ortho - spine

Question 1

spine anatomy

Answer 1

7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae

Question 2

vertebral articulation

Answer 2

• each is encapsulated in synovial joint
• often called apophyseal joints

Question 3

spinal movement

Answer 3

• collectively (large ROM)
• flex/ ext
• L & R rotation
• L & R lateral flexion

Question 4

postural alignment

Answer 4

2 natural curves of back
- lordotic (cervical & lumbar)
- kyphotic (thoracic)

Question 5

lumbar lordosis

Answer 5

• curve inwards on lower spine
• exaggeration of lumbar curve
• associated w/ weakened abdominals
• characterised by low back pain
• in gymnasts & swimmers

Question 6

thoracic kyphosis

Answer 6

• hunch on upper spine
• exaggerated thoracic curve
• occurs more frequently than lordosis
• mechanism: vertebra becomes wedge shaped = hunch
• swimmer’s back
• develops in children swimmers who train with an excessive amount of butterfly
• seen in elderly women w/ osteoporosis

Question 7

scoliosis

Answer 7

• lateral deviation of spinal column
• C / S shape
• involves thoracic &/ lumbar regions
• associated w/ disease, leg length abnormalities, muscular imbalances
• more in females
• mild to severe cases

Question 8

L3 load

Answer 8

• lowest in supine
• normal in standing
• 140% in sitting w/ no back support
• 150% when hunched
• 180% in hunched witting w/ no back support

Question 9

spine conditions

Answer 9

• lumbar disk prolapse
• degenerative disc disease
• trauma
• tumour
• infections

Question 10

trauma general

Answer 10

• upper cervical spine (C1 & C2)
• lower cervical spine (C3-C7)
• thoracic spine (#/dislocation)
• lumbar spine (#/dislocation)

Question 11

spinal injury most common

Answer 11

• lumbar 70%
• thoracic 11%
• cervical 7%
• unspecified 12%

Question 12

spinal conditions - trauma

Answer 12

• 50% trauma associated with other injuries
• MVA / sports injury
• ATLS resuscitation of pt
• x-ray before moving spine

Question 13

spinal trauma upper cervical # - C1

Answer 13

a. Jefferson #
1. burst # of C1
2. axial loading with bilateral outward displacement of lateral masses of C1

b. isolated # of posterior arch of C1
1. hyperextension with impaction of posterior arch

Question 14

spinal trauma upper cervical # - C2

Answer 14

spondylosis:
1. hangman’s # (MC)
2. hyperextension with bilateral # of pars interarticularis

Question 15

spinal trauma lower cervical #

Answer 15

1. hyperextension injuries (impact on face/neck)
2. hyperflexion
3. bilateral interfacet joint dislocation

Question 16

spinal trauma thoracic # types

Answer 16

1. wedge #
   a. simple - anterior vertebra only
   b. severe - anterior + posterior
2. flexion # dislocations

Question 17

spinal trauma thoracolumbar & lumbar spine # types

Answer 17

1. wedge #
   - # of vertebral body w/o involvement of posterior elements
2. burst #
   - vertically oriented fx w/ lateral dispersion of fragments

Question 18

Rx - spinal trauma

Answer 18

• conservative: no neurology present & depending on #
• operative: neurology / instability

Question 19

backache causes

Answer 19

• 97% mechanical
• lumbar disc prolapse
• inflammatory
• active infection
• fracture
• neoplastic
• referred pain
• functional

Question 20

prolapsed / herniated disc

Answer 20

NP - nucleus pulposus

• NP protrudes out from btw vertebrae
• nerves impinged by building NP
• = numbness/ pain

Question 21

Rx - lumbar disc prolapse

Answer 21

conservative:
- acute & chronic backache

operative:
- backache w/ neurology
- discectomy (young pt)
- discectomy + posterior spinal fusion (elderly)

Question 22

spinal infection - causes

Answer 22

• TB
• other bacterial infection
• atypical infection (fungal)

Question 23

spinal infection - investigation

Answer 23

• blood test/culture
• acid fast bacilli culture
• x-rays thoracic and lumbar spine
• MRI scan

Question 24

spinal infection - rx

Answer 24

• antibiotic
• if TB = four drugs (rufafour)
• if neurology = surgery

Question 25

progression disc degeneration

Answer 25

1. healthy 2. loss of hight, loosening of ligaments 3. disc protrusion 4. disc degeneration, osteophyte formation

Question 26

degenerative spine disease cause

Answer 26

result from degenerative changes of bone, ligaments, soft tissue

Question 27

disc degeneration features

Answer 27

triad: - disc bulge - loss of height - loss of water gas in discuvacuum phenomenon

Question 28

degenerative spine disease types

Answer 28

- spinal stenosis - spondylolisthesis & spondylolysis

Question 29

degenerative spine disease - spinal stenosis

Answer 29

- reduced caliber of spinal canal - caused: MC is degenerative changes (disc space, facet joints, lateral foramina) & (epidural lipomatosis, ossification of PLL & LF)

Question 30

degenerative spine disease - spondylolisthesis

Answer 30

degeneration changes of disc & facet joints = spinal instability = malalignment

Question 31

degenerative spine disease - spondylolysis

Answer 31

repeated minor trauma = stress # of pars interarticularis

Question 32

spine tumors types

Answer 32

- primary / secondary primary (benign/ malignant) - cartilage cells - bone cell lines - vascular cells - notochord cell lines secondary (malignant)

Question 33

spine tumor types - primary

Answer 33

benign/ malignant - cartilage cells - bone cell lines - vascular cells - notochord cell lines

Question 34

spine tumor types - secondary

Answer 34

malignant

Question 35

spine tumor investigation

Answer 35

- x-ray - CAT/CT scan - MRI scan - Biopsy

Question 36

spine tumour - benign Rx

Answer 36

- local excision & stabilisation

Question 37

spine tumour - malignant Rx

Answer 37

depend on stage of Tumor Early - excision, radiotherapy or chemotherapy Late - No surgery,only Radiotherapy or chemotherapy alone