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Orthotics > Spine > Flashcards

Spine Flashcards

1
Q

5 types

Types of spinal fractures

A

Compression (wedge) fracture
Axial bust fracture
Flexion/distraction (chance) fracture
Transverse process fracture
Fracture-dislocation fracture

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2
Q

When is a fracture stable?

A

Only the anterior column (not middle or posterior are affected)

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3
Q

Where is most common for spinal fractures to occur?

A

50% occur between T11 and L2

Where ridgid thoracic spine meets more flexible lumbar spine

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4
Q

How can a stable fracture be conservitively managed?

A

minimum 6-12 weeks bracing with gradual increase in activity

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5
Q

Compression (wedge) fracture

A
  • Anterior fractures and loses height
  • Middle and posterior columns typically unaffected
  • Typically stable and therefore not associated with SCI
  • Usually mid-thoracic or thoracolumbar spine
  • Most often in patients with bones weakened by disease (e.g. osteoporosis, bone cancer)
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6
Q

Axial bust fracture

A
  • Vertebral body fracture with fragments in all directions (as vertebra is crushed)
  • Can be from landing on feet from high fall
  • Unstable and usually not suitable for conservative management
  • Can cause SCI
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7
Q

Flexion distraction (chance) fracture

A
  • Vertebra pulled apart
  • Can occur from head-on car collision (pelvis stabilised while trunk flung forward)
  • Unstable but excellent healing potential
  • Commonly L1-3
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8
Q

Transverse process fracture

A
  • From extreme lateral bending
  • Only transverse process affected so does not usually affect stability
  • Treatment gradual increase in movement ± bracing
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9
Q

Fracture-dislocation fracture

A
  • Vertebra moves off adjacent vertebra
  • Most unstable spinal fracture
  • Highest risk of SCI and neurological impairment
  • Typically from major trauma across the back
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10
Q

Spondylolisthesis

A
  • Vertebra body slips forward from the one below it
  • Different types dependant on cause (pathological, congenital, etc)
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11
Q

5 grades

Grades of spondylolisthesis

A

1: < 25% slip

2: 25-50% slip

3: 50-75% slip

4: > 75% slip

5: 100% slip

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12
Q

Osteoporosis

A
  • Progressive disease where bone density and quality educes
  • ↓ bone matrix and minerals (calcium and phosphate)]
  • Remodelling = bone reabsorption and osteoid formation
  • In osteoporosis bone resorption < formation
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13
Q

What population is most at risk of osteoporosis?

A

Post menopausal women
(35%F, 20%M > 50 will have a fracture due to osteoporosis)

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14
Q

What bones do osteoporotic fractures most commonly occur in?

A
  • Hip
  • Wrist
  • Spine
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15
Q

Spondylosis

A
  • Arthritis of the spine
  • Degenerative process affecting vertebral disc and facet joints
  • Facet joints enlarge → bone spur formation
  • Can cause spinal canal to narrow (possible compression of spinal cord)
  • Chronic compression of spinal cord can result in numbness, weakness, pain, difficulty walking
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16
Q

Low back pain

A
  • Most common location of chronic pain
  • 80% will have back pain at some point, 85% will recur
  • LBP is a symptom not a disease
  • Usually resolves on its own with gental exercise
  • Lumbar disc herniation is common cause of LBP in adults
17
Q

Who is most at risk of a prolapsed intervertebral disc?

A

Men (3x more common than in women)

18
Q

Where do most prolapsed discs occur?

A

95% at L4/5 or L5/S1

19
Q

4 stages

Stages of disc prolapse

A
  1. Disc degeneration
    * Nucleus pulposus dries with age
    * Symptoms: back pain only
  2. Prolapse
    * bulge begins to form (may press on spinal cord or column)
    * Symptoms: back pain and leg pain
  3. Extrusion
    * Nucleus pulposus breaks form annulus fibrosus
    * Symptoms: back pain, leg pain. neuro findings
  4. Sequestration
    * nucleus populsus breaks into spinal canal
    * mainly leg pain
20
Q

Sciatica

A
  • Symptom not a pathology
  • Pain, weakness, or tingling through lower back, buttock and leg
  • Compression of 1 or more nerve root L4-S3
  • May be symptom of: herniated disc, spinal stenosis,spondylolisthesis, traums
21
Q

Spinal stenosis

A
  • Narrowing of the spinal canal
  • Often due to degeneration of the facet joints and bone spur growth
  • Severity dependant on size of spinal canal and degree of nerve encroachment
  • May present without any symptoms
22
Q

Pectus carinatum

A

Pigeon chest

  • Breast bone is pushed out and more pronounced
  • Other areas of the ribs may be depressed
  • Symmetrical or asymmetrical presentation
  • Unknown cause (may be genetic, some association with connective tissue disorders)
  • Treated with compression brace 23 hrs/day for up to 2 years
  • Improvement usually seen within a few months
23
Q

What tests are used in scoliosis?

A

Cobb angle
Adams forward bend test
Risser sign (or wrist x-ray)
vertebral rotation

24
Q

Types of scoliosis

A
  • Congenital
  • Neuromuscular
  • Idiopathic
    • Infantile (<3)
    • Juvinile (4-10)
    • Adolecent (10-16)
25
Q

Congenital scoliosis

A

Faliure of formation, segmentation, or both

Can cause SCI (if this is a risk, surgery is indicated)

26
Q

Neuromuscular scoliosis

A

Pelvis may be level (like idiopathic) or oblique

Bracing may reduce function if spine flexibility is used for mobilising

27
Q

Infantile idiopathic scoliosis

A

< 3

M > F
Often resolves on its own

28
Q

Juvinile idiopathic scoliosis

A

4-10
F > M
70% progress
(progression more common than in adolecent as so much growing time remaining)
Can cause serious cardio-pulmonary issues if left untreated

29
Q

Adolecent idiopathic scoliosis

A

10-16
F > M
Occurs in 3% of adolecents
Curves usually progress during periods of rapid gowth

30
Q

Idiopathic hyperkyphosis

A
  • > 5° anterior wedging in =>3 adjacent vertebrae
  • Thoracic - usually asymptomatic but uncosmetic
  • Thoracolumbar - more painful but less noticable
  • Bracing may reduce kyphosis by ~50%
31
Q

5 types

Types of scoliosis bracing

A
  • Milwake - CTLSO, uncosmetic, no de-rotation element
  • Boston - areas of pads and “relief voids”
  • Charleston - over corrective night-time brace
  • Chaneu-gensingen - over corrective brace used with a stretching regime
32
Q

Vertebral rotation

A

0 - no rotation, symmetrical pedicles on x-ray
+1 - pedicle disapearing
+2 - pedicle disapeared
+3 - remaining pedicle in midline
+4 - remaining pedicle beyond midline

Orthotics (6 decks)

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