Spine Flashcards
What is gibbus?
Acute angular deformity of the spine
Define Scoliosis
Lateral deviation of the spine in the coronal plane
OR
Lateral curvature of the spine >10 degrees of Cobb angle with rotation
List 2 types of spinal infection
1. Acute
2. Chronic
Acute -> Pyogenic Spondylodiscitis
Chronic -> Tuberculous spondylodiscitis
Differentiate between pyogenic spondylodiscitis and tuberculous spondylodiscitis
List the stages of degenerative spine disease
Stage 1 -> Annular tear and internal disc disruption
Stage 2 -> Prolapse disc
Stage 3 -> Spondylosis
Stage 4 -> Spondylolisthesis
Define Spondylosis
- Spondylosis is the degeneration of vertebra/disc/facet joint with age
- Bone spurs (osteophytes) formed may encroach upon intervertebral foramina or spinal canal causing pressure on nerve roots or spinal cord
State the differential diagnosis of spurs
A -> Osteophytes (Degenerative joint disease)
B -> Marginal Syndesmophytes (Ankylosing spondylitis)
C -> Non-marginal syndesmophytes (DISH)
Define Spondylolisthesis
Anterior displacement of vertebra or the vertebral column in relation to vertebra below
Name the classification of spondylolisthesis
Wiltse-Newman-Mcnab Classification
Name the scale used for classification of the degree of spondylolisthesis
Meyerding’s Scale
Amount of anterior displacement = x/y x 100%
Define Spondylolysis
Defect in pars intercularis with no movement of vertebral bodies
What can be seen in the Oblique X-ray of spondylolysis?
Scotty dog = Pars
Common primary sites of spine metastasis
- Lungs
- Breast
- Prostate
- Kidney
- Thyroid
- GI Tract
Describe the management of spine metastasis
Harrington Classification
Name the important lines in cervical radiograph
Line 1: Anterior vertebral body
Line 2: Posterior vertebral body
Line 3: Posterior facet joint
Line 4: Spinolaminar line
Line 5: Tip of spinous processes
Prevertebral soft tissue shadow (2cm at C6, 6mm at C2)
What is Steel’s Rule in a cervical spine
Name and describe the grading system for spinal cord injury
Frankel Classification
What are the red flags in back pain?
- The very young (< 20 Y)
- The very old (> 60 Y)
- Presence of night pain and rest pain
- Pain in the thoracic spine
- Change in character of pain
- Presence of constitutional symptoms such as loss of weight/appetite
- Presence of neurological signs and symptoms such as UMN lesion or cauda equina syndrome
How to differentiate spinal vs vascular claudication?
Neurological findings for cervical and lumbar PID
Define Cervical Spondylotic Myelopathy (CSM)
Compression of cervical spinal cord due to degenerative disease leading to cord dysfunction
List the signs of CSM
- UMN signs -> Increased reflexes, tone, babinski positive, clonus
- Romberg sign positive
- Difficulty in toe to heel walk
- Lhermitte’s sign positive
- Other cervical myelopathic sign (Hoffman’s sign, Positive scapular humeral reflex, Finger escape sign, Grip and release test, Positive reverse supinator reflex)
State the indication for surgery in a case of CSM
- Progressive neurological deterioration
- Functional impairment (JOA score < 13)
Name the criteria used to diagnose ankylosing spondylitis
- Low back pain and stiffness for > 3 months and not relieved by rest
- Pain and stiffness in the thoracic region
- Limited motion in lumbar spine
- Limited chest expansion
- History of evidence of iritis or its sequelae
What is the evidence in X-ray that supports the diagnosis of ankylosing spondylosis?
Bilateral sacroiliac changes
- X-ray of BAMBOO SPINE
- X-ray of SACROILITIS
Diagnostic criteria of ankylosing spondylitis based on New York Criteria 1984
Definite radiograph sacroiliitis and one of the following:
1. History of inflammatory back pain
2. Limited motion of the lumbar spine in sagittal and frontal
3. Limited chest expansion related to standard values for age and sex
