Ortho unit 2 Flashcards
what are spondylitides
the non nervous tissue in the spine
what are spondylitis
abnormalities in the spondylitides
structural abnormalities can occur locally causing compression of the SC, or nerve roots. v rare to have abnormalities in the nervous tissue
difference between referred pain and nerve root pain
hard to pin point pain in the back
pain in back may be refereed to bum, thigh, leg - descending as far as mid calf. pain may be referred from the neck shoulder or arm.
nerve roots come out of formaina in the vertebra. they are surrounded by facet joints behind and intervertebral discs in front. disease of facet joint - inflam/pressure/swelling of nerve roots . brain interprets this as pain in the spinal nerve emerging from that nerve root . common in lower lumbar region so pain is perceived in sciatic nerve (sciatica) pain down back of leg and almost always into the foot, can be exaggerated by coughing.
in cervical region, hand forearm are often ass. with tingling. nerve root pain may be ass. with loss of sensation or muscle weakness. these features= localising signs
describe back sprains and treatment
poor lifting, ligament injuries, twisting. no signs of nerve compression.
briefly rest then return to normal activity. anti-infams and simple analgesia
describe mechanical backache
cause unknown
possible causes:
- spondylosis - degeneration of intervertebral disc so more load on facet joints so secondary arthritis
- primary arthritis (facet joints are synovial)
most learn to live with it and get support from specialists and physio. should get better with time
what is spondylolisthesis
slippage of one vertebra relative to the one below. common in lumbar . caused by a bony abnormality which interferes with the stability of facet joints and associated bony and ligamentous elements. may be congenital or acquired (following an acute or more likely fatigue fracture of the parsarticularis = spondylolysis)
symptoms of spondylolisthesis and diagnosis
low back pain
diagnose with x ray. if severe may feel a step
very rarely causes neuro problems
management of spondylolisthesis
spinal corset can relieve pain. dont usually need surgery but if severe pain 2 vertebrae can be fused
what is spondylolysis
pars interarticularis defect such as a fracture but there is no slippage of vertebra. this can exist with no pain. if pain is experienced conservative management usually works, if not fuse
what is disc prolapse and when does it happen
can occur in cervical or lumbar. usually men <40.
acute backache and legache. can occur spontaneously. characteristically - leg ache down back of leg into foot.
abnormality in intervertebral disc - prolapse of nucleus pulpus through the annulus fibrosis. if it extrudes back an lateral it impinges on nerve root. if it extrudes posteriorly it can hit SC or cauda equina. occasionally the peripheral nerve to a muscle or group of muscles pr skin is affected - weakness/numbness
ensure bladder/bowel not affected
need to rest and progressive mobilisation. analgesia and anti-infams drugs. most recover spontaneously. of pain persists the disc material can be removed. radiopaque dye is injected into spinal fluid then take x-ray - the fluid wont be able to flow where prolapse disc presses nerve (technique = myleography and the picture is the myleogram)
what is bony root entrapment
usually >40 with prev history of back ache. develop new symptom of pain radiating to foot, made worse by exercise (spinal claudication). episodes are acute and recurrent on a background pf back pain. physio wont help, surgery in severe cases
usually due to bony overgrowth around vertebral foramina where roots emerge, appears to be secondary degenerative in the adjacent facet joints. may be due to primary OA or result of disc degeneration.
removal of disc may make it worse, bone removal is needed to release the nerve roots. this may cause spinal instability so may need to fuse vertebrae.
cervical spondylosis
DEGENERATION OF IVD
degenerative disc and joint disease. aetiology same as lumbar
>40 and women
dull neck ache often refferred to shoulders and upper arms, maybe tingling. process can be progressive and bony root entrapment may occur with localising, neurological signs.
if no neuro signs - analgesics, nsaids, soft collar, physio for muscle spasm. recurrent attacks common.
if nerve root entrapment is confirmed then fusion of vertebrae and decompression of the nerve root may be necessary
cervical disc disease
similar pattern to lumbar but not as common. lower cervical discs more common that upper. pain and referred pain. hard to differentiate from spondylosis but in disc disease patients tend to not have prev neck ache. after prolapse the neck muscles may be in spasm and movement is therefore restricted.
most recover with rest, gentle traction and wearing a collar. if localising signs are marked/symptoms dont go then consider fusion.
