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MSK block > Spinal Column Pain, Sciatica, C-Spine, Whiplash > Flashcards

Spinal Column Pain, Sciatica, C-Spine, Whiplash Flashcards

1
Q

Describe the normal curvatures of the spine

A

Cervical lordosis

Thoracic Kyphosis

Lumbar lordosis

Sacral kyphosis

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2
Q

In which location does spinal column pain generally occur + 3 reasons why?

A

Generally centred in the lumbar region because

  1. under higher mechanical stresses and strains
  2. upper body loads the lumbar spine region
  3. In upright posture, there is: loading of IV discs, vascular compression and avascular discs from early age
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3
Q

What is the effect of osteoporosis on vertebrae?

A

Osteoporosis causes vertebrae to lose height

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4
Q

List some possible causes of back and neck pain?

A
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5
Q

How can we avoid missing serious causes of back pain (vs musculoskeletal/simple)?

A
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6
Q

What is the main investigation for spinal pathologies

A

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

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7
Q

How do we treat back pain?

A

Note: reffer if you suspect more than ‘simple’ back pain

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8
Q

What surgery may help with segmental causes of back pain?

Give 2 negatives about this surgery

A

Spinal fusion

Negatives:

  • Pain relief at the expense of movement
  • May have progression of movement pain later at levels above and below.
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9
Q

What is Sciatica?

A

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).

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10
Q

List 4 potential causes of Sciatica

A
  1. compression by herniated (slipped) disc
  2. spinal stenosis
  3. trauma due to retro pulsed bone fragments
  4. tumour (rare- remember red flags)
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11
Q

What investigation is used for Sciatica?

A

MRI of lumbar spine

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12
Q

How do we treat sciatica?

A

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

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13
Q

What is Whiplash?

A

Flexion-extension injury to neck

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14
Q

List 4 symptoms of Whiplash

A
  1. Neck pain and stiffness
  2. Tenderness over the neck muscles
  3. Reduced and painful neck movements
  4. Headaches
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15
Q

What is the onset of whiplash symptoms after an accident?

A

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

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16
Q

How do we diagnose whiplash?

A

History and Examination (muscle spasm, neck tenderness, ROM)

* Imaging not usually required

17
Q

How do we treat whiplash?

A
18
Q

List the 3 ways we can view the C-spine on an X-ray

A
  • AP
  • Lateral Skull base - T1
    • Open Mouth View
19
Q

In a lateral C Spine X-Ray how do we assess the following:

  • Adequate film
  • Alignment
  • Bone
  • Spacing
  • Soft tissues
A
20
Q

In a AP C Spine X-Ray how do we assess the following:

  • Adequate film
  • Alignment
  • Bone
  • Spacing
  • Soft tissues
A
21
Q

In a open mouth (odontoid peg) X-ray of the C Spine, how do we assess adequacy of film

A
22
Q

List 5 fractures we can have of C1 (Atlas)

A
23
Q

List the 3 fractures of C2 (Axis)

A
  1. Odontoid fractures: type 1, 2, 3
  2. Hangman’s fractures: type 1, 2, 3
  3. Miscellaneous C2 fractures
24
Q

How do we classify odontoid (peg) fractures?

A
25
Q

How do we treat each of the 3 types of Odontoid fractures?

A

Type I – Neck brace 6-12 weeks

Type II – Screw fixation (if displaced)

Type III – Neck brace or halo orthosis 6-12 weeks.

26
Q

What is a Hangman’s fracture?

A

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

27
Q

What is a Sub-Axial C-spine fracture?

A

Facet joint dislocation which can be Uni-lateral (<50% translation) or Bi-lateral (>50% translation)

28
Q

What is the treatment of facet joint dislocations

A

Relocation with in line traction, may require surgical instrumentation

29
Q

List the 3 types of sub axial fractures and dislocations

A
30
Q

What is the treatment of sub axial fractures

A

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)

MSK block (30 decks)

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