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ClinMed Exam 1 - Spring > Pathologies Related to the Low Back #1 > Flashcards

Pathologies Related to the Low Back #1 Flashcards

1
Q

What is the number one form of spinal malignancy?

A

Multiple myeloma

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2
Q

What is the second most common spinal malignancy?

A

Spinal metastases

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3
Q

Which region is the most common region for spinal malignancy?

A
  • Thoracic is most common by far (70%)
  • Then lumbar
  • Rarely cervical
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4
Q

About what present of spinal malignancies create cord compressions or myelopathies?

A

20%

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5
Q

What is primarily a malignant tumor in bone marrow and typically found in older individuals?

A

Multiple myeloma

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6
Q

What is the most common tumor of the spine and the second most common serious spinal pathology?

A

Spinal metastases

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7
Q

Where are spinal metastases most often found?

A

Breast, Lung, Prostate, Kidney, GI, Thyroid (in that order)

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8
Q

What is the 3rd most common area of metastasis behind the lung and the liver?

A

Bone

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9
Q

Where are spinal metastases most often found in bone?

A

In the vertebral body (mostly in the anterior portion leading to wedging)… disc is rarely involved

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10
Q

What is the most useful indicator of a spinal malignancy?

A

97% of spinal tumors are the results of metastasis meaning that PMH of cancer is the most useful indicator

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11
Q

What is the gold standard for imaging for spinal malignancy?

A

MRI

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12
Q

What is the pathogenesis of spinal malignancy?

A

Healthy bone replaced by tumor

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13
Q

What are PT implications of spinal malignancy?

A
  • Cancer signs and symptoms like spinal pain (most common initial symptom) and unfamiliar/ severe pain that may become progressive and constant
  • Possible bony alterations, including fractures and subsequent joint instability: may be able to lie flat due to the pain, and it is likely mechanical pain
  • Biomechanical components that stress vertebral body and lumbar joints will possibly be (+)
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14
Q

What are signs and symptoms of cancer?

A
  • History of cancer
  • Pain in local or referred areas
  • Nausea and vomiting
  • Loss of appetite
  • Unexplained weight loss of greater than or equal to 5-10% over a 3-6 month period
  • Fever, chills, sweats (night): even in absence of infection due to increased circulating white blood cells (WBCs) or production of pyrogen agent
  • Swollen and non-tender lymph nodes, possibly hard and immobile due to fibrosis
  • Unusual malaise and fatigue
  • Secondary infections due to lowered immunity
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15
Q

What does pain with cancer look like?

A
  • Worsens as the tumor grows and encroaches on other tissue with more inflammation
  • Especially at night, due to tumors metabolic activity, and likely at a similar time after falling asleep
  • Often invariable with position or movement
  • May become constant
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16
Q

What signs and symptoms would likely be present due to involvement of the vertebral body in spinal malignancies?

A
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17
Q

What kind of referral is a spinal malignancy?

A

Urgent referral to an MD unless there are cord signs and symptoms you would want to immobilize for emergency referral

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18
Q

What is the pathogenesis of a lumbar myelopathy?

A

Slow, gradual, and often progressive compression of the cord

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19
Q

What level is the end of the spinal cord?

A
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20
Q

What is the second most common area of the spine for compression?

A

Lumbar spine

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21
Q

Are lumbar myelopathies due to trauma?

A

No

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22
Q

Lumbar myelopathies are most commonly due to what?

A

Degenerative spinal changes such as:
- Lax and buckling ligamentum flavum
- Age-related joint disease with enlarging and encroaching arthritic bone aka stenosis
- Age-related disc disease with herniations
- Vertebral body collapse/ fracture
- Pathological instability (ex: spondylolisthesis)

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23
Q

How often are malignancies are a part of lumbar myelopathies?

A

20% of the time with the only well validated red flag being a history of cancer

24
Q

Can you have central disc herniations with lumbar myelopathies?

A

Yes, but they are rare

25
Q

What kind of history might you see with lumbar myelopathy?

A

Slow, gradual, and often progressive onset

26
Q

What might you observe with lumbar myelopathy?

A

Not acute so not likely to splint

27
Q

What kind of A/PROM might you see with lumbar myelopathy?

A

Extreme spinal pain with mechanical reproduction with scan and biomechanical exam, possibly for age-related changes, vertebral body, instability

28
Q

Are PAs positive or negative with lumbar myelopathies?

A

Positive for neuro symptoms

29
Q

What kind of neuro symptoms might you see with lumbar myelopathy?

A
  • Multisegmental numbness and weakness/ paralysis of lower extremities and trunk below level of injury likely leading to impaired balance
  • Hyperactive DTRs
  • Spastic or retentive bowel or bladder
  • Positive UMN tests
  • Negative dural mobility due to gradual onset
  • Hypoactive superficial reflexes
30
Q

What kind of referral is lumbar myelopathy?

A

Immobilize with emergency referral

31
Q

What is cauda equina syndrome?

A
  • Compression on some degree of the 20 spinal nerves that originate from the end of the spinal cord or conus medullaris in the vertebral canal
  • Acute or chronic
  • Below the L1 or L2 segment
32
Q

What is the prevalence of cauda equina syndrome?

A

Rare with 2% of lumbar age-related disc changes

33
Q

What is the etiology of cauda equina?

A
  • Primarily due to mid to lower lumbar age-related disc changes
  • Secondarily due to other degenerative spinal changes and malignancy
34
Q

What are the risk factors of cauda equina?

A
  • Mid to lower lumbar persistent IDD (central > posterolateral IDD), central stenosis, surgery
  • Less than 50 years old
  • Obesity
35
Q

What are the differences between myelopathy and cauda equina syndrome?

A
36
Q

What kind of history will someone with cauda equina syndrome present with?

A
  • LBP
  • Bowel and bladder incontinence
  • Sexual dysfunction
  • Possible cancer signs and symptoms if malignancy contributing
37
Q

What movements are worse and what movements are better with cauda equina syndrome?

A

Likely limited and worse with extension and better with flexion activities

38
Q

What kind of neuro signs will you find with cauda equina syndrome?

A
  • Progressive or even alternating LE/patchy findings due to movement of spinal nerve
  • Paresthesias and decreased sensation in multiple dermatomes: particularly saddle or groin area
  • Multiple myotomal weaknesses and gait abnormality
  • Hypo-activity with DTRs
  • Possible positive dural mobility tests
39
Q

What kind of referral is cauda equina syndrome?

A

Likely emergency referral due to multiple spinal nerve involvement

40
Q

What imaging is gold standard for cauda equina?

A

MRI

41
Q

What is a spinal infection?

A

Infectious disease of spinal structures

42
Q

What is osteomyelitis?

A

A bone infection

43
Q

What is discitis?

A

A disc infection

44
Q

What is the incidence level of spinal infections?

A
  • Uncommon in wealthier countries, but resurgence with longevity and IV drug use
  • Discitis more common in lumbar spine
45
Q

What is the etiology of spinal infections?

A
  • Primarily from air born bacteria
  • Secondarily, staph bacteria may also be involved
46
Q

What are risk factors (all low evidence) of spinal infection?

A
  • Immunosuppression
  • Surgery, particularly of the spine and repeated procedures
  • IV drug use
  • Social depravation
  • History of TB or another recent infection
47
Q

What is the pathogenesis of spinal infections?

A
  • May take days, months or years to spread to the spine
  • Infection spreads to disc more commonly in lumbar spine
  • Not common but as abscess grows the following may occur… nerve root irritation, vertebral body collapse or fracture, and cord compression may develop
48
Q

What are the PT implications of spinal infection?

A
  • Age related changes with back pain and stiffness is most common presenting symptom (early signs and symptoms)
  • Constitutional and infection symptoms not common initially
49
Q

What are infection signs and symptoms?

A
  • Malaise (most common early symptom)
  • Fever, chills, sweats
  • Nausea and vomiting
  • Enlarged (lymphadenopathy) and likely tender lymph nodes
  • Redness (maybe lymphangitis or streaks toward lymph nodes), abscess, heat, and/or swelling
  • Specific infected system signs and symptoms as well
50
Q

What kind of (low evidence) implications can spinal infections have?

A
  • Localized and progressive spinal pain that limits motion
  • Likely mechanical pain for disc is greater than vertebral body involvement with scan and biomechanical exam
  • Infection signs and symptoms like abnormal fatigue and fever since onset of the back pain
51
Q

If spinal infection is untreated what can happen?

A
  • Unexplained weight loss of greater than or equal to 5-10% over a 3-6 month period with loss of appetite
  • Neurological signs and symptoms influence the lower extremities and coordination as well as bowel and bladder dysfunction
  • Loss of lumbar lordosis
52
Q

What kind of referral is a spinal infection?

A

Urgent referral unless cord or cauda equina signs and symptoms then emergency referral to MD

53
Q

X-rays are helpful in spinal infections if you are suspicious of what?

A

TB

54
Q

What is the image of choice if TB is not in question for a spinal infection?

A

MRI, can observe infection 3-5 days after onset

55
Q

How are blood tests helpful in spinal infections?

A
  • Not diagnostic
  • Inflammatory markers (ex: RBC and C-reactive protein are better indicators of infection than WBC)
  • Presence of normal WBC does not exclude a spinal infection

ClinMed Exam 1 - Spring (4 decks)

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