Spinal Conditions Flashcards by Fatema Arastu

Most common cause of back pain

sprain/strain

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degeneration of the spine

spondylosis

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anterior or posterior displacement of a vertebrae in relation to the vertebrae below

spondylolisthesis

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infection of intervertebral disc (discitis)

vertebral osteomyelitis

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types of spinal tumors

extradural (vertebral- most common), intradural, and intramedullary

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what is osteoporotic thoracolumbar vertebral compression fracture?

vertebral fx without major trauma

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wry neck aka

torticollis- unilateral spasm of SCM

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where is pancoast tumor located

apex of lung- can compress nearby structures

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dowagers hump aka

hyperkyphosis (overcurvature of thoracic spine)

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Scheurmann kyphosis diagnosis

self limited skeletal disorder in children defined as anterior wedging of 5 or more degrees in at least 3 adjacent vertebral bodies on lateral xray

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patient presents with back pain. started a couple hours ago. pain increases with stretching and bending. happened after soccer practice. pain improves with rest. dx and tx?

sprain/strain. x ray to r/o fracture. conservative tx, avoid prolonged bed rest. resolves in 2-3 days

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most common complication from sprain/strain

decreased activity leading to weight gain, loss of bone density and mm strength

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most common location of spinal radiculopathy

lumbosacral region

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Patient presents with tingling, achy or burning back pain that is sometimes sharp. Positive Spurlings and Lhermittes. MRI ordered to see if herniated disc present as a potential cause. dx and tx

Cervical radiuculopathy- treat underlying cause, conservative management

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most common etiology of radiucopathy is

disc herniation (use MRI) and spondylotic changes

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Patient presents with tingling, achy or burning back pain that is sometimes sharp. Positive SLR, positive slump test. MRI ordered to see if herniated disc present as a potential cause. dx and tx

lumbosacral radiculopathy- treat underlying cause, conservative tx

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tear in annulus fibrosis (outer ring) of disc, allows soft tissue to bulge out

herniated nucleus pulposis

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herniated nucleus pulposis aka

herniated disc, prolapsed disc, ruptured disc, slipped disc

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most common slipped discs

C6/C7 and L4/L5, L5/S1

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common age of slipped disc

middle aged pts d/t disc drying out as you age

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what tests to order if patient presents with radiculopathy with positive spurlings and lhermittes. Pain is increased with standing, sitting, coughing, laughing and at night. You suspect it to be d/t slipped disc.

order Xray initially to r/o other causes. Get MRI after 12 weeks. can start conservative measures in meantime- often have spontaneous improvement, this is why MRI is not done initially

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possible complications of slipped disc

cauda eqina, chronic pain, perm neurological sequelae

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Most common causes of spinal stenosis

spondylosis (degeneration of spine)

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65 year old patient presents with gradual pain in spine. Has previous history of spondylosis. Pain more in lumbar region. Positive rhombergs. Neuro exam normal, polyradiculopathy, wide based gait. dx and tx?

spinal stenosis in lumbar region. MRI is test of choice. conservative tx usually works. if not, injection/surgery considered.

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75% of the time, spinal stenosis occurs in lumbar region. But it may also occur in cervical region. How would this present?

cervical stenosis more serious because complication can be cauda equina, and perm. neurological eval.

term used to describe back pain with degeneration but no specific caues

spondylosis

how to treat spondylosis, complications

conservative tx usually helps resolve sx. complications- spondylolisthesis, spinal stenosis, cauda equina, neuro impairments, vertebrobasilar insufficiency

Patient presents with history of spondylosis. Has stiffening of back and tightening of hamstrings. Snapping sensation when returning to standing positiion. decreased ROM, altered gait and posture. What do you suspect and what is in differential?

spondylolisthesis- presents similar to spinal stenosis

types of slips that can occur

anterolisthesis (forward slip) and retrolisthesis (backwards slip)

types of spondylolisthesis

degenerative (most common), dysplastic, isthmic, pathologic, traumatic

spinal stenosis, spondylosis, and spondylolisthesis all have similar tx:

conservative tx

patient presents with back pain that starts insiduously and progressively gets worse over last couple hours. Also has fever. Tenderness and warmth, decreased ROM in lumbar region. co-existing conditions include DM. dx and tx?

Increased WBC, CRP, ESR, blood cultrure. Bone biopsy is definitive diagnosis for vertebral osteomyelitis, but MRI is PREFERRED. Echo to r/o endocarditis. tx- bed rest x 10 days, intensive in-bed non-weight bearing PT, analgesics, and debridement then IV abx for 6 weeks

Patient presents with c/o headache and neck pain. Has head tremors, stiffness, and swelling of neck mm. No fever or back pain. SCM mass is palpated on R side. what do you observe about head and chin in PE, how would you diagnose and treat

head tilts toward shortened SCM (R), head tilt to opposite side. US confirms. Can resolve spontaneously, conservative measures- active/passive stretching, ice/heat, analgesics.

if child with torticolis, what additional tx besides conservative measures?

opthalmologist referral- may cause problem with vision alignment

Most common cause in kids of torticolis

congenital

patient presents with upper extremity weakness, paresthesias, aching pain. Gilliat sumner hand, positive compression test, positive wright test, and positive EAST test. suspect

neurogenic TOS

patient presents with upper extremity weakness, paresthesias, aching pain. positive adson's test and EAST test (stick em up). asymmetric pulses. suspect

arterial TOS

types of TOS

neurogenic disputed neurogenic (90%), arterial, and venous

imaging/tests in TOS

neurogenic TOS- EMG/NCS. vascular TOS- vascular imaging. disputed TOS- clinical diagnosis

patient presents with upper extremity weakness, paresthesias, aching pain. activity related pain, tenderness of scalene mm. suspect

disputed neurogenic TOS

patient presents with upper extremity weakness, paresthesias, aching pain.UP edema, DVT, swelling and cyanosis. collateral venous pattern seen in neck/shoulder. suspect

venous TOS

tx for TOS

most respond to conservative tx. may use injections. vascular- anticoag, thrombolysis

Shoulder and arm pain in lower distribution of patient. Also has Horner's syndrome and weakness and atrophy of mm. of hand. May also have superior vena cava syndrome and TOS. dx and tx?

CT/MRI- order after 4 weeks, biopsy. Pancoast tumor- gold standard is chemo followed by surgical resection (if no mets)

cause of pancoast tumor

from NSCLC and mets by local invasion

Patient presents with mild pain in back/discomfort, breathing/digestive issues, fatigue, increased falls, increased fracture risk. abnormal occiput- to wall. what diagnostic tests to order

Xray- cobb angle and r/o osteoporosis fx, PFT to assess lung funciton prn. bone density if suspected osteoporosis

Most common cause and tx of hyperkyphosis

postural. tx underlying disease (posture or osteoporosis). analgesia, postural taping, PT/exersie Tx

Patient with history of cancer has pain with nocturnal awakening, neurological impairments. dx and tx?

MRI is test of choice to detect spinal tumor. Bone scan for metastases. Biopsy for diagnosis. tx- surgery is tx of choice. chemo, radiation may be added.

major complication of spinal tumor

spinal cord compression

Most spinal cord tumors are...

gliomas

Patient with positive adams forward bend test (school finding). what else do you examine on PE?

evaluate for leg length discrepancies, cafe au lait spots (NF), dimpling of skin (intraspinal tumor), patch of hair over spine (spinal dysraphism), joint laxity (marfans, ehlers danlos)

diagnostic measures in scoliosis

curves of 10 degrees= scoliosis. scoliometer reading equal or more than 7 degrees. Xray- standing PA and Lat view, cobb angle, riser sign.

who is important to screen for scoliosis

all children before growth spurt!

tx of scoliosis

observation and re-evaluation every 6-8 months, or sooner if younger. consider bracing and surgery

worst progrosis in scoliosis

prepubertal onset

when to refer in scoliosis

1. trunk rotation greater than 7 degrees and cannot get cobb angle. 2 cobb angle 20-29 in premenarche female or 12-14 in boy. 3. cobb angle greater than 30 in ANYONE. 4. progression of cob more than 5 in anyone. 5. neuromuscular scoliosis signs

risks for progression in scoliosis

3-10x more in females

fracture occuring in spine a/w osteoporosis

osteoporotic thoracolumbar vertebral compression fracture

Child with back pain that increases with activity and improves with rest at end of day. No neurological impairment. Upon PE, there is rigid kyphosis which sharp angulation as child bends over. Curvature does not flatted. Increased lumbar lordosis. dx and tx?

Xray- lateral spine views. self limited disease - correct kyphosis while spine is still growing via PA and bracing

what kind of neuro deficits seen in cauda equina syndrome

detrusor weakness, sexual dysfunction, decreaed rectal tone, bilateral ankel reflexes absent, saddle anesthesia.

Dx and tx of cauda equina

MRI. Emergency- spinal immobilization, surgical debridement within 48 hours. treat underlying cause

how many nerve roots does cauda equina involve

at least 2 of the nerve roots

most common causes of cauda equina syndrome

disc herniation and central canal spinal stenosis. also pregnant, infection, trauma, spondylolisthesis

what cervical fractures are unstable vs. stable

jefferson's-highly unstable and hangman's-unstable. clay shovelers- stable

fracture of C1 that occurs when there's vertical compression through occipital condyles to the lateral masses of the atlas

jefferson's fracture

traumatic spondylolysis of C2 fracture caused by cervicocranium thrown in extreme hyperexxtension from sudden deceleration

hangman's fracture

fracture of spinous process in lower cervical vertebrae from sudden deceleration causing forced neck flexion

clay shovelers fracture

burst fracture aka

jeffersons fracture