ortho - spine Flashcards
spine anatomy
7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
vertebral articulation
- each is encapsulated in synovial joint
- often called apophyseal joints
spinal movement
- collectively (large ROM)
- flex/ ext
- L & R rotation
- L & R lateral flexion
postural alignment
2 natural curves of back
- lordotic (cervical & lumbar)
- kyphotic (thoracic)
lumbar lordosis
- curve inwards on lower spine
- exaggeration of lumbar curve
- associated w/ weakened abdominals
- characterised by low back pain
- in gymnasts & swimmers
thoracic kyphosis
- 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
scoliosis
- 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
L3 load
- lowest in supine
- normal in standing
- 140% in sitting w/ no back support
- 150% when hunched
- 180% in hunched witting w/ no back support
spine conditions
- lumbar disk prolapse
- degenerative disc disease
- trauma
- tumour
- infections
trauma general
- upper cervical spine (C1 & C2)
- lower cervical spine (C3-C7)
- thoracic spine (#/dislocation)
- lumbar spine (#/dislocation)
spinal injury most common
- lumbar 70%
- thoracic 11%
- cervical 7%
- unspecified 12%
spinal conditions - trauma
- 50% trauma associated with other injuries
- MVA / sports injury
- ATLS resuscitation of pt
- x-ray before moving spine
spinal trauma upper cervical # - C1
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
spinal trauma upper cervical # - C2
spondylosis:
1. hangman’s # (MC)
2. hyperextension with bilateral # of pars interarticularis
spinal trauma lower cervical #
- hyperextension injuries (impact on face/neck)
- hyperflexion
- bilateral interfacet joint dislocation
spinal trauma thoracic # types
- wedge #
a. simple - anterior vertebra only
b. severe - anterior + posterior - flexion # dislocations
spinal trauma thoracolumbar & lumbar spine # types
- wedge #
- # of vertebral body w/o involvement of posterior elements - burst #
- vertically oriented fx w/ lateral dispersion of fragments
Rx - spinal trauma
- conservative: no neurology present & depending on #
- operative: neurology / instability
backache causes
- 97% mechanical
- lumbar disc prolapse
- inflammatory
- active infection
- fracture
- neoplastic
- referred pain
- functional
prolapsed / herniated disc
NP - nucleus pulposus
- NP protrudes out from btw vertebrae
- nerves impinged by building NP
- = numbness/ pain
Rx - lumbar disc prolapse
conservative:
- acute & chronic backache
operative:
- backache w/ neurology
- discectomy (young pt)
- discectomy + posterior spinal fusion (elderly)
spinal infection - causes
- TB
- other bacterial infection
- atypical infection (fungal)
spinal infection - investigation
- blood test/culture
- acid fast bacilli culture
- x-rays thoracic and lumbar spine
- MRI scan
spinal infection - rx
- antibiotic
- if TB = four drugs (rufafour)
- if neurology = surgery
progression disc degeneration
- healthy
- loss of hight, loosening of ligaments
- disc protrusion
- disc degeneration, osteophyte formation
degenerative spine disease cause
result from degenerative changes of bone, ligaments, soft tissue
disc degeneration features
triad:
- disc bulge
- loss of height
- loss of water
gas in discuvacuum phenomenon
degenerative spine disease types
- spinal stenosis
- spondylolisthesis & spondylolysis
degenerative spine disease - spinal stenosis
- reduced caliber of spinal canal
- caused: MC is degenerative changes (disc space, facet joints, lateral foramina) & (epidural lipomatosis, ossification of PLL & LF)
degenerative spine disease - spondylolisthesis
degeneration changes of disc & facet joints
= spinal instability
= malalignment
degenerative spine disease - spondylolysis
repeated minor trauma
= stress # of pars interarticularis
spine tumors types
- primary / secondary
primary (benign/ malignant)
- cartilage cells
- bone cell lines
- vascular cells
- notochord cell lines
secondary (malignant)
spine tumor types - primary
benign/ malignant
- cartilage cells
- bone cell lines
- vascular cells
- notochord cell lines
spine tumor types - secondary
malignant
spine tumor investigation
- x-ray
- CAT/CT scan
- MRI scan
- Biopsy
spine tumour - benign Rx
- local excision & stabilisation
spine tumour - malignant Rx
depend on stage of Tumor
Early - excision, radiotherapy or chemotherapy
Late - No surgery,only Radiotherapy or chemotherapy alone
