Spinal Disorders Flashcards
Specific risk factors for low back pain
Poor abdominal musculature, obesity, pregnancy
What is a CT myelogram?
Real time CT with injection of contrast material
Best to evaluate spinal cord, nerve roots, meninges, disc abnormalities (or post op study or patients who can’t do MRI)
Neurophysiology studies
Measure electrical activity in muscles and nerves
Electromyography: detects response of muscle to nerve stimulation
Nerve conduction studies: can determine specific site of nerve injury
Often ordered together
What do you look for on spine plain films (x-ray)?
Alignment, disk space narrowing, fractures, degenerative changes, presence of osteophytes (especially in intervertebral foramina)
Indications for cervical spine xray
Trauma, infection, atypical pain, extremity pain, osteoporosis, degenerative changes
Cervical spine x-ray views and which ones are needed in trauma
AP, lateral:
Trauma: odontoid (mouth open view), swimmers view (C7-T1), oblique (R/L)
Jefferson fracture
C1 (atlas)
Caused by axial compression with typically no spinal cord damage
C2 (axis) fracture
Odontoid (dens)
Caused by forceful flexion or extension
Hangman’s fracture
C2 fracture involving bilateral pedicles
Caused by hyperextension with compression
Can transect spinal cord
Burst fracture
Lower cervical vertebra
Caused by direct axial load
Fragments displaced in all directions, can enter spinal canal
Indications for lumbar spine xray
Trauma/fall/accident Acute, severe back pain Neurological deficit/GCS less than 8 Post-op Chronic conditions History of cancer and associated back pain
Views of lumbar spine xray
Lumbar (AP/lateral)
Oblique view (see facets and pars interarticularis)
Flexion-extension view
Radiculopathy
Cervical/thoracic or lumbar nerve root dysfunction, ALL in a dermatomal distribution
Sciatica
Radiculopathy in a lumbar nerve root (L4, L5 or S1)
Nerve symptoms along posterior or lateral lower leg to foot or ankle
Signs of radiculopathy
Neurologic deficit related to lower motor neuron or nerve root in a dermatomal pattern (weakness/decreased muscle tone, muscle atrophy, hyporeflexia/areflexia, muscle fasiculation)
Myelopathy
Injury to the spinal cord from spinal stenosis, trauma, infection, cancer or neurological
Signs of myelopathy
Increased muscle tone (spasticity), weakness in affected distribution, hyperreflexia, clonus (sustained), Babinski sign, cervical (shooting pain down spine with cervical spine flexion)
Spondylosis
Nonspecific, degenerative changes of spine
Spondylolisthesis
Anterior displacement of a vertebral body due to bilateral defects of posterior arch
Spondylolysis
Unilateral or bilateral defect (fracture or separation) in vertebral pars interarticularis, usually in lower lumbar vertebrae
Spinal stenosis
Causes neurogenic claudications (vascular cause must be ruled out)
Acquired or congenital (narrowing of central canal, narrowing of lateral recess, narrowing of neural foramen)
Acquired spinal stenosis
Most common is spondylosis
Spondylolisthesis (L4-L5 common with L5-S1 next)
Space occupying lesion/herniate nucleus pulposis, ligamentum flavum hypertrophy
Traumatic/post-op causes (fibrosis)
Skeletal disease
Congenital spinal stenosis
Dwarfism
Congenitally small spinal canal
Spina bifida
Cause of cervical strain/sprain
Frequently due to whiplash mechanism with rapid acceleration-deceleration causing rapid neck extension/flexion