Spine Flashcards
How are intervertebral disc prolapses managed?
Most are managed conservatively - analgesia / neuropathic pain meds, physiotherapy.
Surgery - if pain is not relieved after all the conservative measures, if there is progressive muscle weakness, or spinal cord compression.
What is a special test that assesses for disc herniation in patients presenting with lower back pain?
Lasegue sign (straight leg raise) - patient lies on their back, examiner lifts leg while knee is straight. A positive sign is when pain is elicited during the leg raising.
(It’s not very specific though).
According to NICE guidelines, when would you image suspected degenerative disc disease?
If red flags are present
If there is ridiculopathy and pain for more than 6 weeks
If there is evidence of spinal cord compression
If imaging would significantly alter management
We may do spine radiographs to rule out fracture (if there are risk factors).
MRI spine is the gold standard.
How should degenerative disc disease be managed?
In the acute stage - adequate pain relief. (Simple analgesics up to neuropathic analgesics). Encourage mobility, physiotherapy.
If pain continues beyond 3 months - referral to the pain clinic.
N.b. There is no evidence to support surgical intervention for low back pain.
What classification system is used for cervical fractures?
AO classification.
What are the 3 eponymous cervical fractures?
Jefferson fracture - burst fracture of c1 (the atlas) due to axial loading.
Hangman’s fracture - fracture of c2 (the axis) usually through the pars interarticularis, due to hyperextension and distraction (tension pulling).
Odontoceti peg fractures - can be fatal, often low impact trauma in elderly patients.
What imaging should be requested in a suspected cervical fracture?
If the Canadian C spine rules suggest imaging is needed:
- CT scan for adults
- MRI scan for children
We only do plain film radiograph for children who do not meet the full criteria, but we still suspect their might be cervical injury.
How should a cervical spine fracture be managed?
ATLS assessment including 3-point C spine immobilisation.
Conservative (for patients who have stable fractures) - rigid collars.
If unstable - halo vest / traction devices.
Surgical - (for unstable fractures) fusing of injured segments / fixation with screws or rods.
How are thoracolumbar fractures classified?
AO classification:
Type A - compression injuries
Type B - distraction injuries
Type C - translation injuries
What is a chance fracture?
A vertebral fracture that result from excessive flexion of the spine and involve all three spinal columns (anterior,middle,posterior). They are unstable injuries and will need surgery to stabilise.
They typically occur following a head-on road traffic accident when the person is only wearing a lap belt.
What imaging should be done for a suspected thoracolumbar fracture?
Plain film radiograph AP and lateral views (if there are no neurological signs).
Then if this is abnormal a CT should be performed. Or a CT should be performed straight away if there are neurological signs.
MRI may also be done to assess for soft tissue injury (such as spinal cord).
N.B. If we suspect a pathological cause we may do further work up including a serum calcium and myeloma screen.
How should a thoracolumbar fracture be managed?
By ATLS guidelines.
Immobilisation.
Analgesia
If stable conservative management - extension bracing / lumbar corsets.
The thoracolumbar injury classification and severity (TLICS) scoring system can be used to quantify the likelihood of instability and the need for surgery.
Surgical management - decompression and spinal fusion (fixation with pedicle screws and rods).
