spine Flashcards
the vertebra consists of ____ vertebra divided into ____ regions
33 vertebra; 5 regions
____ cervical vertebrae
____ thoracic vertebrae
____ lumbar vertebrae
____ fused sacral vertebrae
____ fused coccygeal vertebrae
7 cv
12 tv
5 lv
5 fused sv
4 fused cv
the adult vertebra presents _____ anteroposterior curvatures
four
discuss kyphotic curve
found in thoracic and sacral; concave anteriorly
discuss primary curve
thoracic and sacral curvatures; appear during embryonic period proper
discuss lordotic curve
found in cervical and lumbar; concave posteriorly
discuss secondary curve
appear later (although before birth); accentuated in infancy by support of the head and adoption of upright posture
slight kyphotic angle of thoracic vertebra, ranges from
20 deg - 45 deg (ave 35 deg); >45 deg is hyperkyphosis
lumbar lordosis, ranges from
40 deg - 80 deg (mean, 60 deg); decreases w age
60 - 70% of lumbar lordosis occurs at (vertebra level)
L4 to S1
“round back”; anteroposterior curvature of the spine w convexity posteriorly; normal in thoracic and sacral level
kyphosis
give the causes of adult kyphosis
- faulty posture
- degeneration of iv discs (senile kyphosis)
- atrophy of muscles
- collapse of vertebral bodies (menopausal and senile osteoporosis)
pathalogic causes of adult kyphosis
- chronic arthritis
- osteitis deformans
- polio
- fracture
- TB
- metastatic tumor
- plasma cell myoloma
- myelomeningocele
clinical features of adult kyphosis
- deformity of kyphosis w or w/o pain; weakness of back and fatique
- (+) tenderness is recent compression fracture in senile osteoporosis
treatment
- maintain to correct posture
- use of light spinal brace or corset
- exercises to strengthen muscle of the back and abdomen
- rest of fracture board and sponge rubber mattress
- treat underlying disease
characteristics of dowager’s hump
- severely kyphotic upper posterior (dorsal) region
- results from multiple anterior wedge compression fractures of several vertebra of middle to upper thoracic spine
- caused by post menopausal osteoporosis or long term corticosteroid therapy
- more than 1 vertebra affected
- curve is more rounded
characteristics of hump back
- deformity is localized, sharp, posterior angulation called GIBBUS
- anterior wedging of one of the two thoracic vertebra as result of infection (tb), fracture, congenital bony anomaly of spine
- only one vertebra is affected
- curve is more angulated
defined as structural sagittal plane deformity in the thoracic or thoracolumbar spine
also called adolescent kyphosis, juvenile kyphosis, vertebral epiphysitis
common in male; 12 - 16 yrs old
scheuermann’s kyphosis
criteria for scheuemann’s kyphosis
- thoracic kyphosis > 45 deg
- wedging > 5 deg of three adjacent vertebrae
- for thoracolumbar: > 30 deg
clinical diagnosis of scheuermann’s kyphosis
- common in males; predilection; hereditary
- symptoms begin bet ages 12-16
- ## first subject complaint is fatigue and pain in the back but many are non symptomatic
causes of scheuermann’s kyphosis
growth disturbance of the vertebra epiphyses usually dure to vascular disturbance
in xray: end plate abnormality; three or more vertebral bodies are wedged on anterior aspect seen on lat radigraphs
management of scheuermann’s kyphosis (discuss criteria for each management)
- PT and obsevration if curve is < 50 deg with no evidence of progression
- bracing if curves are 50-70 deg in skeletally immature person; milwaukee brace x 1-2 years
- surgery: failure of brace, significant symptoms as back pain, curves > 70 deg w pain, posterior spinal arthrodesis and use of harrington compression rod; for severe deformity combined ant and post spinal fusion
also known as eosinophilic granuloma or calve’s disease; uncommon, affects children 2-12 yrs old
vertebra plana
discuss pathology of vertebra plana
vertebral lesion is a pathologic fracture caused by benign destructive process usually and eosinophilic granuloma
clinical of vertebra plana
- pain, fatigue, and mild angular kyphosis
- muscle spasm and tenderness
- occasionally, spinal cord or nerve root compression
radiographical of vertebra plana
- affected vertebral body is eroded or fragmented
- uniformly flattened or wedge shape
- child may regain considerable height as growth progresses
management of vertebral plana
- rest in recumbent position
- brace or planter jacket
dowager’s hump vs hump back
dowagers
- more than 1 vertebra is affected (2-3)
- curve is more rounded
hump back
- only one vertebra affected
- curve is more angulated
scheuermann’s vs vertebra plana
scheuermann’s
- more common in male
- occurs in older children, 12-16
- cause is epiphysis
vertebra plana
- nor gender specific
- occurs in younger children, 2-12 yrs old
- cause is eosinophilic granuloma
