Spine Flashcards
Scoliosis is named by the ____ portion.
convex
Scoliosis is a lateral curvature of the spin with some ___ component.
rotatary
Adolescent idiopathic scoliosis - gender and age incidence?
females > males
11-14 years
Adolescent idiopathic scoliosis % incidence and clinical presentation:
2% of population
usually appears as a painless and progressive R thoracic curve
Hypotonic children may get ____ scoliosis.
neuromuscular
Congenital scoliosis accounts for 10-15% of scoliosis and often results from:
failure of normal formation of spine
hemivertebra
Describe Adams test:
Observation in standing and forward bending
Negative if no indication of rib hump or curvature
What is the best way to obtain a definitive diagnosis for scoliosis?
full spine Xray to calculate Cobb Angle
What are some predictors of scoliosis progression?
- AGE: younger and less skeletal maturity
- GENDER: females
- SEVERITY: cobb angle > 20 degrees curvature
- CURVE: lumbar > thoracic
Major goals of medical management for scoliosis:
- prevent curve progression
2. prevent loss of respiratory fxn
Management for Scoliosis:
< 20 degrees
observe, exercises, re-examine in 4-6 months
Management for Scoliosis:
20 degrees and 5 degrees progression in last 6 months
brace and exercises
Management for Scoliosis:
>30 degrees
usually brace immediately
Management for Scoliosis:
>40 degrees
operative –usually fusion with pedicle screws, interbody fusions, sublaminar wires
Scoliosis orthoses examples:
3 point positions
Boston brace, summit brace
Most importnat therex intervention for scoliosis?
flexibility of spine, hips
strength of spinal extensors
Classic RA is mostly associated with ___ spinal level.
cervical
Ank Spondyltitis progression:
begins with sacro-illiatis (thinning of cartilage and bone condensation at SI joints) and leads to fusion of the spine with flexed trunk, hips, knees
Most importnat therex intervention for ank spond?
strengthen extensors and postural education
What are two alternative names for spondylosis?
DJD (degenerative joint)
DDD (degenerative disc)
Spondylosis vs spondylitis?
OSIS - degenerative changes of the spine
ITIS - spinal rheumatic conditions
Vertebral body and anterior disc supports / of the weight of the body. Paired facet joints posteriorly support / of the weight of the body.
2/3; 1/3
Peak bone mass is associated with this age range:
20-40 yrs
Marked increased menopausal loss of cortical vertebra bone is associated with this age range:
40-60 yrs
At 60+ yrs, age-related cortical vertebra bone changes include:
- bone loss
- traction or claw osteophytes
- calcification of ALL/PLL
- can get bony ankylosis
Disc changes at 20-40 yrs include:
nucleus pulposus begin to lose water
Disc changes at 40-60 yrs include:
tears in annulus lead to disc space narrowing
increased nucleus pulposus water loss
Disc changes at 60+ yrs include:
nucleus fibrotic rather than gelatinous
Facet joints tend to be intact in which age group? When does arthrosis change usually begin to occur?
20-40 yrs
40-60 yrs
Describe the early destructive phase of spinal degeneration:
Synovitis of facet joints
Circumferential or radial tears in annulus of the disc
One segment of the spine is defined as:
2 vertebra and interposed disc
Describe the intermediate instability phase of spinal degeneration:
vertebral and peri-facet osteophytes and traction spurs
Laxity of posterior joint capsule and annulus
Laxity of posterior joint capsule and annulus can lead to:
spondylo/retrolisthesis
disc herniation
Describe the final stabilization phase of spinal degeneration:
- Fibrosis of the facets and capsule
- Loss of disc material and height
- Osteophytes
- Bony ankylosis of vertebral bodies
- Stenosis (closing of joint space)
What are the 3 phases of spinal degeneration?
- early destructive
- intermediate instability
- final stabilization
Describe the degenerative changes of disc and vertebral body:
Disc space narrowing
Vacuum discs
Vertebral sclerosis
Claw osteophytes from vertebral body
Describe the degenerative changes of facet joints:
OA of the facet joints
Subluxation of the facet joints
At 60+ years, what are changes that occur with the facet joints?
subluxation likely
intervertebral foramen (IVF)
narrowing and decreased disc height
What happens with central spinal stenosis?
the central canal narrows and can impinge the SC and caudal equina
What happens with lateral spinal stenosis?
the IV foramen narrows and can impinge on spinal nerve roots
Clinical presentation of spinal stenosis?
Back pain with unilateral or bilateral radicular symptoms
Loss of trunk mobility
What causes spinal instability?
Loss of integrity of the segmental soft tissue structures
Abnormal quantity or quality of motion (can be seen on fluoroscopy)
Degenerative changes
Trauma, rupture or overstretching of ligaments
Spondylolisthesis
Describe the clinical presentation of spinal instability:
fBack or neck pain with radicular symptoms
Protective muscle spasm
“Juttering” with motion
May have “step deformity” on palpation
May require bracing or fusion for support
What is spondylolysis?
fx of the pars interarticularis
What is the radiological feature on X-ray for spondylolysis?
scotty dog “collar” on oblique X-ray
What is spondylolisthesis?
ANTERIOR subluxation of vertebral body
What levels of the spine is spondylolisthesis?
L4, L5
What radiological view is useful for identifying spondylolisthesis?
lateral view
Describe management of spondylolisthesis:
Stabilization exercises Limit spinal extension Posture to reduce lordosis Bracing Fusion
Describe this IV disc lesion: Bulge/Protrusion, prolapse
nucleus bulges but outer annular fibers remain intact and contain the nuclear material
Describe this IV disc lesion: Extruded
nuclear material breaks through the annulus but is still connected
Describe this IV disc lesion: Sequestered
nuclear material has broken away form the disc and is a free mass
An IV disc lesion is also known as HNP:
herniated nucleus pulposus
Posterior longitudinal ligament is thin in what spinal level?
lumbar
Anterior longitudinal ligament is thin at what spinal level?
cervical
What is the most common direction of disc herniation?
posterolaterally
thin PLL in L spine
What direction of disc herniation could lead to bilateral symptoms?
central herniation
*can create cauda equina syndrome if large enough
Anterior directed disc herniation may be observed in what spinal level?
cervical
Most common age group and gender for disc herniations?
31-50 yrs
somewhat more common in men
What are the most common segments for disc herniation?
Cervico-thoracic transition: C4-5, C5-6
Lumbo-sacral transition: L4-5, L5-S1
What repetitive motions commonly lead to disc herniation?
lifting, forward bending, twisting, driving
Pts presenting with acute lumbar disc dysfxn may have muscle ____.
spasm
Clinical presentation for pts with lumbar disc dsyfxn:
May see (lateral) shift of lumbar spine, or forward bent position, gait deviations
+ SLR, Slump tests
+ cervical quadrant tests in neck
What pathology is more likely than any other pathology to have neurological sxs below the knee?
Lumbar disc dsyfxn
Clinical findings for pts with lumbar disc dsyfxn:
LBP/neck pain with/without radiculopathy
Myotomal, dermatomal, reflex changes possible
Describe the most to least comfortable positions for patients with lumbar disc dysfxn:
Lying>walking>standing>sitting
Diagnostic evidence for lumbar disc dysfxn:
Plain films – not helpful MRI - most common Myelography/CT EMG CT discography – painful but can help distinguish between scar tissue and recurrent HNP
Conservative management of acute disc lesion:
Limited bedrest – 2 days Meds - NSAIDS, muscle relaxants Exercise programs, modalities etc Pt ed re postures and positions Epidural steroid injections
Common spinal procedures:
Decompression:
Microdiscectomy – usually for HNP
Laminectomy for HNP or stenosis
Describe a Posterior Gutter fusion:
place graft strips along the lamina , often now done with pedicle screw fixation
Describe Interbody Fusions:
Can be anterior (ALIF) or Posterior (PLIF) use cages
Describe post fusion recovery:
braces, no movement in spine for 2-3 months as graft heals
Describe post Discectomy/laminectomy recovery
patient mobile very quickly , early spinal mobility
