Spinal Column Pain, Sciatica, C-Spine, Whiplash Flashcards
Describe the normal curvatures of the spine
Cervical lordosis
Thoracic Kyphosis
Lumbar lordosis
Sacral kyphosis
In which location does spinal column pain generally occur + 3 reasons why?
Generally centred in the lumbar region because
- under higher mechanical stresses and strains
- upper body loads the lumbar spine region
- In upright posture, there is: loading of IV discs, vascular compression and avascular discs from early age
What is the effect of osteoporosis on vertebrae?
Osteoporosis causes vertebrae to lose height
List some possible causes of back and neck pain?
How can we avoid missing serious causes of back pain (vs musculoskeletal/simple)?
What is the main investigation for spinal pathologies
MRI scan
- XR not useful outside of the trauma setting (fractures/alignment)
- CT also more useful in trauma setting
* Investigation not required for simple back pain/no red flags
How do we treat back pain?
Note: reffer if you suspect more than ‘simple’ back pain
What surgery may help with segmental causes of back pain?
Give 2 negatives about this surgery
Spinal fusion
Negatives:
- Pain relief at the expense of movement
- May have progression of movement pain later at levels above and below.
What is Sciatica?
Pain in the leg in the distribution of the sciatic nerve caused by nerve root compression or irritation.
It is a nerve root pain (aka Radicular).
List 4 potential causes of Sciatica
- compression by herniated (slipped) disc
- spinal stenosis
- trauma due to retro pulsed bone fragments
- tumour (rare- remember red flags)
What investigation is used for Sciatica?
MRI of lumbar spine
How do we treat sciatica?
Analgesia and advise patient to remain active. Most sciatica spontaneously resolves with time
If persistant pain, and MRI corresponds to dermatomal distribution of symptoms, then discectomy can be considered
What is Whiplash?
Flexion-extension injury to neck
List 4 symptoms of Whiplash
- Neck pain and stiffness
- Tenderness over the neck muscles
- Reduced and painful neck movements
- Headaches
What is the onset of whiplash symptoms after an accident?
It can take up to 6-12 hours for the symptoms to develop.
Neck pain and stiffness is often worse on day 2, and may continue to get worse for several days
How do we diagnose whiplash?
History and Examination (muscle spasm, neck tenderness, ROM)
* Imaging not usually required
How do we treat whiplash?
List the 3 ways we can view the C-spine on an X-ray
- AP
- Lateral Skull base - T1
- Open Mouth View
In a lateral C Spine X-Ray how do we assess the following:
- Adequate film
- Alignment
- Bone
- Spacing
- Soft tissues
In a AP C Spine X-Ray how do we assess the following:
- Adequate film
- Alignment
- Bone
- Spacing
- Soft tissues
In a open mouth (odontoid peg) X-ray of the C Spine, how do we assess adequacy of film
List 5 fractures we can have of C1 (Atlas)
List the 3 fractures of C2 (Axis)
- Odontoid fractures: type 1, 2, 3
- Hangman’s fractures: type 1, 2, 3
- Miscellaneous C2 fractures
How do we classify odontoid (peg) fractures?
How do we treat each of the 3 types of Odontoid fractures?
Type I – Neck brace 6-12 weeks
Type II – Screw fixation (if displaced)
Type III – Neck brace or halo orthosis 6-12 weeks.
What is a Hangman’s fracture?
Caused by forced hyperextension usually in a high energy injury
It is a bilatereal fracture of pars intra-articularis of C2
High correlation with spinal cord damage, often fatal ➞ above C3-4-5 therefore can cause quadriplegia, and inhibits diaphragm
What is a Sub-Axial C-spine fracture?
Facet joint dislocation which can be Uni-lateral (<50% translation) or Bi-lateral (>50% translation)
What is the treatment of facet joint dislocations
Relocation with in line traction, may require surgical instrumentation
List the 3 types of sub axial fractures and dislocations
What is the treatment of sub axial fractures
Determine stability of the fracture (often requires specialist spinal surgeon opinion)
Most are stable and can be treated with a collar for 6-12 weeks, some require instrumentation (anterior or posterior)
