spinal conditions Flashcards
lumbar spondylosis
=wear and tear in the discs and facet joints of the back
aetiology–> degenerative arthritis. age related degeneration
clinical features–> pain, stiffness worse in am, loss of movement, crepitus, relieved by activity
x-ray findings–>CT/MRI. wide canal sign, deviation of spinoud processes, sclerosis of the contralateral pedicle
pathophysiology–>occurs as a result of new bone formation (osteophytes, bone spurs) in areas where the annular ligament is stressed
contraindications–> spinal infection, acute inflmmatory joint disorders, osteoporosis, spinl cancers, central spinal cord pressures (herniations, tumours etc)
cautions–> joint hypermobility, acute inflammation, BP fluctuations, symptoms aggravated by traction
management–>manual therapy, massage, lumbar back support, taping
lumbar facet irritation/ degeneration
=painful irritation of posterior facets
aetiology–>injury, repetitive movements, obesity, poor posture
clinical features–> dull ache, radiating pain, standing/ periods of inactivity makes it worse, twisting irritates it, crepitus, referred pain
x-ray findings–> CT, MRI, plain radiograph. joint space narrowing, subchondral sclerosis/bone erosions, osteophytes
pathophysiology–> Swelling from the surrounding structures, can cause pain due to an irritation of the nerve roots. Little capsular tears can originate at the level of the posterior facet joints due to a trauma
management–> medication, physical therapy, joint injections, nerve blocks
herniated disc
=where the disc pushes out of place
types: degeneration, prolapse, extrusion, sequestration
aetiology–> heavy lifting, repetitive strain, twisting, wear and tear
clinical features–> lower back pain, numbness/ tingling, problems bending, muscle weakness, sciatica
x-ray findings–> need mri. protrusion (base wider than herniation, confined to disc level, outer annular fibres intact), extrusion (base narrower than herniation, may extend above or below adjacent vertebrae, complete annular tear, disc material migrates) myelogram. spinal dye to show pressure on spinal cord from multiple herniations
pathophysiology–> a combination of the mechanical compression of the nerve by the bulging nucleus pulposus and the local increase in inflammatory chemokines
management–> medications, therapy, surgey
lumbar spondylolisthesis
=where one of the vertebra slips onto vertebra below
aetiology–> spondylosis, degenerative conditions, overgrown bones, crack/ fracture (isthmic), spine not forming properly (congenital)
clinical features–> muscle spasms in hamstrings, back stiffness, difficulty walking/ standing for long periods, pain when bending, numbness/ weakness/ tingling in foot
xray findings–> lateral x-ray can see that one of the vertebra has slipped off the spinal column. myelogram if nerves are involved
pathophysiology–> occurs when one vertebral body slips with respect to the adjacent vertebral body causing radicular or mechanical symptoms or pain
management–> medication, steroid injections, physical therapy, bracing
spinal stenosis
=when the space inside the spinal canal narrows
aetiology–> wear and tear due to arthritis, bone spurs, herniation, thick ligaments, tumours, spinal injuries
clinical features–> numbness, tingling/ weakness in hand/ foot/ leg/ arm, problems walking, neck pain, bowel/ bladder problems
x-ray findings–> plain radiograph- disc space narrowing, osteophyte formation. myelogram- degree of cutoff. CT myelography- compression, bony abnormalities, bony facet hypertrophy. MRI- central stenosis, ligament hypertrophy
pathophysiology–> The relative instability initiated by degeneration of the intervertebral disc leads to hypermobility of the vertebral segments, resulting in increased pressure on the posterior facet joints, followed by a narrowing of the intervertebral disc space, an increased extension angle, and hypertrophy of the facet joints, especially the hypertrophy of the superior articular process. As it gradually progresses, the joints become ankylosed
contraindication–> cauda equina syndrome
management–> medications (NSAIDs, antidepressants, opioids), physical therapy, steroid shots, surgery
arachnoiditis
=a rare pain disorder caused by inflammation (swelling) of the arachnoid, one of the membranes that surrounds and protects the nerves of your spinal cord
aetiology–> complications from spinal surgery or multiple lumbar punctures, direct injury to spine, chemicals (dye from myelograms), infection from bacteria or viruses, chronic compression of spinal nerves
clinical features–> headaches, radiating pain, tingling/ numbness/ weakness in legs, formication, muscle cramps/ spasms, neurogenic bladder, bowel dysfunction, sexual dysfunction
xray findings–> MRI- subarachnoid space. seen in lumbar area. nerve roots become adherent to each other and to the theca
pathophysiology–> The injury to and inflammation of thesubarachnoid or subdural space precipitate collagen deposits, scar tissue encapsulation of nerve roots, fibrosis, decreased CSF flow, clumping of nerve roots, impaired blood supply, starvation of oxygen and nutrients and accumulation of waste products, nerve atrophy, nerve damage, and possibly tethered nerves
contraindications–> cauda equina
management–> physical therapy, stretching, drugs (NSAIDs, painkillers), adaptive equipment, spinal cord stimulation
spinal infection
=an infection that has been carried to spine from the bloodstream
aetiology–> can be bacterial or fungal. may occur after a urological procedure
clinical features–> localised pain, wound drainage, redness, swelling, tenderness
xray findings–> MRI- vertebral body and disc T1 hypointensity/ T2 hyperintensity, endplate destruction, psoas sign: non-enhanced T2 hyperintensity in iliopsoas muscle
pathophysiology–> Bacteria can reach the spine and infect the spinal column via the following three routes: (1) hematogenous spread from a remote site, (2) direct external inoculation after trauma (injury or surgery), and (3) dissemination from a contiguous tissue [1]. Hematogenous spread is the most common route for vertebral osteomyelitis in children and adults
management–> antibiotics or antifungal therapy, may need surgery
nerve degeneration (multiple sclerosis)
=where the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between the brain and the body
aetiology–> immune system attacking body. combo of genetics and environmental factors
clinical features–> numbness/ weakness in limbs, tingling, electric shock feeling, lack of coordination, inability to walk, loss of vision, vertigo, double vision, fatigue, slurred speech, cognitive disturbances
xray findings–> MRI can confirm diagnosis but follow up can see how they are reacting to treatment
pathophysiology–> the plaques that form in the CNS combined with inflammation, demyelination, axonal injury and axonal loss. These plaques are found in the brain and spinal cord, essentially in the white matter around the ventricles, optic nerves and tracts, corpus callosum, cerebellar peduncles, long tracts and subpial region of the spinal cord and brainstem, but also in the gray matter
management–> steroid tablets, steroid injections, anti-fatigue medicine, cognitive behavioural therapy, physical therapy, mobility aids
