Spine 2 Flashcards

1
Q

Pars Defect

Spondylolysis/ Spondylolisthesis

A

Fracture in the pars intraarticularis (spondylolysis)

When there is separation at the fracture and slipping of the vertebra it is spondylolisthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Spondylolysis/ Spondylolisthesis

Sx
Pain exacerbated by

A

Pain is usually unilateral, localized, and exacerbated by hyperextension
The pain may spread across the back and feel like a muscle strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Spondylolysis/lithesis

PE

A

Special examination includes pain with extension

Single-leg hyperextension test when standing on one foot and bringing the back into extension

pain with deep palpation of the spine

a step-off is sometimes palpable with spondylolisthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Spondylolysis/ Spondylolisthesis

imaging

A

X-rays…SCOTTY DOGS for spondylolysis and will see visible step off with spondylolisthesis

Confirm the extent of damage with MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spondylolysis/ Spondylolisthesis

Tx

A

Depends on severity
If no slip: activity restriction or bracing if noncompliant
If minimal spondylolisthesis: brace, PT, Tylenol
The rest will have arthrodesis/ fusion surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SI Joint Disorders

general and Sx

A

Inflammation of one or both sacroiliac joints

Very low back pain
Painful with sitting
Sometimes will complain it is hard to find a comfortable sleeping position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SI Joint Disorders

PE and imaging

A

Physical Exam:
TTP (tenderness to palpation) over SI joints
Does not typically have nerve involvement

Tests:
Nothing is really needed; usually diagnosed with HPI and PE
X-rays might show arthritic changes
MRI will show inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SI Joint Disorders

Tx

A

Treatment:
NSAIDs
Bracing/ SI belt
Steroid injection
Surgical fusion

Misc: common in several diseases like ankylosing spondylitis, ulcerative colitis, psoriasis, very common in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Compression Fracture

general and Sx
Describe pain

A

Fracture of vertebral body because of weakened bone (osteoporosis, tumor, etc)

Common complaints/ symptoms:
Sometimes will have no symptoms
Usually will have deep, aching pain in the area of the fracture
Do not typically have nerve involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Compression Fracture

PE and imaging

A

Physical Exam:
clinical based on Sx
Might also notice hyperkyphosis because of multiple thoracic fxs (new and old)

Tests:
X-rays
DEXA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Compression Fracture

Tx

A

Treatment:
Manage pain with medication
Brace will sometimes help
Kyphoplasty
Treat underlying cause

Misc:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Burst Fracture

general and clin man

A

Compression fracture related to high-energy axial loading
Disruption of vertebral body endplate and posterior vertebral body cortex.
May be retropulsion of posterior cortex fragments into spinal canal.

Clinical presentation
Back pain and/or LE neurologic deficits in clinical scenario of trauma.

Pathology
Most commonly occur at L1
~90% occur from T9-L5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

burst fracture

patho

A

Mechanism
High-energy compressive injury.
Fall from height (often landing on feet)
MVA
Intervertebral disc is driven into vertebral body below.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

burst fracture

Radiographic features

A

Loss of vertebral height on lateral views: anterior portion often compressed more than posterior portion of vertebral body
Always involves posterior vertebral body cortex
Bone fragment retropulsion into spinal canal may occur
Spinal cord contusion may occur – assess with MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Jefferson Fracture

general

A

Burst fracture of the atlas. C1
Bilateral fracture of anterior and posterior arch

Epi
50% associated with other C-spine injuries
33% associated with C2 fracture
25-50% of young children have concurrent head injury
May be vertebral artery injury

Mechanism
Axial/vertical compression injury
Typical is diving headfirst into shallow water.
Not normally associated with neurological deficit, though spinal cord injurymay occur if retropulsed fragment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Jefferson Fx

Dx
X-ray findings

A

Diagnosis:Xrays–
Lateral radiographs: increased space in the predental space between C1 and odontoid
Open mouth view: stepoff of the lateral masses of the atlas

always get CTA

17
Q

jefferson

Tx

A

Treatment
Operative: posterior C1-2 fusion vs occipitocervical fusion
Nonoperative: hard C collar vs halo immobilization

18
Q

Hangman’s (C2/ axis pedicle) Fracture

general. MOI

A

Bilateral fracture traversing pars interarticularis of c2 with associated traumatic subluxation of C2 on cervical vertebra 3.

Epidemiology
Second most common fracture of C2 vertebra (odontoid fracture is most common).

Mechanism
extreme hyperextension with secondary flexion with subluxation
associated tearin of posterior longitudinal ligament

19
Q

Hangman’s Fracture

Sx and imaging

A

Clinical manifestation
Pain
neuro exam typically spared

Diagnosis
Xray (C2 subluxation)
CT scan: exam of choice

20
Q

hangman’s Fx

Tx
When to operate

A

Nonoperative: Immobilization +/- closed reduction (rigid C collar vs halo)

Operative: if > 5 mm displacement, severe angulation or face dislocations

21
Q

Odontoid Fracture

general and MOI

A

Fracture of dens

Mechanism of Injury:
forced flexion or extension

Diagnosis:
Xray–seen best on AP odontoid (open mouth) view

22
Q
A

Type 1: cervical orthosis
Type 2: Halo immobilization vs surgery
Type 3: cervical orthosis

23
Q

Clay Shoveler Fractures

general

A

Fracture of spinous process avulsion of a lower cervical vertebra.

Mechanism of Injury
Forced neck flexion with simultaneous muscle contraction
sudden deceleration injury

24
Q

clay shoveler’s

clin man

A

Clinical presentation
Often unrecognised at the time and found incidentally years later when cervical spine imaged for other reasons.
Acutely they tend to be associated with1:
motor vehicle accidents
sudden muscle contraction
direct blows to the spine

25
Q

clay shovelers

Radiographic features

A

seen on lateral radiographs as an oblique lucency through the spinous process, usually of C7
typically displaced

26
Q

Clay Shoveler’s Fracture

Tx

A

Nonoperative: symptomatic management, C collar for comfort
Surgical excision for nonunion/chronic pain

27
Q

Chance Fractures (seatbelt fractures)

general

A

Mechanism
Flexion injury of vertebral body and distraction injury of posterior elements.
Flexion fulcrum occurs anterior to the abdomen. The anterior and middle columns fail in compression, and the posterior column fails in distraction.

Location
Most commonly upper lumbar spine/thoracolumbar junction.

Associations
High incidence of associated intra-abdominal injuries (especially pancreas and duodenum).

28
Q

Chance Fractures (seatbelt fractures)

Tx

A

Treatment
Nonoperative: immobilization in TLSO brace
Operative: in setting of neurological injury
decompression and surgical fixation (typically fusion)

29
Q

Atlanto-occipital dislocation

general and Tx

A

caused by extreme flexion of the neck involving C1/C2
May be associated with odontoid fractures
“internal decapitation”
nonsurvivable injury in 70% of cases, high risk of neurological injury

Tx: occipitalcervical fusion

30
Q

Atlantoaxial Instability

general

A

Instablility C1-C2 not dislocation
Traumatic (extreme flexion/rotational injury) vs chronic degeneration
Downs, RA, Os odontoideum

Clinical Presentation: neck pain, muscle weakness, hyperreflexia, wide gait
Dx: odontoid view, Flex/Ex XRays