spine Flashcards
bones of spinal column
7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccyx
red flags lower back pain
<20 or >50, history malignany, night pain, trauma, systemic symptoms
invx for lower back pain
lumbar Xray // MRI if needed (for neurological or soft tissue)
mx mechanical lower back pain
NSAIDs, mobilise physio
what is radiculopathy
pinched nerve at spinal nerve root
symptoms radiculopathy
tingling, numbness, weakness, loss of sensation, pain on movement
what is spondylosis
loss of fluid from intervertebral discs
what causes spondylosis
OA
where does spondylosis usually occur in cervical and lumbar spine
C5-7 or L4/L5
symptoms cervical spondylosis
neck pain + stiffness which can radiate to shoulders // can have some radiculopathy + myelopathy
what is myelopathy
compression of spinal cord itself
what is spondylothesis + which part of spine
vertebra slips forward – L4/5 or L5/S1
what can cause an acute lumbar disc tear
usually heavy lifting
symptoms lumbar disc tear
pain, worse coughing
mx lumbar disc tear
analgesia and physio
what pattern of leg pain is seen with lower back prolapsed discs
dermatomal pain + neuro deficits // worse when sitting // usually worse than back pain
symptoms L3/4 prolapsed disc (4)
sensory loss over ant thigh (L3) or ant knee (L4) // weak quads // reduced knee reflex // positive femoral stretch test
symptoms L5 slipped disc
sensory loss dorsum foot // weak dorsiflexion // OK reflexes // positive sciatic stretch test
symptoms L1 nerve compression
sensorly loss posterolateral leg + foot // weak plantar flexon // reduce ankle reflex // positive sciatic stretch test
where does the sciatic nerve exit
L4,5 S1,2,3
symptoms sciatica
unilateral pain, sensory loss, numbness, tingling, weakness // radiating buttocks –> legs
mx sciatica
analgesia, physio, NSAIDs // (maybe gabapentin duloxetine?)
what invx should be done for sciatica after 4-6 weeks
MRI
what is bony nerve root entrapment
OA –> osteophytes –> damage nerve roots
mx bony nerve root entrapment
surgery for osteophyte trimming
what can cause lumbar spinal stenosis
tumour, disc prolapse, spondylosis, osteophytes
symptoms spinal stenosis (4)
similar to claudication (pain on walking, overweight, burning pain) // sitting better than standing // better to walk uphill // pedal pulses intact
invx spinal stenosis
MRI
mx spinal stenosis
surgical decompression eg laminectomy
what is CES
damage to nerve roots that extend below spinal cord
causes CES
disc prolapse (L4/5 or L5/S1) // tumours // abscess // trauma
symptoms CES
low back pain // bilateral sciatica // saddle anaesthesia // reduced anal tone // urinary incontinence
invx CES
MRI (+ PR)
mx CES
surgical decompression
what is meralgia paresthetica
entrapment of lateral cutaneous nerve of the thigh
RF for meralgia paresthetica
30-40 // men // fat // obese // pregnant // trauma // recent surgery
symptoms meralgia paresthetica
all side of thigh: burning, numb, ache, altered sensation // NO weakness
invx meralgia paresthetica
ASIS pelvic compression test // USS // nerve conduction
RF osteoporotic crush fracture
age (women 65, men 75) // history fractures // steroids // falls // secondary osteoporosis // low BMI // smoking and drinking
symptoms osteoporotic crush fracture
back pain // breathing + GI problems (compression of organs) // loss of height // kyphosis
invx osteoporotic crush fracture
1) Xray // CT or MRI
invx to establish future risk of osteoporotic crush fractures
DEXA // FRAX criteria
what is cervical spinal instability
atlanto-axial subluxation –> destruction of synovical joint
symptoms cervical spinal instability
wide gait + weakness + increased tone
what is spinal shock
physiological response to trauma –> complete sensory and motor loss below level of injury
where does spinal shock usually occur
above T6
what reflex can be done to test for spinal shock
squeeze gland of penis –> anal sphincter contraction
how long until spinal shock usually resolves
24 hours
what is neurogenic shock
spinal cord transection –> decreased symp or increased parasymp response
how does neurogenic shock cause bradycardia and hypotension
reduced sympathetic response (or incrased para) so reduced vasoconstriction + HR
