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Clin Med I-II > Pathologies Related to The Low Back I > Flashcards

Pathologies Related to The Low Back I Flashcards

1
Q

Spinal Malignancy: Incidence
-what is the primary malignant tumor and its location?
-typically seen in ______ ______

A

multiple myeloma; bone marrow
older adults

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2
Q

Spinal Metastases - secondary or primary?

________ MOST common tumors of the spine

A

secondary
2nd

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3
Q

Spinal Metastases is MOST often from ________,_______,______,________,______ and _________in that order.

A

breast, lung, prostate, kidney, GI, and thyroid tumors
(BL PK GT)

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4
Q

What is the 3rd MOST common area of metastasis, behind lung and liver

A

Bone

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5
Q

The ______ _________ is the MOST common structure for bone metastasis MOSTLY in the ________ portion leading to wedging

-_______ is rarely involved

A

vertebral body; anterior

disc

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6
Q

What is the most common region for spinal metatatsis?

A

thoracic 70% > lumbar

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7
Q

What is the most useful indicator of spinal malignancy?

A

PMH of cancer; 97% of spinal tumors are the result of metastasis

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8
Q

Pathogenesis of spinal metastasis is

A

healthy bone replaced by tumor

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9
Q

What is the common initial symptom of spinal malignancy?

A

spinal P!; unfamiliar or severe P! may become progressive

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10
Q

______________ S&S include possible myelopathy bony alteration, fxs, and joint instability unable to lie flat due to P!

-likely mechanical P! or no?
-stress test _____ for bone involvement

A

spinal malignancy
Yes
(+)

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11
Q

Spinal Malignancy referral?

A

urgent referral to MD unless cord S&S

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12
Q

Slow, gradual, and often progressive compression of the cord is known as

A

lumbar spinal cord myelopathy

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13
Q

What region is the 2nd most common area for spinal myelopathy?

A

lumbar

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14
Q

Spinal Myelopathy is most commonly due to

A

degenerative spinal changes
-lax and bulking ligamentum flavum
-age-related joint disease w/enlarging and encroaching arthritic bone (stenosis)
-age-related disc disease w/herniations
-vertebral body collapse/fx
-spondylolisthesis

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15
Q

Central disc herniation is rare? T or F

A

true

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16
Q

Lumbar spinal cord myelopathy S&S:
sensation
DTRs
Myotomes
Bowel/Bladder
Clonus/Babinksi
Superficial reflexes

A

hyposensitivity
hyperreflective
fatiguing
retentive/spastic
positive
hypoactive

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17
Q

Lumbar spinal myelopathy referral

A

immobilize emergency referral

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18
Q

What is cauda equina syndrome:

A

compression on some degree of the 20 spinal nn. that originate from the end of the spinal cord or conus medullaris in the vertebral canal

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19
Q

Where does the cauda equina begin?
Is cauda equina syndrome common?

A

below L1,L2 segment
no, rare 2% of lumbar age-related disc changes

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20
Q

Cauda equina is primarily due to:
-primary
-secondary

A

mid to lower lumbar age-related disc changes

secondarily due to other degenerative spinal changes and malignancy

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21
Q

Cauda equina syndrome risk factors:

A

mid to lower lumbar
persistent IDD, central > postlat IDD
central stenosis
Sx
<50 yrs.
Obesity

22
Q

Clinical S&S of Cauda Equina Syndrome –Hx including:

A

LBP
Bowel and Bladder incontinence
Sexual dysfunction
Possible cancer S&S
Unilateral or Bilateral LE and patchy neuro S&S (not consistent)

23
Q

Cauda Equina Syndrome:
sensation
DTRs
Myotomes
Dural Mobility

A

diminished/decreased
hypoactive
fatiguing
(+)

24
Q

PT implications: cauda equina syndrome is _____ referral

_________is gold standard

A

emergency referral due to multiple spinal nn. involved

MRI

25
Q

what is a spinal infection?

A

infectious disease of spinal structures

26
Q

what is osteomyelitis? discitis?

A

bone infection
disc infection - more common in lumbar

27
Q

how prevalent are spinal infections?

A

uncommon in wealthier countries - resurgence with longevity and IV drug use

28
Q

what is the cause of spinal infections?

A

primarily from mycobacterium TB
staphylococcus aureus and brucella are also involved at times

29
Q

what are risk factors for spinal infections?

A

immunosuppression
surgery, particularly of the spine and repeated procedures
IV drug use
social depravation
Hx of TB or another recent infection

30
Q

how does spinal infections develop? where does it commonly spread to?

A

2-3 years after initial air droplet infection into lungs
spreads within the body through lymph and blood
as abscess grows, nerve root irritation, vertebral body collapses and cord compression may develop
spreads to disc more commonly in lumbar spine

31
Q

what are early S&S of spinal infection? what are not common initially?

A

age related changes with back p!/stiffness is most common
constitutional symptoms NOT common initially

32
Q

what are S&S of spinal infection?

A

localized and progressive pain that limits motion
likely mechanical P! for disc but possibly vertebral body involvement
stress tests (+) for disc
infection S&S
– abnormal fatigue
– fever since onset of back P!
unexplained weight loss of > 5-10% over a 3-6 month period
possible TTP, percussion, vibration

33
Q

what S&S could show if spinal infections are left untreated?

A

neuro S&S influence the LEs, coordination, bowel and bladder dysfunction
loss of lumbar lordosis

34
Q

what referral would a spinal infection be?

A

urgent unless cord S&S

35
Q

what is the best imaging for a spinal infection?

A

MRI
otherwise can observe infection 3-5 days after onset

36
Q

why would one order an x ray for a spinal infection?

A

if suspicious of TB

37
Q

what is ankylosing spondylitis?

A

a type of spondyloarthropathy or spondyloarthritide

38
Q

what are the two causes of ankylosing spondylitis?

A

genetics (90% (+) for HLA-B27 antigen)
environment

39
Q

what condition is almost as common as RA?

A

ankylosing spondylitis

40
Q

who has a higher prevalence of getting ankylosing spondylitis?

A

15-30 year olds
2-3x more likely males vs females

41
Q

what region is ankylosing spondylitis most common in?

A

lumbosacral region

42
Q

how does ankylosing spondylitis develop?

A

chronic inflammation at cartilage, tendon, ligament and synovium attachments to bone
erosive osteopenia and bony overgrowth

43
Q

what does ankylosing spondylitis lead to?

A

fusion of involved joints (fibrotic changes spread)
appears bamboo like on x ray

44
Q

S&S of ankylosing spondylitis

A

autoimmune S&S
multi-jt inflammation and P!
– > 30 min of P!/stiffness after prolonged positions
– improved P! w easy and regular movement
– chronic inflammation and P! of axial skeleton most often
– asymmetric or unilateral extremity involvement (typically smaller extremity joints and localized)
familial predisposition
extraarticular involvement of eyes, skin, GI tract and renal and cardiac systems
“hurts to see, pee and bend my knee”

45
Q

what are signs you would find in the history of someone with ankylosing spondylitis?

A

progressive LBP primarily from greatest influence on SI > neck and lumbar regions
< 40 years
insidious lasting > 3 months
no change with rest
night pain from static positioning
buttock and hip P!

46
Q

what would you observe in someone with ankylosing spondylitis?

A

hyperkyphosis
loss of lumbar lordosis

47
Q

what would you find in a scan of someone with ankylosing spondylitis?

A

multiple directions of limited motion of involved joints
consistent block
stress tests - prolonged holds may be painful

48
Q

what would you find in a biomechanical exam of someone with ankylosing spondylitis?

A

multiple directions of hypomobile accessory motion, possibly no motion
limited thorax excursion with manubrial and rib springs, possibly compromising breathing
positive Berlin and inflammatory back pain CPRs

49
Q

what type of referral for ankylosing spondylitis?

A

urgent to rheumatologist
a “do not want to miss” condition in any young adult with low back pain

50
Q

what two criteria are used for ankylosing spondylitis?

A

Berlin Criteria
IBP Criteria

51
Q

PT Rx for ankylosing spondylitis

A

be sensitive to trauma in these patients
fall prevention
gentle ROM and exercise considering fragility
postural education
above also helps with bone pathologies

52
Q

Ankylosing spondylitis may lead to:

A

osteoporosis
fractures
craniovertebral subluxations
stenosis
fusion in upright or MORE often forward bent position
extraarticular conditions –> IBS, uveitis
cardiopulmonary disorders

Clin Med I-II (21 decks)

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