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clin med II - exam I > Pathologies related to the Low Back I > Flashcards

Pathologies related to the Low Back I Flashcards

1
Q

What is the incidence of spinal malignancy?

A
  • multiple myeloma
  • spinal metastasis (secondary)
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2
Q

How can multiple myeloma cause spinal malignancy? In what population primarily?

A
  • primary malignant tumor in bone marrow
  • typically in older individuals
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3
Q

What is the most common tumor of the spine?

A

spinal metastases

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4
Q

Spinal metastases is the ___ MOST common serious spinal pathology?

A

2nd

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5
Q

What areas is spinal metastases most often from?

A
  • breast
  • lung
  • prostate
  • kidney
  • GI
  • thyroid tumors

in this order

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6
Q

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

A
  • bone
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7
Q

What Is the MOST common structure for spinal metastasis?

A

Vertebral body
- mostly in anterior portion leading to wedging

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8
Q

What is the most common region for spinal malignancy?

A
  • Thoracic
  • more than lumbar, rarely in cervical
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9
Q

What percentage of spinal malignancy creates cord compression or myelopathy?

A

20%

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10
Q

What is the most useful indicator of spinal malignancy?

A

Past medical history

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11
Q

What is the pathogenesis of spinal malignancies?

A
  • healthy bone replace by tumor
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12
Q

What is the standard for imaging of spinal malignancies?

A

MRI

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13
Q

What are cancer S&S?

A
  • Hx of cancer
  • P!- local and referred
  • 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
  • N&V
  • Loss of appetite
  • Unexplained weight loss of ≥ 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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14
Q

What are PT clinical S&S of spinal malignancy?

A
  • Cancer S&S
  • Spinal pain that is the MOST common initial symptom
  • unfamiliar and severe pain that may become progressive and constant
  • possible bony alterations, including fractures and subsequent joint instability
  • May be unable to lie flat due to pain
  • likely mechanical pain with scan and biomechanics exam component that stress vertebral body and lumbar joints will possibly be positive
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15
Q

What kind of referral is spinal malignancy?

A

Urgent referral to MD unless cord S&S you would want to immobilize for emergency referral

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16
Q

What is the pathogenesis of lumbar myelopathy?

A
  • slow, gradual and often progressive compression of cord
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17
Q

What level is the end of the spinal cord?

A

L1/2

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18
Q

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

A

Lumbar

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19
Q

What is the MOST common etiology of lumbar myelopathy?

A

NOT due to trauma
MOST commonly due to degenerative spinal changes

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20
Q

What degenerative spinal changes can cause lumbar myelopathy?

A
  • lax and bucking ligamentum flavum
  • age related joint disease with enlarging and encroaching arthritic bone aka stenosis
  • age related disc disease with herniations
  • vertebral body collapse
  • pathological instability
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21
Q

What is the only validated red flag for lumbar myelopathy malignancy?

A
  • history of cancer
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22
Q

What will we find in hx for lumbar myelopathy?

A

Slow, gradual and often progressive onset

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23
Q

What we we observe with lumbar myelopathy?

A

not acute - won’t splint

24
Q

What will we find with AROM/PROM with lumbar myelopathy?

A
  • extreme spinal pain with mechanical reproduction with scan and biomechanical exam possibly for:
    > age-related changes
    > vertebral body
    > instability
25
Q

What stress tests will be positive with lumbar myelopathy?

A
  • PA stress tests possibly positive for neuro symptoms
26
Q

What are clinical manifestations of lumbar myelopathy?

A
  • Multi-segmental numbness and weakness/paralysis of LE and trunk below level of injury likely leading to impaired balance
  • DTRs = hyperactive
  • UMN tests positive
  • Spastic or retentive bowel and bladder
  • dural mobility most often negative due to gradual onset
  • superficial reflexes = hypoactive
  • Less often cancer S&S
27
Q

What kind of referral is lumbar myelopathy?

A

IMMOBILIZE with emergency referral

28
Q

What is caudal equina syndrome?

A

compression on some degree of the 20 spinal nerves that originate from the end of the spinal cord or conus medullar is in the vertebral canal

29
Q

Is cauda equina syndrome acute or chronic?

A

Can be either

30
Q

What segment does the spinal cord end?

A

L1/2 segment

31
Q

What is the prevalence of cauda equina syndrome?

A

Rare with 2% of lumbar age-related disc changes

32
Q

What is the etiology of cauda equina syndrome?

A
  • primarily due to mid to lower lumbar age-related disc changes
  • secondarily due to other degenerative spinal changes and malignancy
33
Q

What are risk factors for cauda equina syndrome?

A
  • mid to lower lumbar: persistent IDD (central > postlat IDD), central stenosis, surgery
  • < 50 years
  • Obesity
34
Q

What are the differences between myelopathy and cauda equina syndrome?

A
  • myelopathy = UMN S&S
  • Cauda equina syndrome = LMN S&S
35
Q

What are clinical manifestations of cauda equina syndrome?

A
  • hx
  • respective S&S of contributing degenerative condition
  • likely limited and worse with ext, better with flx
  • progressive or altering LE/patchy findings due to movement of spinal nerves
36
Q

What will we find in hx indicating cauda equina syndrome?

A
  • LBP
  • Bowel and bladder incontinence
  • sexual dysfunction
  • possible cancer S&S if malignancy contributing
37
Q

What are the progressive or alternating LE findings due to movement of spinal nerves?

A
  • paresthesias and decreased sensation in multiple dermatomes - saddle/groin area
  • Multiple myotomal weakness and gait abnormality
  • hypoactive DTRs
  • possible positive dural mobility tests
38
Q

What is the gold standard for imaging for cauda equina syndrome?

A

MRI

39
Q

What kind of referral is cauda equina syndrome?

A

Emergency referral due to multiple spinal nerves involved

40
Q

What is a spinal infection?

A

infectious disease of spinal structures

41
Q

What is osteomyelitis?

A

Bone infection

42
Q

What is discitis?

A

Disc infection

43
Q

What is the incidence of spinal infections?

A
  • uncommon in weather countries but resurgence with longevity and iV drug use
44
Q

Where is discitis more common?

A

Lumbar spine

45
Q

What is the etiology of spinal infections?

A
  • primarily from airborne bacteria
  • secondarily from staph bacteria that may also be involved
46
Q

What are risk factors for spinal infection?

A
  • Immunosuppression
  • surgery, particularly of spine and repeated procedures
  • IV drug use
  • Social depravation
  • Hx of TB or another recent infection

** all low evidence

47
Q

What is the pathogenesis of spinal infections?

A
  • days, months, or years to spread to spine
  • infection spreads to disc more commonly in lumbar spine
48
Q

What is not common but may occur as the abscess grows with spinal infections?

A
  • nerve root irritation
  • vertebral body collapse/fx
  • and cord compression may develop
49
Q

What are clinical manifestations of spinal infections?

A
  • age-related changes with back pain/stiffness is MOST common presenting symptom
  • constitutional and infection symptoms NOT common initially
50
Q

What are infection S&S?

A
  • malaise
  • fever, chills, sweats
  • N&V
  • enlarged and likely tender lymph nodes
  • redness (maybe lymphangitis or streaks towards lymph nodes), abscess, heat, and/or swelling
  • Specific infected system S&S as well
51
Q

What are PT implications of spinal infection?

A
  • localized and PROGRESSIVE spinal pain that limits motion
  • likely mechanical pain for disc > vertebral body involvement with scan and biomechanics exam
  • Infection S&S particularly fatigue and fever since onset of back p!
52
Q

What can happen if the spinal infection goes untreated?

A
  • unexplained weight loss of ≥ 5-10% over a 3-6 month period with a loss of appetite
  • Neuro S&S influence the LEs and coordination as well as bowel and bladder dysfunction
  • loss of lumbar lordosis
53
Q

What kind of referral is a spinal infection?

A

Urgent referral unless cord or cauda equina s&s then emergency referral to MD

54
Q

What kind of imaging should we have done if we are suspicious of TB with a spinal infection?

A

x-ray

55
Q

What is an MRI showing with a spinal infection?

A
  • can observe infection 3-5 days after onset
56
Q

What are blood tests useful for with spinal infections?

A
  • not diagnostic
  • inflammatory markers such as RBC and C-reactive proteins are better indicators of infection than WBC
  • presence of normal WBC does not exclude spinal infection

clin med II - exam I (4 decks)

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