Spine Flashcards
Name Myotome and Dermatome of L2-L3 and associated reflexes
Myotome:Iliopsoas(hip flexion)
Dermatome:Medial aspect of thigh and knee
Reflex:Nil
Name Myotome and Dermatome of L4 and associated reflexes
Myotome:Tibialis Anterior
Dermatome: Medial calf,Medial foot
Reflex: Knee Jerk
Name Myotome and Dermatome of L5 and associated reflexes
Myotome: extensor digitorum Longus
Dermatome:Lateral calf,Lateral foot
Reflex: Nil
Name Myotome and Dermatome of S1 and associated reflexes
Myotome:Peroneus Longus and Brevis
Dermatome: sole of foot,side of foot including lateral malleolus
Reflex:ankle jerk
Name Myotome and Dermatome of S2-S5 and associated reflexes
Myotome:Clawing of toes:FDL?
Dermatome:Anal area
Reflex:Anal wink
Reason for palpating pulses at the end of every PE
As part of Neurovascular exam, to differentiate between neurogenic or vascular claudication
Possible indications of discogenic pathology
Pain worse on sitting,relieved on standing
Pain worse on flexion than extension
Impulse symptoms:Worse on coughing,straining to pass motion etc
Possible indications of Posterior column pathology
Pain worse on extension than flexion
Is generalized limb numbness indicative of radiculopathy
No. Need to be able to identify the dermatomal distribution
Name 3 common types of Intervertebral disc prolapse+ its effect on nerve roots
Postero-Lateral: Traversing nerve root affected( Most common type I think)
Far-lateral: Exiting nerve root affected
Central: Both traversing nerve roots affected( Bilateral symptoms)
Features of degenerated intervertebral disc
Dehydration of disc, reduced turgor, reduced disc height, syndesmophytes(?)
Most Common levels of Prolapsed Intervertebral disc
L4/L5 and L5/S1
What is the Meyerding classification for+describe the grades
For Grading of Spondylolisthesis severity Grade I:0-25% II:25-50% III:50-75% IV:75-100% V: >100% (Spondyloptosis)
What is sequestrated disc prolapse?
condition in which a portion of the vertebral disc fragments and migrates into the spinal canal. The condition results when the nucleus pulposus of a herniated disc extrudes through the annular fibers and a piece of the nucleus breaks free.
What surgical procedure is commonly used for a prolapsed disc
Discectomy
What is spondylolysis
Fracture of the pars interarticularis of vertebrae: Scotty dog with collar sign
Common cause of Gibbus deformity(Severe kyphotic deformity, often with an “apex” at a single vertebral level)
Mycobacterium Tuberculosis of the spine(Spinal TB)
How does Spinal TB usually spread
Along the Anterior longitudinal ligament of the spine
Common principle for surgical management of spinal conditions
Depends on the level of disability in the patient, such as pain, neurological symptoms and bowel/urinary changes
Main differences between bulging and herniated intervertebral disc
Bulging: Annulus still intact but compresses structures while Herniated: Disc materials breaks through annulus
Bulging USUALLY insidious progression while herniated USUALLY acute
Adequacy for C spine lateral XR
C1-C2 and C7-T1 junctions
Sacral sparing significance
Suggests incomplete rather than complete spinal cord injury
Components of sacral sparing
Anal wink
Perianal sensation
Firm anal tone
Trick for identifying level of C spine imaging
Look for ice cream cone upside down: odontoid peg of C2
What is Maloneys Arc
The Shentons line of shoulder dislocation
What are the 3 columns compromising spinal stability
Anterior: ant. 2/3 of vertebral body/disc
Middle:post 1/3 of vertebral body/disc and PLL
Posterior: everything posterior to PLL
Chance fracture definition
Flexion distraction injury often causing disruption of all 3 columns of spine
Where does lateral corticospinal tract decussate
In the brain
Where does lateral corticospinal tract decussate
In the brain
Scoring of Spinal Cord injury
ASIA
A: Complete SCI
B C D: Incomplete
Prognosis for ASIA A Spinal Cord Injury
Poor likelihood of rehab, but may not be a true ASIA A
Types of spinal cord injury
Brown Sequard
Central cord
Posterior cord
Anterior cord
Pattern of central cord syndrome
Cervical is outermost fibres, sacral lower. Hence UL affects more than LL
Pattern of brown sequard
Retain PT-I and MO-C
Most common cause of anterior cord syndrome
Vascular cause: anterior spinal artery?
Signs of neurogenic shock
Hypotension with BRADYCARDIA
Most impt parts of managing neurogenic shock
Prevent secondary injury
Immobilisation
Vasopressors if shock
Oxygen supplementation
Fluid rhesus not as impt
Indication to send spinal cord injury to HD
High spinal cord injury: Risk of phrenic nerve injury(C3-C5)
How to check for resolution of spinal shock
Return of bulbocavernosus reflex after 48hrs. Tug on glans penis or urinary catheter
Type of urinary incontinence in Cauda Equina Syndrome
Overflow incontinence
What does disruption of Scottie dog suggest and what is common demographic
Pars interarticularis fracture
Often hyperextension injury in gymnasts
Score for spinal instability
TLICS
-Morphology
-Posterior Column integrity
-Neurology
Manifestations of spinal injuries
Neurological compromise or structural instability
Most common MOI for central cord syndrome
Hyperextension injury from fall etc
Cause of anterior cord syndrome
Disruption of blood supply from anterior spinal artery
How to try ddx CES and CMS
Unilateral vs bilateral
Saddle vs perianal
Areflexic,atrophy vshyperreflexic, fasciculations
Late vs early presentation
Unlikely vs common impotence
Nexus criteria for spine acronym
NSAID
Neuro deficit
Spinal tenderness
AMS
Intoxication
Distracting injury
Red flag for possible CES that may progress
Bilateral straight leg raise positive
3 components of balance
Vision
Proprioception
Vestibular
3 components of balance
Vision
Proprioception
Vestibular
3 components of balance
Vision
Proprioception
Vestibular
4 gaits in spine exam
Antalgic, myelopathic, tredelenberg and high stepping
Signs of inverted supinator jerk
Finger flexion esp Thumb and index
Elbow extension
Smth else?
Pathophysiology of inverted supinator jerk
Lesion at C5/C6 where C6 nerve root exits. C7 and below is UMN lesion hyperreflexic hence finger flexion and elbow extension
Pathophysiology of finger escape sign
Generalised weakness. Imbalances of forces as extensors are stronger, and intrinsics are weaker Hence small finger is abducted
5 special tests for Cervical Myelopathy and 2 bonus
- Lhermitte’s test
- Finger escape(ulnar deviation of digiti minimi)
- Hoffman’s test
- Grip and release
- Inverted Supinator jerk
Bonus: Ankle clonus >3 beats and babinski positive
Etiologies of Cervical myelopathy
- Degenerative Cervical Spondylosis
- Ossification of Posterior Longitudinal Ligament(OPLL)
- Malignancy primary or secondary
- Epidural abscess
- TB Spine(Pott’s disease)
- Trauma/ fracture
- Kyphoscoliotic deformities
- Congenital spinal stenosis
Classification system for cervical myelopathy
JOA( Japanese Orthopaedics Association)
Causes of winking/ blinking owl sign on spine XR
- Spinal metastasis
- TB or other infections
- Intraspinal malignancies (e.g. hemangioma, spinal cord tumours like astrocytoma)
- (Uncommon) primary bone lesion, lymphoma
Blood test for ankylosing spondylitis
HLAB 27( Human leukocyte antigen B 27)
Most common level on spondolysis
Most commonly L5 on S1
What to look for in XR of Adolescent Idiopathic Scoliosis
Cobb angle( Scoliosis severity) >10 and Risser staging(Skeletal maturity)
