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spinal pathologies Flashcards

1
Q

adolescent presentation of spinal ortho

A

scolisosis

stress fracture

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2
Q

adult presentation of spinal ortho

A

non-specific back pain
DDD
Inflammatory arthritis

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3
Q

adult >60 presentation of spinal ortho

A

spinal stenosis
osteoporotic #
metastasis

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4
Q

other causes of back pain

A
  • thoracic night pain malignancy
  • infection
  • referred pain pancreatitis, renal, peritonism, AAA
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5
Q

what is a true radicular pain

A

pain that follows the dermatome

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6
Q

red flags of spine history

A
  • neurology CES features
  • immunosuppressed, IVDU
  • malignancy: weight loss and fever
  • trauma
  • change in urinary retention, incontinence (cauda equina)
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7
Q

upper motor neuron lesion vs lower mn

A

upper=hyperreflexia, hypertonia, babinski reflex

lower=hyporeflexia, weakness and muscle wasting

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8
Q 
myotomes
c5
c6
c7
c8
t1
A 
c5=shoulder abduction
c6=wrist extensors and elbow flexion
c7=elbow extensors and wrist flexion 
c8=thumb extension 
t1=finger abduction
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9
Q

myotomes

l1-s2

A 
l1/l2=hip flexion
l3=knee flexion
l4=ankle dorsiflexion
l5=big toe extension
s2=knee flexion
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10
Q

what is tip toe walking caused by

A

s1 weakness

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11
Q

what if heel walking caused by

A

l5 weakness as cant dorsiflex big toe

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12
Q

what causes flexion from the hips when walking

A

ank spond

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13
Q

what is the tape measure test called

A

schober’s test

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14
Q

MRC scale of power

A

grade 5=normal

grade o=no muscle movement

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15
Q

imaging of the spine and what they are for

A

x-ray=hard to interpret
mri=shows oedema and soft tissue
ct=fractures

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16
Q

what does a winking owl sign mean

A

loss of pedicle

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17
Q

case: 40 yr old man with lumbar back pain radiating to thighs and no other hx

A

=non-specific back pain

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18
Q

case: 35 year old female lumbar back pain radiating to right foot 1 week, weak plantar flex and calf reflex, normal perineum sensation

A

loss of s1 dermatome

degenerative disc disease

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19
Q

case 3: 6 month back pain and leg weakness, worse on walking struggle to walk 100 yards

A

spinal stenosis

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20
Q

case 4: 6 day hx of back pain, IVDU and fever

A

spinal infection

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21
Q

case 5: 30 year old female, hx of back pain and 12 hr history painless incontinence with absent anal tone and perineum sensation

A

cauda equina syndrome

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22
Q

what are the main back pathologies

A
  • non specific lower back pain
  • degenerative disc disease
  • spinal stenosis
  • spinal infection
  • cauda equina
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23
Q

non specific lower back pain prevalence

A

50-80% experience an episode at some point

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24
Q

features of a non-specific lower back pain

A
  • no nerve route involvement
  • muscle strain/spasm
  • degneration of spine(but no neuro involvement)
  • large psychosocial component
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25
who do you image for non specific lower back pain 4
only those with red flag features - neurology - immunosuppression - malignancy - trauma
26
treatment for non specific lower back pain
-mobilise -physio -analgesia -reassure recovers in own time
27
degenerative disc disease cause
- disc herniation via degenerative annulus fibrosis into spinal cord - bulging of the disc
28
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
29
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
30
spinal stenosis what should you think of
claudication symptoms but strong pulses
31
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
32
what is spondylolithesis
slipping of vertebrae | -anterior translation
33
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
34
treatment of spinal stenosis
lumbar decompression
35
what causes spinal stenosis in a young person
stress fracture in sport causing sponylolysis
36
meaning of sponylolysis
fatigue fracture leads to a defect in the pars interarticularsis of the vertbral arch in the pedicle
37
what can spondylolysis lead too
spondylolisthesis or slippage of vertebrae
38
who is spondylolysis more common in and where
more common in females at L5
39
risk factors for spondylolysis
hereditary | over use-gymnast
40
management spondylolysis
rest analgesia brace physio
41
where does spondylolithesis usually happen
l4/l5
42
causes of spondylolithesis
- congenital - isthemic secondary to spondylolysis - arthritis degenerative - traum - pagets - iatrogenic post op
43
clinical features of spondylolithesis
- asymptomatic possibly - insidious onset lbp and muscle spasm - flattening of the back - claudication symptoms
44
what is adult pyogenic vertebral osteomyelitis
- also known as discitis | - infection of the intervertebral disc and adjacent vertebrae
45
what is an epidural abscess
pus between the dura mater and surrounding adipose in spinal cord -often seen with discitis
46
what is discitis
collection of pus of inflammatory granulation tissue between intevertebral discs
47
what are the risk factors for discitis
- ivdu - diabetes - recent systemic infection (uti,pneumonia) - obesity - malignancy - immunosuppressive - malnutrition - smoking
48
pathogens
staph aureus | staph epidermidis
49
route of infection for spinal infection
- haematogenous - direct - local infection
50
clinical presentation of spinal infection
- 1/3 have fever - pain that is unrelenting and wakes patient - neurology: radiculopathy, myelopathy (spinal cord)
51
investigation of spinal infection
- inflamamtory markers - MRI - blood culture
52
treatment spinal infection
- antibiotics - dont miss endocarditis in sab - decompression, debride and stabilise
53
where does the cauda quina start and what does it occupy
starts at the conus medullaris at l2 | -occupies the lumbar cisterna
54
what goes through the cauda equina
the filum terminale
55
prevalence cauda equina
1in 65,000
56
causes of cauda equina
- central compression of cauda equina - large central disc prolapses - inflamamtory, trauma, infection and malignancy less common
57
diagnosis of cauda equina
- perianal/saddle anaesthesia: loss of sensation to the back of the buttocks - bladder/ bowel dysfunction - reduced or absent anal tone
58
2 types of cauda equina syndrome and prevalence
CES-I : incomplete 40% | CES: R with retention 60%
59
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
60
what is a cauda equina with retention
- dense paraesthesia and absent anal tone | - often overflow incontinence
61
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
62
diagnosis of cauda equina
Emergency MRI
63
treatment of cauda equina
emergency decompression in 48 hours
64
poor prognosis cauda equina
- poor if delayed - sexual and urinary dysfunction - chronic pain and weakness
65
precautions for a spinal injury
log roll lie flat catheterised
66
management of spinal injury
``` c-spine immobilise decompress cord stabilise fracture steroids within 1st 8hrs extensive rehab catheter if in retention ```
67
what is tetraplegia
injury to cervical spine and impaired arms, legs and spine
68
what is paraplegia
injury to thoracic/lumbar and sacral | -get impaired legs, trunk and pelvis
69
what is neurogenic shock
loss of sympathetic trunk activity with profound shock (hr and bp)
70
what is a complete injury spine
injury with no sparing of motor or sensory function below level
71
what is an incomplete spinal injury
injury with some preserved motor and sensory below a certain level

othopaedics (21 decks)

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