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Undergraduate notes > Spine > Flashcards

Spine Flashcards

1
Q

Sagittal plumb line?

A

Line from C2 cross C7-T1 intervertebral disc, T12-L1 intervertebral disc and posterior superior corner S1

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2
Q

Gibbus

A

An acute angular deformity of the spine

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3
Q

Kyphosis

A

Abnormally increases convex curvature of the thoracic spine

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4
Q

Scoliosis

A

3-D deformity of the spine defined as a lateral curvature of the spine in the coronal plane of more than 10 degree of Cobb angle.

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5
Q

Spine infection : Pyogenic spondylodiscitis
Key features (12 points)

A
  • Acute
  • Staph. Aureus / Gram negative (Pseudomonas, E.coli)
  • Site = Lumbar
    -Origin = Vertebral end plate
    -Spread = PLL causing epidural abscess
    -Single level
    -No skip lesions
    -Abundant bone formation
    -Segmental deformity
    -Involvement 3 columns
    -Disc in MRI = destroyed early
    -Less osteoporosis
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6
Q

Spine infection : Tuberculous spondylodiscitis
Key features (12 points)

A
  • Chronic
  • Mycobacterium tuberculosis
  • Site = Thoracic
  • Origin = Anterior superior/inferior corners at metaphyseal region
  • Spread = ALL causing psoas/paravertebral abscess
  • Multilevel
  • Skip lesions
  • Minimal bone formation
  • Angular deformity
  • Involve anterior column
  • Osteoporosis
  • Disc preserved until late
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7
Q

Degenerative spine disease :
- Definition and stage

A

Definition : Natural aging process of spinal column

Stage :
1. Annular and internal disc disruption
2. Prolapsed disc
3. Spondylosis (Degeneration of vertebra/disc/facet with bone), osteophyte formed at foramina or spinal canal (stenosis)
4. Spondylolisthesis

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8
Q

Wiltse-Newman-Mcnab Classification

A

I - Congenital = Dysplastic abnormalities in the posterior elements or the upper sacrum cause listless

II - Isthmus = A : Lytic, presumed to be stress fracture of pars
B : A healed version of lytic type, resulting in an elongated but intact pars
C : Acute fracture of pars from high energy

III - Degenerative = Neural arch is intact, olisthesis due to longstanding segmental instability

IV - Traumatic = Fracture other than pars

V - Pathologic = Generalized or localized bone disease leads to olisthesis

VI - Postsurgical

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9
Q

Myerding scale

A

A classification of degree of anterior displacement
1 = <25%
2 = 25-50%
3 = 50-75%
4 = 75-100%
5 = >100%

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10
Q

Define spondylolysis

A

Defect in pars articularis with no movement of vertebral bodies

= Oblique view to assess pars (Pars = neck of scotty dog)

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11
Q

5 common primary site for spine metastasis?

A
  1. Lungs
  2. Breast
  3. Prostate
  4. Kidney
  5. Thyroid
  6. Gastro-intestinal
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12
Q

Harrington classification of metastatic disease of spine

A

I - No significant neurological involvement (Non-surgical)
II - Involvement of bone without neuro (Non-surgical)
III - Major neuro impairment (sensory/motor) without bone (Indeterminate)
IV - Vertebral collapse with pain resulting from mechanical causes or instability (Surgical)
V - Vertebral collapse or instability combined with major neuro impairment (Surgical)

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13
Q

Prevertebral soft tissue shadow

A

2cm at C6, 6mm at C2

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14
Q

Atlantodens interval (ADI)

A

ADI difference in flexion and extension
>3mm = Instability
>6mm = Disruption of alar ligaments
>9mm = High risk of neurological injury

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15
Q

Steel’s rule

A

1/3 by dens
1/3 by spinal cord
1/3 by free space

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16
Q

Spinal cord injury

A
  1. Primary injury
  2. Secondary injury (Ischaemia & Hypoxia)

a. Local factors
- Compression of spinal cord
- Haemorrhage
- Loss of auto regulation
- Inflammation and edema

b. Systemic factors
- Respiratory compromise
- Hypotension

17
Q

NASCIS (National Acute Spinal Cord Injury)

A

NASCIS 2
- Dosage = Bolus 30mg/kg followed by 5.4mg/kg for the next 23 hours
> Steroid given within 8 hours has a better outcome

NASCIS 3
- Dosage = Bolus 30mg/kg followed by 5.4mg/kg for 24 or 48 hours
> Patients who receive steroid treatment within 3 hours showed no difference if steroids is given within 24 or 48 hours
> If between 3-8 hours, will have advantage if steroid continued for 48 hours

18
Q

Treatment for scoliosis

A

Based on the degree of curvature
10-20 = Observation
20-45 or progressive = Bracing
>45 degree = Surgical correction

19
Q

Mechanical pain without instability

A

1). Symptoms = Musculo-ligamentous pain
Anatomical site = Musculo-ligamentous
Pathophysiology = Musculo-ligamentous injury/sprain

2). Symptoms = Discogenic pain aggravated by activities that increase pressure within the disc
Anatomical site = Intervertebral disc
Pathophysiology = Disc disruption mediated through the sine-vertebral nerve

3). Symptoms = Facet pain - aggravated by hypertension, where facet joints capsule stretches
Anatomical site = Facet joint
Pathophysiology = Facet synovitis or arthrosis

20
Q

Mechanical pain with instability

A

Symptom = Pain aggravated with movement
Anatomical site = Spinal unit
Pathophysiology = Disruption of spinal unit (degenerative, spondylolisthesis, fracture, tumor, infection)

21
Q

Inflammatory pain

A

Symptoms = Rest pain , night pain
Anatomical site = Spinal unit
Pathophysiology = Inflammatory disease, tumor, infection or metabolic

22
Q

Neurological symptoms (UNILATERAL)

A

Sciatica or radicular pain
> lateral recess stenosis
> Radiculopathy = compression of nerve root by prolapse disc and facet hypertrophy

23
Q

Neurological symptoms (BILATERAL)

A

Intermittent or neurological claudication, severe can lead to CES
> Central canal stenosis
> Due to posterior osteophytes, anterior disc, hypertrophied facet joints, and ligamentum flavum posteriorly

Upper motor neuron symptoms
>Central canal stenosis (Thoracic, cervical)
>Myelopathy

24
Q

Red flags in back pain

A
  • Very young <20 years old
  • Very old >60 years old
  • Night pain or rest pain
  • Pain in thoracic spine
  • Change in character of pain
  • Constitutional symptoms
  • Neurological deficits
25
Q

Nerve root involvement in cervical PID

A

C6/7 PID compress C7 nerve root, exit nerve root at the same level

26
Q

Nerve root involvement in lumbar PID

A

L5/S1 compress S1 nerve root which is transversing nerve root exits one level below

27
Q

Central canal vs lateral canal

A

Central = bordered by dural margin
Lateral = divided into subarticular, foraminal, extraforominal

28
Q

Storey 3

A

Pedicle level, nerve root located medial to the pedicle

29
Q

Storey 2

A

Dorsal root ganglion level, visualizing the dorsal root ganglion of the exiting nerve root which located over foraminal region

30
Q

Storey 1

A

Disc space level, visualizing transversing nerve root.
No nerve seen at foraminal level as nerve root at extraforaminal region

31
Q

Cervical spondylotic myelopathy (CSM)

A

Compression of cervical spinal cord due to degenerative disease leading to cord dysfunction

32
Q

CSM symptoms

A
  • Weakness all 4 limbs
  • Numbness all 4 limbs
  • Gait disturbances
  • Bladder, bowel dysfunction
  • Loss of propioception
33
Q

CSM signs

A
  • Upper motor neuron (increased reflexes, tone, babinski positive, clonus)
  • Romberg test positive
  • Difficulty in toe to heel walk
  • Lhermitte’s sign positive
  • Hoffman sign
  • Positive scapular humeral reflex
  • Finger escape sign
  • Grip and release test (20 in 10sec)
  • Reverse supinator reflex
34
Q

Pavlov’s ratio <0.8

A

consistent with cervical stenosis

35
Q

Canal AP diameter

A

Relative stenosis <13mm
Absolute stenosis <10mm
Also known as developmental stenosis

36
Q

Marfan syndrome Major signs

A
  • Ectopia lentis
  • Aortic dilation
  • Severe kyphoscoliosis
  • Thoracic deformity
37
Q

Marfan syndrome Minor signs

A
  • Myopia
  • Tall stature
  • Mitral valve prolapsed
  • Ligamentous laxity
  • Arachnodactaly

Undergraduate notes (1 decks)

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