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Clin Med Exam 3 > Spinal Disorders > Flashcards

Spinal Disorders Flashcards

1
Q

Cervical spine x-ray indications

A 
trauma
infection
atypical pain
extremity pain
osteoporosis
degenerative changes
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2
Q

Cervical spine x-ray views

A

AP, Later
Odontoid
Swimmer’s
Oblique

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3
Q

Cervical spine fractures

A

Jefferson- C1, axial compression, no spinal damage

C2 (axis)- dens, forceful flexion or extension

Hangman’s- C2 fracture involving bilateral pedicles, caused by hyperextension w/ compression, can transect spinal cord

Burst- lower cervical vertebrae, caused by direct axial load, fragments can displace and enter spinal canal

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4
Q

Lumbar spine x-ray indication

A 
fall from heigh >3 meters
fall from standing >60 yo
ejection from MVA, pedestrian vs. vehicle
Significant trauma
Acute, severe back pain
neuro deficit/GCS less than 8
Postop imaging
chronic conditions
hx of cancer w/ back pain
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5
Q

Lumbar x-ray views

A

AP/lateral
Oblique
Flexion-extension view (spinal stability, r/o spondylolisthesis)

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6
Q

Purpose of oblique view

A

view articular facets and pars interarticularis

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7
Q

Radiculopathy

A

cervical/thoracic or lumbar nerve root dysfuntion: all in dermatomal pattern

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8
Q

Sciatica

A

lumbar nerve root (L4, L5, S`); along posterior or lateral aspect of lower leg to foot or ankle

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9
Q

Radiculopathy s/sx (lower motor neuron/nerve root)

A

weakness/dec. muscle tone
atrophy
hyporeflexia/areflexia
muscle fasciculation

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10
Q

Myelopathy

A

injury to spinal cord

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11
Q

Causes of myelopathy

A 
spinal stenosis
trauma
infection
oncological
neurological
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12
Q

Myelopathy s/sx

A 
increased muscle tone (spasticity)
weakness
hyperreflexia
clonus (sustained)
up-going plantar reflex (babinski)
Cervical: shooting pain down spine with cervical spine flexion
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13
Q

Degenerative diseases in the spine

A

spondylosis
spondylolistehsis
spondylolysis

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14
Q

Spondylosis

A

nonspecific, degenerative changes of the spine

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15
Q

Spondylolithesis

A

Anterior displacement of a vertebral body due to bilateral defects of the posterior arch

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16
Q

Spondylolysis

A

unilateral or bilateral defect (fracture or separation) in the vertebral pars interarticularis, usually in the lower lumbar vertebrae

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17
Q

Spinal stenosis causes

A

neurogenic claudication (vascular cause must be rules out),

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18
Q

Cause of spinal stenosis

A

acquire vs congenital:

narrowing of central canal, lateral recess or neural formamen

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19
Q

Acquired spinal stenosis

A 
spondylosis (most common)
spondylolisthesis (L4/L5, or L5/S1)
Herniated nucleu pulposis (HNP)
Ligamentum flavum hypertrophy
trauma/post-op (fibrosis)
Skeletal disease (RA, ankylosing spondylitis)
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20
Q

Congenital spinal stenosis

A

dwarfism, small spinal canal, spina bifida

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21
Q

Strain

A

injury to: muscle, tendon, musculotenindous junction

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22
Q

Sprain

A

injury to: ligament (bone to bone)

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23
Q

Sx of spinal stenosis

A

all areas below stenosis (extremitis/trunk)

pain/numbness/tingling/weakness/bowel/bladder changes

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24
Q

Whip lash

A

cervical strain/sprain; due to rapid acceleration-decelration causing rapid neck extension-flexion (rear ended in MVA)

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25
Q

What must you do before PE in cervical strain/sprain

A

thorough hx and clear C-spine (nexus/canadian)

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26
Q

Nexus criteria and canadian c-spine rule are used to determine

A

if imagine is needed prior to testing ROM or manipulation

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27
Q

Nexus criteria

A
  1. Absence of posterior midline tenderness
  2. Normal alertness
  3. no intoxication
  4. no abnormal neuro findings
  5. no other painful distracting injuries

*if all 5 criteria are met, no imaging needed

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28
Q

Canadian C-spine rule

A

Condition one: radiographs for:

  • > 65 YO
  • dangerous MOI
  • paresthesia in extremities

Condition two:

  • simple rear end MVA
  • sitting position in ED
  • ambulatory at any time
  • delayed onset of neck pain/or no midline pain

*can test ROM, if rotation to 45 degrees no imaging needed

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29
Q

Sx of Cervical strain/sprain

A

non-radicular, non-focal neck pain from base of skull to cervicothoracic junction
SCM or trap pain
pain worse with motion
spasms of paraspinous muscles

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30
Q

PE for cervical strain/sprain

A

TTP of paraspinous/trap muscles and maybe SCM
limited ROM
neuro exam is usually normal

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31
Q

Dx for cervical strain/sprain

A

AP, later, odontoid; flexion-extension views once C-spin is cleared
all cervical vert must be seen
swimmer’s view to visualize cervicothoracic junction

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32
Q

Tx for cervical strain-sprain

A 
opiods 1-2 weeks
NSAIDs
collar
cervical pillows for sleep
avoid manipulation following trauma until improvement
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33
Q

Cause of cervical radiculopathy in younger people

A

HNP (causes neuroforaminal narrowing)

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34
Q

Cause of cervical radiculopathy in older patients

A

decreased intervertebral disc space due to degenerative disease; also could be HNP

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35
Q

Signs of cervical radiculopathy

A 
neck pain, H/A
pain in upper extremeites (numbness, paresthesia)
Unilateral
pain may radiate down paraspina
weakness/reduced grip strength
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36
Q

PE for cerv. radiculopathy

A 
assess motor/sensory function 
assess DTR
loss of lordosis
decreased ROM
gait eval for myelopathy
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37
Q

Cervical myelopathy sx

A

trunk or leg dysfunction, gait changes, bowel/bladder changes

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38
Q

Imaging for cervical radiculopathy

A

AP, lateral- may show spondylosis or DDD as a cause of symptoms
MRI w/w/o contrast : HNP as sx
Spine surgeon may order CT myelogram

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39
Q

Tx for cervical radiculopathy

A 
spontaneous resolution 2-8 weeks
NSAIDs
PT
Possible surgical decompression
pain management referral-epidural steroid
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40
Q

When to refer for cervical radiculopathy

A

patient not improving with non-surgical tx
atrophy of muscles develops
sx concerning the “BAD”

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41
Q

Osteoarthritis of cervical spine

A

cervical spondylosis

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42
Q

Spondylosis effects what joints

A

facet joints and intervertebral discs (DDD)

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43
Q

Spondylosis may cause

A

stenosis or neural foraminal narrowing resulting in radiculopathy or myelopathy

44
Q

Sx of spondylosis

A 
decreased cervical ROM***
chronic neck pain
sx worse when upright
paraspinous spasm
occipital headaches
bilateral radicular sx associated w/ bilateral foraminal stenosis
advanced: myelopathy
45
Q

PE for sponylosis

A

TTP cervical paraspinal
TTP spinous processes
Decreased AROM of cervical spine
pain with “facet loading”- Spurling test (rotation, extension of neck with +/- applied axial reproduces sx)

46
Q

+ Spurling test

A

spondylosis

47
Q

Imaging for spondylosis

A

Ap, lateral
MRI (impingement, inflammation)
CT myelogram (surgeon)

48
Q

Tx for spondylosis

A 
sx last several months
NSAIDs
PT 
Possible decompression
Possible epdiural or medial branch block/radiogrequency ablation for pain
49
Q

Thoracic outlet syndrome

A

compression of upper extremity neuromuscular bundle above the first rib and behind the clavicle

50
Q

Causes of thoracic outlet syndrome

A 
repetitive injury or athlete (pitching)
cervical rib anomaly
muscular anomaly
Trauma- hyperextension/flexion neck injury
Fracture (1st rib/clavicle)
51
Q

3 types of thoracic outlet syndrome

A

neurogenic (nTOS)- brachial plexus
Arterial (aTOS) - subclavian artery
Venous (vTOS)- subclavian vein

52
Q

Most common TOC

A

neurogenic

53
Q

nTOC

A

reproducible w/ elevation of arm/sustained use
upper extremity pain
dysesthesia
weakness/numbness
progressive weakness of hypothenar muscle
numbness in ulnar or medial nerve distribution
tenderness over scalene

54
Q

vTOS cause

A

vigorous, repetitive UE activities

55
Q

vTOS sx

A 
SWELLING OF EXTREMITY (HALLMARK)
paresthesia secondary to swelling
upper extremity venous thrombosis
cyanosis
pain in extremity
fatigue in forearm within minutes of use
56
Q

aTOS

A

sx. develop spontaneous unrelated to work/trauma- usually associated with cervical rib
thromboembolism
young patients
ichemia: pain/paresthesia/pallor/coolness to arm/hand

57
Q

Imaging for nTOS

A

electrodiagnostic testing

brachial plexus block positive

58
Q

Imaging helpful for aTOS

A

US, chest-xray (no cervical rib = rules ot aTOS)

59
Q

TOS caused by cervical rib

A

artery

60
Q

U/x Useful for what TOC

A

aTOS, vTOS

61
Q

Tx for nTOS

A

PT for 4-6 weeks
steroid injection, botulinum toxin
decompression surgery for worsening, failed tx

62
Q

vTOS

A

catheter directed thrombolysis (w/i 2 weeks of onset)

decompressive surgery

63
Q

aTOS

A

surgical embolectomy

decompressive surgery

64
Q

Most rare spine injury

A

thoracic

65
Q

Most common cause of LBP

A

lumbar sprain/strain

66
Q

Cause of lumbar sprain/strain

A

injury to paravertebral spinal muscles; hx of repeated lifting and twisting; acute onset of LBP following lifting episode or bending to pick something up

67
Q

Sx of lumbar sprain/strain

A

axial pain, radiates to buttocks, may report lumbar spasm, patient may not be able to stand erect and may change position frequently

68
Q

PE of lumbar sprain/strain

A

TTP to lumbar or SI joint
flexion ROM limited to pain
+/- spasms
normal neuro/DTR

69
Q

Imaging for lumbar sprain/strain

A

no radiographs unless dangerous MOI;

atypical sx (nigh pain or pain at rest): get AP and lateral radiographs to T10 level (infection, neoplasm, fracture, sponylolisthesis)

70
Q

Tx of lumbar sprain/strain

A 
neuro findings: rever
Avoid strenuous activity
NSAIDs/muscle relaxers NOT recommended
PT, TENs unit, U/S
Core strengthening
ROM is good way to assess progress
71
Q

Waddell’s signs

A

Non-organic behavior or inappropriate findings:
non-atomic tenderness
simulation sign with minimal compression or rotation
distractions sign
Regional sensor/motor disturbance that doesn’t follow dermatome (glove or stocking paresthesia)
overreaction usually to light touch

72
Q

Lumbar spondylosis

A

pain lasting >3 months (RULE OUT BAD)

Exacerbated by: injury, repetitive trauma, deconditoning

73
Q

Sx of lumbar spondylosis

A

LBP that radiates to one or both buttocks**
mechanical pain aggravated by bending or lifting objects from ground
pain relieve with lying down
axial pain usually
normal motor/sensory/DTR
ROM decreased

74
Q

Imaging for lumbar spondylosis

A

AP/Lateral show: osteophyte formation, disk space narrowing

75
Q

Tx for lumbar spondylosis

A

PT (core strengthening)

facet arthritis is present - refer to interventional pain managment for block

76
Q

Lumbar spondylolisthesis sx

A

may be asymptomatic or minimally symptomatic
back pain that radiates posteriorly to below the knees that is worse with standing
spasms in hamstrings that make it hard to bend forward
limitied flexion
Nerve compression sx rare

77
Q

PE for spondylolisthesis

A 
diminished lordosis
step off deformity palpable if severe
more distal = more prominent
decreased ROM flexion
Decreased straight leg raise ROM
78
Q

Most common neurogenic leg pain in elderly

A

Spinal stenosis

79
Q

Imagine for spondylolisthesis

A

AP radiograph- forward translation of vertebrae
interval radiographs q 6 mo
oblique view for isolated spondylolysis

80
Q

Tx for spondylolisthesis

A

Refer to ortho spine or neurosurgeon

may require surgery

81
Q

Lumbar spondylolysis

A

defect in par interarticularis; usually at L5
Usually seen in adolescents with repetitive forced back extension (football/gymnasts)
usually asymptomatic, incidental finding, may have low back pain

82
Q

Tx for spondylolysis

A

bracing/PT/Restriction of activity

83
Q

Spondylolysis causes

A

spondylolisthesis

84
Q

Lumbar HNP cause

A

lifting/twisting activities increase pressure on the disc causing it to herniate; can also be trauma related; herniation applies pressure to existing spinal nerve roots

85
Q

Lumbar HNP can cause

A

nerve root compression/radiculopathy

86
Q

Most common locations for lumbar HNP

A

L4-L5 or L5-S1

87
Q

Sx of lumbar HNP

A

abrupt onset
unilateral radicular leg pain following LBP
pain is severe and aggravated by sitting, walking, standing, coughing, sneezing
pain radiates down buttocks to posterior or posterior-lateral leg all way down to foot
lying on back with knees elevated or fetal position relieves pain

88
Q

When does HNP cause anterior thigh pain

A

L1-L4

89
Q

PE for lumbar HNP

A

(+) straight leg raise
reverse straight leg raise for lesions above L4
LBP and spasms
do complete neuro exam: should follow nerve root distribution

90
Q

Reverse straight leg raise

A

patient prone, lift hip into extension; pain over antior thigh suggests upper lumbar disk problem above L4

91
Q

Imaging for lumbar HNP

A

MRI to confirm if:
sx >4 weeks
significant neuro deficit
for pre-op eval

92
Q

Most common cause of neurogenic leg pain in elderly

A

lumbar spinal stenosis

93
Q

Lumbar spinal stenosis

A

neurogenic claudication- progressive bilateral leg pain (butt, legs, thighs) that is aggravated by standing/walking; relieved by leaning forward or laying supine; radicular sx can be present without actual back pain

94
Q

Old ladies who hung over shopping cart

A

Lumbar spinal stenosis

95
Q

Most common cause of lumbar spinal stenosis

A

spondylosis

96
Q

Sx of lumbar spinal stenosis

A

may have diminished DTR
wide based gait
possible multilevel sensory defects
SLR + in around 10% patients

97
Q

Imaging for lumbar spinal stenosis

A

AP, lateral to T10
MRI
CT myelogram but its invasive
EMG/NCS if unclear etiology or to r/o alternate dx

98
Q

Tx for lumbar spinal stenosis

A

Initial: NSAIDs and PT/opiods; water exercise, epidural steroi injection

Surgical decompression:
No spondylolisthesis: laminectomy or intraspinous spacer implant, MILD if due to ligamentum flavum hyperfrophy

+Spondylolisthesis: lumbar fusion

99
Q

Surgical emergency

A

cauda equina syndrome

100
Q

Cauda equina syndrome nerves effected

A

lumbar, sacral and coccygeal nerve roots

101
Q

Causes of cauda equina

A 
intervertebral disc herniation
epidural abscess
tumor
lumbar spinal stenosis
metastatic disease (meninges)
infectious
autoimmune
102
Q

Sx of cauda equina

A

leg weakness in multiple distributions (L3-S1) - weak plantar flexion, loss of ankle reflex

LBP w/ radiation to one or both legs

PERINEAL SENSORY LOSS***- sadlle anesthesia- buttocks, perineal, posterior/superior thighs
Urinary retention w/ or w/o incontinence
decreased anal sphincter tone
sexual dysfunction

103
Q

Tx for cauda equina

A

Dexamethasone 10 mg IV x 1 IMMEDITELY
Emergent MRI w/ contrast; if not, CT myelogram
scan entire spine if concern of metastatic disease or unsure of etiology ; surgical consult

104
Q

First thing you do for cauda equina

A

administer dexomethasone and page surgery!

105
Q

Malignancy red flags

A 
unexplained weight loss
failure of pain to improve w/ tx
duration of pain >1 mo
pain at night (wakes up)
PMHx of cancer
age >50
new onset of spine pain in patient with known malignancy is metastasis until proven otherwise
106
Q

infection red flags

A 
fever
pain at rest
immunocompromised
IV drug use
hx of recent infection

Clin Med Exam 3 (7 decks)

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