Spinal cord injury Flashcards by Cialmar Janesa Pelovello

Injury to lumbar annual incidence %

5-10

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Red Flags
Clinical Presentation:
Gait Ataxia/ upper motor neuron changes

Myelopathy

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Red Flags
Clinical Presentation:
Bowel/ bladder/sexual dysfunction

Cauda equina syndrome

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Red Flags
Clinical Presentation:
Night pain/ weight

Tumor

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Red Flags
Clinical Presentation:
Fever/ chills

Infection ( TB of spine)

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3 General types of cervical disk disorder

Herniated Nucleus Pulposus
Internal Disc Disruption
Degenerative Disc Disruption

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Nucleus Pulposus

Type II collagen
Inside
Braces annulus

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Annulus fibrosus

Type I collagen

Arranged obliquely

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Degenerative Disc Disease
Aging effects
DECREASES

Proteoglycan molecular weight
Ratio of chondroitin-keratin
Nuclear water content

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Degenerative Disc Disease
Aging effects
INCREASED

Cartilage cells
Amorphous tissue
Fibrous tissue

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Degenerative Cascade (3)

Dysfunction
Instability
Stabilization

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Result of repetitive trauma.
Z-joints undergo minor capsular tears, cartilage degeneration and synovitis causing abnormal motion.
Hypomobility

Dysfunction

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Due to scar formation
Each successive injury caused incomplete healing of Z joint capsules and annular fibers
Hypermobility

Instability

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Progression leads to z joint articular cartilage destruction , internal FIBROSIS, hypertrophy
Hypomobility

Stabilization

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Are new bone formation that outpouch from the spine

Osteophyte

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Are osteophytes that tries to breach the gap with next segment above the osteophyte

Syndesmophyte

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HNP
No annulus defect.
Disc convexity is beyond vertebral margins

Bulging disc

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HNP

Nuclear material protrudes into an annulus defect

Prolapsed disc

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Nuclear material extends to the posterior longitudinal ligament

Extruded disc

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Nuclear fragment free in the canal

Sequestered disc

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HNP location
Mag or may nit have radicular symptoms
Possible multiroot involvement if affecting the cauda equina, or myelopathy if involving the spinal cord

Central

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HNP location

More common in the lumbar spine due to tapering presentation of the PLL

Posterolateral

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May or may not have low back pain

Possibly affects the exiting root of that level

Far lateral/ foramina

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ROOT: C5
REFERRED PAIN:
PARESTHESIA:
WEAKNESS:

ROOT: C5
REFERRED PAIN: Shoulder and upper arm
PARESTHESIA: lateral side of arm, antecubital fossa
WEAKNESS: biceps

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ROOT: C6 REFERRED PAIN: PARESTHESIA: WEAKNESS:

ROOT: REFERRED PAIN: radial aspect of forearm PARESTHESIA: thumb WEAKNESS: biceps, brachioradialis

ROOT: C7 REFERRED PAIN: PARESTHESIA: WEAKNESS:

ROOT: REFERRED PAIN: dorsal aspect of forearm PARESTHESIA: index and middle fingers WEAKNESS: triceps, pronator

ROOT: C8 REFERRED PAIN: PARESTHESIA: WEAKNESS:

ROOT: REFERRED PAIN: ulnar aspect of forearm PARESTHESIA: index and middle fingers WEAKNESS: triceps, finger flexor

To centralize extremity pain, these are extension biased programs used for posterior lateral HNP

Mckenzie Program

Flexion biased | For far lateral HNP

Williams

Degradation of the intern architecture of the disc without gross herniation

Internal disc disruption

Internal disc disruption grading

0- no annular disruption 1- inner 1/3 annular disruption 2- inner 2/3 annular disruption 3- outer 1/3 annular disruption +/- circumferential spreading

Degenerative changes to the spine resulting in disc narrowing, vertebral body, osteophytosis, and joint arthropathy

Spinal stenosis | Causes entrapment of the nerve leading to weakness and sensory loss

Decreased size of the vertebral canal secondary to hypertrophic facets, hypertrophic ligamentum flavun, disc encroachment or degenerative spondylolisthesis

Central stenosis

The spinal cord is approx

10mm

Spinal canal is | Length

17mm

Relative stenosis | Length

12mm | Normal:17mm

Absolute stenosis (length)

10mm | Normal:17 mm

Tendons and muscles of other soft tissues Nerve and nerve roots Small and conplex joints

Low back pain

Up to % of adult experience back pain at some point in life

>80% 5th leading cause of medical office visits Most common work related disability

Most common cause of low back pain

Mechanical 80-90% -disc generation , fractured vertebrae, instability, unknown cause Neurogenic 5-15% - herniated disc, spinal stenosis, osteophytes damage to the nerve root Non- mechanical 1-2% -neoplasm, infection, inflammatory arthritis, paget Referred visceral pain 1-2%- GI dse, kidney dse Other 2-4%- fibromyalgia, faking pain

Neuropathic component of low back pain causes:

Mechanical neuropathic nerve root pain Local neuropathic pain Inflammatory mediators

Blocks the calcium channel which inhibit the transmission of C fibers pain to the cns

Transcutaneous electrical berve stimulation

A vertebral defect most commonly seen in children and adolescents at the L5 vertebral level

Spindylosus

Localized back pain exacerbated by motion( hyperextension), standing, lying prone and relieved with flexion

Spondylosis

Collar on the scotty dog

Spondylosis

A forward( anterolisthesis) or backward (retristhesis) slippage of one vertebral body on another

Spondylolisthesis

Spondylolisthesis Etiology Class 1

``` 1- Dysplastic ( congenital) 2 Isthmic ( MOST COMMON) 5-50 3 degenerative ( elderly) 4 traumatic (young) 5 pathological ( any) 6 postsurgical ( adult) ```

Spondylolisthesis etiology | Criteria

1- Dysplastic ( congenital) Congenital anormality lumosacral z joint 2 Isthmic ( MOST COMMON) 5-50 Pars intercularis fracture at l5-s1( subtype A) Elingation (subtype b) 3 degenerative ( elderly) Facet arthrosis causing subluxation ( common in l4-l5) 4 traumatic (young) Acute fracture other than pars 5 pathological Gen dse, CA, infxn, metabolic disorder 6. Postsurgical ( adult) Excessive resection of neural arches

Used if increased pain occurs despite decreased activity or in an increased slippage is suspected

TLSO ( spinal brace)

An adolescent disorder of the vertebral end plates and apophysis resulting in an increased thoracic kyphosis ( involves 3 segmental vertebra)

Scheurmann’s disease ( epiphysitis)

Etiology of scheurmann’s disease (3)

Anterior wedging of the vertebral bodies Fixed thoracolumbar kyphosis Intervertebral disc herniation

Herniation of disc material thru vertebral endplate into the spongiosa of the vertebral body

Schmorl’s nodes | Seen in scheurmann’s dse

Typically assoc with osteoporosis | Commonly seen in thoracolumbar junction

Compression fracture

Dennis 3 column criteria | ANTERIOR

Stable Anterior longitudinal ligament Anterior 2/3 of the vertebral body and annulus fibrosis

Dennis 3 column theory | MIDDLE

Unstable Posterior longitudinal ligament Posterior 1/3 of the vertebral body and annulus fibrosis

Dennis 3 column theory | POSTERIOR

Stable Ligmanetum flavum, supraspinous and infraspinous ligament Post. Elements: pedicles, facets, spinous process

Sudden onset of constant thoracolumbar pain. | Exacerbated with valsalva maneuvers, turning in bed, coughing, or incidental such as stepping off a curb

Compression fracture

``` Etiology: Hyper/hypomobile joint patterns Repetitive overloads Trauma Capsular tears/ injury ```

Sacroiliac joint dysfunction

Acute or gradual back, buttock, leg or groin pain with tenderness over the joint If ask for flexion, abduction, external rotation- there will be pain in the groin, px cant achieve these positions

Sacroiliac joint dysfunction

Pain reproduction with FLEXION, ABDUCTION, and EXTERNAL ROTATION of the hip joint, ipsilateral pain occurs in the degenerative hip Contralateral pain in the dysfunctional S1 joint

Patrick’s (faber) test

Sacroiliac joint pain is reproduced with dropping the involved leg off the table while the contralateral hip is held in flexion

Gaenslen’s test

SI joint pain with downward force placed on the iliac crest

Iliac compression test

SI joint pain with hip extension and ilium rotation

Yeoman’s test

Monitor PSIS motion when the px raises the leg to 90 deg. The PSIS on raised leg should rotate down. Restriction of this motion is considered abnormal

Gillet test

Monitor the PSIS of the seated px as they bend forward. Asymmetric cephalad motion of the PSIS indicated a sacroiliac dysfunction.

Sealed flexion

A general spinal deformity characterized by lateral curvatures and vertebral rotation

Scoliosis

Test for scoliosis | Ask the px to bend forward, you can see asymmetry because of vertebral rotation

Adam’s test

When you do x ray and do bending views, if there is no decrease in the curvature of the spine. May not reduce curvature with surgery or bracing

Fixed structural scoliosis

Reducible, can still manage the lx with surgery or bracing | Scoliosis

Reducible functional curve

An angle formed by the perpendicular lines drawn from the end plates pf the most tilted proximal and distal vertebrae to measure scoliotic curve

Cobb angle

Cobb angle Grade | Pedicle in full view no rotation

Cobb angle Grade | Pedicle disappearing

Cobb angle Grade | Pedicle disappears

Cobb angle Grade Pedicle disappears Contralateral pedicle move to midline

Cobb angle Grade Complete pedicle rotation. Contralateral pedicle moves beyond midline

E grade ++++

Degree of angulation required for treatment Observation Bracing Surgery

<20 20-40 >45 (<35 neuromuscular disease)

Curve of ______ - it is a must to request pulmonary function test

<40

Brace that encompassed the chin and occiput

Milwaukee brace

3 forces in milwaukee brace

Postero-anterior force Antero- posterior Upward force

Brace without chin piece | Below PA

Yamamoto brace