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Ortho > Spine > Flashcards

Spine Flashcards

1
Q

What are chance fractures?

A

trauma fractures of T and L spine due to flexion-distraction mechanism.
A/w high rates of mechanical instability and GI injuries.

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2
Q

In chance fractures how to spinal columns fail

A

Mid and post columns fail under tension
Ant column fails under compression

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3
Q

Comp of chance fracture?

A

Deformity - scoliosis, progressive kyphosis, flat back, post-trauma syringomyelia
Nonunion

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4
Q

Lumbar vertebrae has no _______

A

No transverse foramina, costal facets, bifida spinous processes

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5
Q

What is spondylosis?

A

With ageing, bones and discs degenerate. Bone spurs [osteophytes] may form and spinal canal narrows.
Osteophytes can fuse vertebrae together to minimize movement

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6
Q

Degenerative cycle of spondylosis includes?

A

Disc degeneration - disc bulging, possible disc herniation
Joint degeneration
Ligamentous changes = Ligamentum flavum thickening
Deformity = kyphosis sec to loss of disc height

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7
Q

Neurological manifestations of cervical spondylosis?

A

Cervical radiculopathy
Cervical myelopathy
Lumbar radiculopathy
Lumbar spinal stenosis

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8
Q

Cervical radiculopathy causes?

A

Degenerative cervical spondylosis
Disc herniation - posterolateral herniation commonest

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9
Q

Characteristics of cervical radiculopathy?

A

Unilateral arm pain, numbness + tingling in dermatomal distribution in hand.
Weakness in specific muscle groups
Occipital headache, trapezial or interscapular pain
Neck pain worse with vertebral motion
Pain can radiate to shoulders

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10
Q

Provocative tests for cervical radiculopathy

A

Spurling’s test
Shoulder abduction test
UL tension tests
Valsalva maneuver
Neck distraction test

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11
Q

3 signs of Prolapsed Intervertebral Disc on MRI

A

Disc prolapse w/wo nerve root compression
Narrowed intervertebral height
Dark signal intensity

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12
Q

Marker of severity in PID imaging?

A

Pavlov’s ratio = diameter of spinal canal/diameter of vertebral body.
Normal is above 1. Spinal stenosis shows below 0.8

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13
Q

Evaluation method for scoliosis?

A

Cobb’s angle (T12-L4)
above 10 means scoliosis

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14
Q

Criteria for stable / unstable acute spine fractures?

A

Number of affected columns!
1 = stable
2 or more = unstable
Disruption of post ligamentous complex = chronic unstable

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15
Q

Criteria for stable / unstable acute spine fractures?

A

Number of affected columns!
1 = stable
2 or more = unstable
Disruption of post ligamentous complex = chronic unstable

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16
Q

What is radiculopathy?

A

Nerve root lesion causing neurological effect of affected dermatomes and myotomes

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17
Q

What is Prolapsed Intervertebral Disc?

A

Posterior/postero-lateral bulging of disc with outer part of annulus intact towards spinal canal

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18
Q

What posture lowers/raises intradiscal pressure?

A

Lowest = lying on bed
Highest = sitting and bending forwards simultaneously

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19
Q

Signs of PID on MRI?

A

Disc prolapse w/wo nerve root compression
Narrowed interverterbral height
Dark signal intensity

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20
Q

Surgical principles for PID?

A

Decompression + instrumentation + fusion

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21
Q

What is Ankylosing Spondylitis?

A

Chronic inflammatory disease of unknown etiology affecting spine.
Commonest spondyloarthropathy

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22
Q

Hallmark of ankylosing spondylitis?

A

Synovial joint of SI joint involved at Axial skeleton

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23
Q

Progress of ankylosing spondylitis?

A

Widened with erosions at first, then ankylosis

Bilaterally symmetrical

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24
Q

Genetic factor for Ankylosing Spondylitis?

A

HLA-B 27 positive in >90%

25
Q

Presentation of Ankylosing Spondylitis?

A

Lower back pain and stiffness, worse in morning.
SOB due to costovertebral joint involvement = poor chest expansion
Systemic manifestations

26
Q

What does neurogenic claudication point towards in spine?

A

Lumbar spinal stenosis

27
Q

Clinical presentation of Spondylosis in axial spine?

A

Neck or back pain
Facetogenic pain due to facet joint arthritis - worse on extension and standing
Discogenic pain - worse on flexion and sitting
Stiffness and reduced ROM
Can cause deformities like Kyphoscoliosis

28
Q

Myelopathy vs Radiculopathy?

A

Myelopathy is compression of spinal cord.
Radiculopathy in nerve root lesion causing neurological defect of affected dermatomes and myotomes

29
Q

Some causes of myelopathy/radiculopathy?

A

PID
Bulging intervertebral disc
Hypertrophied/infolding of ligamentum flavum
Osteophytes/Syndesmophytes

30
Q

Presentation of Cervical Myelopathy?

A

Chronic
Bilateral
Shooting radicular pain
Patchy numbness>pain
Clumsiness
Unsteadiness
Autonomic dysfunction

What abt compared to cervical radiculopathy?

31
Q

Presentation of Cervical Radiculopathy?

A

Acute
Unilateral
Pain > Dermatomal numbness

32
Q

Presentation of Lumbar Spinal stenosis?

A

Chronic
Bilateral
Back pain + neurogenic claudication
Patchy numbness>pain
Clumsiness
Unsteadiness
Autonomic dysfunction

No autonomic dysfunction, loss in postural stability

33
Q

Presentation of lumbar radiculopathy?

A

Acute
Unilateral
Shooting radicular pain
Pain > Dermatomal numbness

No autonomic dysfunction, loss in postural stability

34
Q

Difference btw paracentral and foraminal herniation?

A

Cervical = Paracentral & Far lateral prolapse affects same nerve root
Lumbar = Paracentral & far lateral prolapse affect different nerve roots

35
Q

Affected Power in cervical level patho?

A

C4 - scapula winging and respiration
C5 = Elbow flexion [Biceps, brachioradialis]
C6 = Wrist extension [ECRL, ECRB]
C7 = Elbow extension [Triceps]
C8 = DIP middle finger flexion [FDP]
T1 = Pinky abduction [ADM]

36
Q

Affected Sensory in Cervical level patho?

A

C2 = behind ear
C3 = on SCM
C4 = Clavicles and base of neck
C5 = lateral arm, regimental patch
C6 = Palmar thumb
C7= Palmar middle finger
C8 = Palmar pinky
T1 = Medial elbow - ulnar side of antecubital fossa

37
Q

Reflex affected in Cervical level patho?

A

C5 = Biceps jerk
C6 = Supinator reflex
C7, C8 = Triceps jerk

38
Q

Motor affected in Lumbar level patho?

A

L2 = Hip flexion [iliopsoas]
L3 = Knee extension [Quads]
L4 = ankle dorsiflexion [tibialis ant]
L5 = Big toe dorsiflexion [Extensor hallucis longus]
S1 = Ankle plantarflexion [gastro, soleus]

39
Q

Sensory affected in Lumbar level patho?

A

L2 = Anteromedial thigh
L3 = Medial femoral condyle above knee
L4 = over Medial Malleolus
L5 = Dorsum of foot, 3rd MTPJ
S1 = Lateral aspect of calcaneus [soleus]

40
Q

Reflex affected in Lumbar level patho?

A

L2 ~ L4 = Knee jerk
S1 = Ankle jerk

41
Q

Suggestive signs or Cervical spine fracture/injury

A

Unconscious from head injury
Abnormal head position
Tenderness on palpation
Pain and paraesthesia in limbs (spinal cord or nerve root injury)

42
Q

Which section of spine especially prone to injury? Why?

A

Thoracolumbar junction!
Transition point btw relatively fixed thoracic spine and relatively mobile lumbar spine

43
Q

C1 Burst fracture? Jefferson fracture!

A

Sudden severe load on head - axial compression - ring of atlas fracture

44
Q

C2 Pedicle fracture? Hangman fracture

A

Often in RTA when forehead strikes dashboard - bilateral pars articularis fracture - spondylolisthesis

45
Q

Fracture dislocation injury of spine?

A

Ant + Medial + Post fracture.
Translation of one vertebra over another.
Mechanism is high energy injury. Commonly thoracolumbar area affected

46
Q

What can be seen in XR of Wedge compression fracture?

A

Decrease in anterior height.
Wedge is when front of vertebral body collapses but the back does not

47
Q

What can be seen in Burst fracture XR?

A

Uniform loss of vertebral height
Burst is vertebrae crushed in all directions

48
Q

What can be seen in Chance fracture XR?

A

Ant column loss of vertebral body height
Transverse fracture extending through pedicles/transverse processes.

From Lat view

49
Q

XR views for cervical spine investigations?

A

AP
Lateral**
Open mouth Odontoid.** To view C1 and C2 e.g. their alignment etc.

50
Q

Anatomic lines in Spine lateral view XR?

A

Ant vertebral line
Post vertebral line
Spinolaminar line
Posterior Spinous line

51
Q

Definitive management for spinal fractures by type?

A

Stable = Closed reduction KIV open with spine brace
Unstable = Surgical decompression + Spinal stabilization
Neurological deficit = Surgical decompression
Long-term rehab = PT, OT

52
Q

What is cauda equina syndrome?

Emergency!!

A

Severe compression of nerve roots in thecal sac of lumbar spine. Most commonly L4-5 level
Most commonly due to acute lumbar disc herniation

53
Q

Early diagnosis of Cauda Equina critical, clinically presents as _____

A

Characteristic symptoms of saddle-like paresthesias + Acute back and leg pain.

Other symptoms include bowel and bladder dysfunction, Lower extremity weakness/arreflexia

Saddle paresthesia: S3-S5 proide sensory innervation to rectum, perineum, inner thigh

54
Q

Treatment of acute cauda equina syndrome?

A

Surgical decompression preferably in 24 hrs.
Absolutely within 48 hrs

55
Q

What is spondylolisthesis?

A

degenerative condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body with intact pars

56
Q

Who and where does spondylolisthesis usually occur?

A

Most common in females >40yo, at L4/L5 level

57
Q

What shape is inter-vertebral space on imaging?

A

Usually rectangle shaped. If its like wedge-shaped ish then its narrowing of joint space

58
Q

What can u see on PID in MRI?

CSF is white on T2-MRI

A

Spinal canal suddenly narrows at one point - look at CSF flow

Ortho (11 decks)

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