spinal pathologies Flashcards
adolescent presentation of spinal ortho
scolisosis
stress fracture
adult presentation of spinal ortho
non-specific back pain
DDD
Inflammatory arthritis
adult >60 presentation of spinal ortho
spinal stenosis
osteoporotic #
metastasis
other causes of back pain
- thoracic night pain malignancy
- infection
- referred pain pancreatitis, renal, peritonism, AAA
what is a true radicular pain
pain that follows the dermatome
red flags of spine history
- neurology CES features
- immunosuppressed, IVDU
- malignancy: weight loss and fever
- trauma
- change in urinary retention, incontinence (cauda equina)
upper motor neuron lesion vs lower mn
upper=hyperreflexia, hypertonia, babinski reflex
lower=hyporeflexia, weakness and muscle wasting
myotomes c5 c6 c7 c8 t1
c5=shoulder abduction c6=wrist extensors and elbow flexion c7=elbow extensors and wrist flexion c8=thumb extension t1=finger abduction
myotomes
l1-s2
l1/l2=hip flexion l3=knee flexion l4=ankle dorsiflexion l5=big toe extension s2=knee flexion
what is tip toe walking caused by
s1 weakness
what if heel walking caused by
l5 weakness as cant dorsiflex big toe
what causes flexion from the hips when walking
ank spond
what is the tape measure test called
schober’s test
MRC scale of power
grade 5=normal
grade o=no muscle movement
imaging of the spine and what they are for
x-ray=hard to interpret
mri=shows oedema and soft tissue
ct=fractures
what does a winking owl sign mean
loss of pedicle
case: 40 yr old man with lumbar back pain radiating to thighs and no other hx
=non-specific back pain
case: 35 year old female lumbar back pain radiating to right foot 1 week, weak plantar flex and calf reflex, normal perineum sensation
loss of s1 dermatome
degenerative disc disease
case 3: 6 month back pain and leg weakness, worse on walking struggle to walk 100 yards
spinal stenosis
case 4: 6 day hx of back pain, IVDU and fever
spinal infection
case 5: 30 year old female, hx of back pain and 12 hr history painless incontinence with absent anal tone and perineum sensation
cauda equina syndrome
what are the main back pathologies
- non specific lower back pain
- degenerative disc disease
- spinal stenosis
- spinal infection
- cauda equina
non specific lower back pain prevalence
50-80% experience an episode at some point
features of a non-specific lower back pain
- no nerve route involvement
- muscle strain/spasm
- degneration of spine(but no neuro involvement)
- large psychosocial component
who do you image for non specific lower back pain 4
only those with red flag features
- neurology
- immunosuppression
- malignancy
- trauma
treatment for non specific lower back pain
-mobilise
-physio
-analgesia
-reassure
recovers in own time
degenerative disc disease cause
- disc herniation via degenerative annulus fibrosis into spinal cord
- bulging of the disc
clinical features of degenerative disc
- nerve route involvement
- but no bladder involvement
- l5/s1 most common (heel walk or tip toe)
- unilateral
- pain radiates to hip/buttock or thigh
- worse with walking or axial loading
- radicular symptoms
management for DDD
-conservative for 3 months and 90% settle with analgesia, physio
-non-conservative after 3 months
either discectomy take out herniated bit or laminectomy- remove the back part
spinal stenosis what should you think of
claudication symptoms but strong pulses
cause of spinal stenosis
reduction of lumbar spine canal due to degeneration
- narrow and impinge of nerve roots or cauda equina
- osteophytes/spondylolithesis
- soft tissue
what is spondylolithesis
slipping of vertebrae
-anterior translation
clinical features of spinal stenosis
- central crushing= non specific lower limb weakness
- foraminal stenosis= corresponds to nerve root
- worse up hill extension and relieved on sitting flexion
treatment of spinal stenosis
lumbar decompression
what causes spinal stenosis in a young person
stress fracture in sport causing sponylolysis
meaning of sponylolysis
fatigue fracture leads to a defect in the pars interarticularsis of the vertbral arch in the pedicle
what can spondylolysis lead too
spondylolisthesis or slippage of vertebrae
who is spondylolysis more common in and where
more common in females at L5
risk factors for spondylolysis
hereditary
over use-gymnast
management spondylolysis
rest
analgesia
brace
physio
where does spondylolithesis usually happen
l4/l5
causes of spondylolithesis
- congenital
- isthemic secondary to spondylolysis
- arthritis degenerative
- traum
- pagets
- iatrogenic post op
clinical features of spondylolithesis
- asymptomatic possibly
- insidious onset lbp and muscle spasm
- flattening of the back
- claudication symptoms
what is adult pyogenic vertebral osteomyelitis
- also known as discitis
- infection of the intervertebral disc and adjacent vertebrae
what is an epidural abscess
pus between the dura mater and surrounding adipose in spinal cord
-often seen with discitis
what is discitis
collection of pus of inflammatory granulation tissue between intevertebral discs
what are the risk factors for discitis
- ivdu
- diabetes
- recent systemic infection (uti,pneumonia)
- obesity
- malignancy
- immunosuppressive
- malnutrition
- smoking
pathogens
staph aureus
staph epidermidis
route of infection for spinal infection
- haematogenous
- direct
- local infection
clinical presentation of spinal infection
- 1/3 have fever
- pain that is unrelenting and wakes patient
- neurology: radiculopathy, myelopathy (spinal cord)
investigation of spinal infection
- inflamamtory markers
- MRI
- blood culture
treatment spinal infection
- antibiotics
- dont miss endocarditis in sab
- decompression, debride and stabilise
where does the cauda quina start and what does it occupy
starts at the conus medullaris at l2
-occupies the lumbar cisterna
what goes through the cauda equina
the filum terminale
prevalence cauda equina
1in 65,000
causes of cauda equina
- central compression of cauda equina
- large central disc prolapses
- inflamamtory, trauma, infection and malignancy less common
diagnosis of cauda equina
- perianal/saddle anaesthesia: loss of sensation to the back of the buttocks
- bladder/ bowel dysfunction
- reduced or absent anal tone
2 types of cauda equina syndrome and prevalence
CES-I : incomplete 40%
CES: R with retention 60%
what is an incomplete cauda equina
- perianal/ saddle anaesthesia: loss of sensation to back of buttocks
- and weak anal tone
- hesitancy or lack of urine control
what is a cauda equina with retention
- dense paraesthesia and absent anal tone
- often overflow incontinence
range of other symptoms cauda equina syndrome
- lbp
- bilateral leg pain
- lower limb paraesthesia &/or motor weakness
- reduction/absent lower limb reflexes
- unilateral/bilateral
- sexual dysfunction
diagnosis of cauda equina
Emergency MRI
treatment of cauda equina
emergency decompression in 48 hours
poor prognosis cauda equina
- poor if delayed
- sexual and urinary dysfunction
- chronic pain and weakness
precautions for a spinal injury
log roll
lie flat
catheterised
management of spinal injury
c-spine immobilise decompress cord stabilise fracture steroids within 1st 8hrs extensive rehab catheter if in retention
what is tetraplegia
injury to cervical spine and impaired arms, legs and spine
what is paraplegia
injury to thoracic/lumbar and sacral
-get impaired legs, trunk and pelvis
what is neurogenic shock
loss of sympathetic trunk activity with profound shock (hr and bp)
what is a complete injury spine
injury with no sparing of motor or sensory function below level
what is an incomplete spinal injury
injury with some preserved motor and sensory below a certain level
