Define cauda equina syndrome

A

Damage/compression of the cauda equina (incl. nerve roots below L2)

91
Q

What are the aetiologies of cauda equina syndrome?

A

Central lumbar disc prolapse (most common)
Tumours
Trauma (burst, or chance fracture)
Spinal stenosis
Infection (epidural abscess)
Iatrogenic (surgical, manipulation, spinal epidural injection)

92
Q

What are the clinical features of cauda equina syndrome?

A

Injury/precipitating event
Bilat buttock pain and leg pain, varying dysaesthesia/weakness
Bowel and bladder dysfunction (urinary retention +/- incontinence overflow)
PR exam - saddle anaesthesia, loss of perianal sensation, anal tone and anal reflex

93
Q

When should you have a high index of suspicion for cauda equina syndrome?

A

Spinal post-op patients w. increasing leg pain and urinary retention

94
Q

How do you investigate cauda equina syndrome?

A

Urgent MRI

If CI - lumbar CT myelogram

95
Q

What is the treatment for cauda equina syndrome?

A

Emergency surgery within 48h

Remove disc, wash away haematoma, reconstruct vertebrae to take pressure off tumour etc. etc.

96
Q

What is the prognosis of cauda equina syndrome?

A

Worse the later its treated

Can result in permanent bladder and anal dysfunction and incontinence

97
Q

Define spondylosis

A

Broad term used to describe degenerative changes of the spine that may cause irritation/damage to the nerve roots

98
Q

Where do degenerative changes occur in spondylosis?

A

Facets, discs, joints, ligaments etc.

99
Q

What is the pathophysiology of spondylosis?

A

Discs dehydrate –> facets become misaligned as disc height reduces –> misaligned vertebral canal –> myelopathy
Joints become arthritic and osteophytes appear putting pressure on nerves –> radiculopathies

Shrinkage of disc leads to ligamentum flavum buckling in and encroaching into the canal –> pressure on caudal equina (not caudal equina syndrome as it is slow changes)

100
Q

What are the ligaments supporting the spine?

A

Anterior longitudinal ligament - along front of vertebral bodies, broad, strong

Posterior longitudinal ligament - along backs of bodies

Ligamentum flavum - between laminae

Interspinous and supraspinaous ligaments between the spinous processes

Intertransverse ligament between transverse processes

101
Q

Define spinal claudication

A

Common symptom of spinal stenosis, causing impingement or inflammation of nerves coming off the spinal cord due to marked narrowing of the spinal cord

102
Q

How can you distinguish between spinal and vascular claudication?

A

Usually bilateral radiation of buttocks/legs vs unilateral calf pain
Sensory dysaesthesia
Possible weakness (e.g. foot drop)
Takes several mins to ease after stopping walking
Walking downhill worse (as spinal canal smaller in extension), walking better uphill/ridding bike

103
Q

Define spinal stenosis

A

Disease caused by narrowing of central spinal canal, lateral recess and/or neural foramen –> progressive nerve root compression

104
Q

What tends to cause spinal stenosis?

A

Degenerative spinal changes (i.e. spondylosis and spondylolisthesis)

105
Q

What is lateral recess stenosis?

A

Narrowing of the rear sides of the spinal canal

106
Q

How do you treat lateral recess stenosis?

A

Nerve root/epidural injection or operative

107
Q

What is central spinal stenosis?

A

Narrowing of the central canal

108
Q

How do you treat central spinal stenosis?

A

Epidural steroid injection or surgery

109
Q

What is foraminal spinal stenosis?

A

Narrowing as the nerve root is about to leave the transverse foramina

110
Q

How do you treat foraminal spinal stenosis?

A

Nerve root/epidural injection or surgery

MSK (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions