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Musculoskeletal Pathophysiology > Spine > Flashcards

Spine Flashcards

1
Q

Scoliosis is named by the ____ portion.

A

convex

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2
Q

Scoliosis is a lateral curvature of the spin with some ___ component.

A

rotatary

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3
Q

Adolescent idiopathic scoliosis - gender and age incidence?

A

females > males

11-14 years

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4
Q

Adolescent idiopathic scoliosis % incidence and clinical presentation:

A

2% of population

usually appears as a painless and progressive R thoracic curve

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5
Q

Hypotonic children may get ____ scoliosis.

A

neuromuscular

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6
Q

Congenital scoliosis accounts for 10-15% of scoliosis and often results from:

A

failure of normal formation of spine

hemivertebra

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7
Q

Describe Adams test:

A

Observation in standing and forward bending

Negative if no indication of rib hump or curvature

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8
Q

What is the best way to obtain a definitive diagnosis for scoliosis?

A

full spine Xray to calculate Cobb Angle

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9
Q

What are some predictors of scoliosis progression?

A
  1. AGE: younger and less skeletal maturity
  2. GENDER: females
  3. SEVERITY: cobb angle > 20 degrees curvature
  4. CURVE: lumbar > thoracic
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10
Q

Major goals of medical management for scoliosis:

A
  1. prevent curve progression

2. prevent loss of respiratory fxn

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11
Q

Management for Scoliosis:

< 20 degrees

A

observe, exercises, re-examine in 4-6 months

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12
Q

Management for Scoliosis:

20 degrees and 5 degrees progression in last 6 months

A

brace and exercises

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13
Q

Management for Scoliosis:

>30 degrees

A

usually brace immediately

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14
Q

Management for Scoliosis:

>40 degrees

A

operative –usually fusion with pedicle screws, interbody fusions, sublaminar wires

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15
Q

Scoliosis orthoses examples:

A

3 point positions

Boston brace, summit brace

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16
Q

Most importnat therex intervention for scoliosis?

A

flexibility of spine, hips

strength of spinal extensors

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17
Q

Classic RA is mostly associated with ___ spinal level.

A

cervical

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18
Q

Ank Spondyltitis progression:

A

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

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19
Q

Most importnat therex intervention for ank spond?

A

strengthen extensors and postural education

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20
Q

What are two alternative names for spondylosis?

A

DJD (degenerative joint)

DDD (degenerative disc)

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21
Q

Spondylosis vs spondylitis?

A

OSIS - degenerative changes of the spine

ITIS - spinal rheumatic conditions

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22
Q

Vertebral body and anterior disc supports / of the weight of the body. Paired facet joints posteriorly support / of the weight of the body.

A

2/3; 1/3

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23
Q

Peak bone mass is associated with this age range:

A

20-40 yrs

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24
Q

Marked increased menopausal loss of cortical vertebra bone is associated with this age range:

A

40-60 yrs

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25
Q

At 60+ yrs, age-related cortical vertebra bone changes include:

A
  1. bone loss
  2. traction or claw osteophytes
  3. calcification of ALL/PLL
  4. can get bony ankylosis
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26
Q

Disc changes at 20-40 yrs include:

A

nucleus pulposus begin to lose water

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27
Q

Disc changes at 40-60 yrs include:

A

tears in annulus lead to disc space narrowing

increased nucleus pulposus water loss

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28
Q

Disc changes at 60+ yrs include:

A

nucleus fibrotic rather than gelatinous

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29
Q

Facet joints tend to be intact in which age group? When does arthrosis change usually begin to occur?

A

20-40 yrs

40-60 yrs

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30
Q

Describe the early destructive phase of spinal degeneration:

A

Synovitis of facet joints

Circumferential or radial tears in annulus of the disc

31
Q

One segment of the spine is defined as:

A

2 vertebra and interposed disc

32
Q

Describe the intermediate instability phase of spinal degeneration:

A

vertebral and peri-facet osteophytes and traction spurs

Laxity of posterior joint capsule and annulus

33
Q

Laxity of posterior joint capsule and annulus can lead to:

A

spondylo/retrolisthesis

disc herniation

34
Q

Describe the final stabilization phase of spinal degeneration:

A
  1. Fibrosis of the facets and capsule
  2. Loss of disc material and height
  3. Osteophytes
  4. Bony ankylosis of vertebral bodies
  5. Stenosis (closing of joint space)
35
Q

What are the 3 phases of spinal degeneration?

A
  1. early destructive
  2. intermediate instability
  3. final stabilization
36
Q

Describe the degenerative changes of disc and vertebral body:

A

Disc space narrowing
Vacuum discs
Vertebral sclerosis
Claw osteophytes from vertebral body

37
Q

Describe the degenerative changes of facet joints:

A

OA of the facet joints

Subluxation of the facet joints

38
Q

At 60+ years, what are changes that occur with the facet joints?

A

subluxation likely
intervertebral foramen (IVF)
narrowing and decreased disc height

39
Q

What happens with central spinal stenosis?

A

the central canal narrows and can impinge the SC and caudal equina

40
Q

What happens with lateral spinal stenosis?

A

the IV foramen narrows and can impinge on spinal nerve roots

41
Q

Clinical presentation of spinal stenosis?

A

Back pain with unilateral or bilateral radicular symptoms

Loss of trunk mobility

42
Q

What causes spinal instability?

A

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

43
Q

Describe the clinical presentation of spinal instability:

A

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

44
Q

What is spondylolysis?

A

fx of the pars interarticularis

45
Q

What is the radiological feature on X-ray for spondylolysis?

A

scotty dog “collar” on oblique X-ray

46
Q

What is spondylolisthesis?

A

ANTERIOR subluxation of vertebral body

47
Q

What levels of the spine is spondylolisthesis?

A

L4, L5

48
Q

What radiological view is useful for identifying spondylolisthesis?

A

lateral view

49
Q

Describe management of spondylolisthesis:

A 
Stabilization exercises
Limit spinal extension
Posture to reduce lordosis
Bracing 
Fusion
50
Q

Describe this IV disc lesion: Bulge/Protrusion, prolapse

A

nucleus bulges but outer annular fibers remain intact and contain the nuclear material

51
Q

Describe this IV disc lesion: Extruded

A

nuclear material breaks through the annulus but is still connected

52
Q

Describe this IV disc lesion: Sequestered

A

nuclear material has broken away form the disc and is a free mass

53
Q

An IV disc lesion is also known as HNP:

A

herniated nucleus pulposus

54
Q

Posterior longitudinal ligament is thin in what spinal level?

A

lumbar

55
Q

Anterior longitudinal ligament is thin at what spinal level?

A

cervical

56
Q

What is the most common direction of disc herniation?

A

posterolaterally

thin PLL in L spine

57
Q

What direction of disc herniation could lead to bilateral symptoms?

A

central herniation

*can create cauda equina syndrome if large enough

58
Q

Anterior directed disc herniation may be observed in what spinal level?

A

cervical

59
Q

Most common age group and gender for disc herniations?

A

31-50 yrs

somewhat more common in men

60
Q

What are the most common segments for disc herniation?

A

Cervico-thoracic transition: C4-5, C5-6

Lumbo-sacral transition: L4-5, L5-S1

61
Q

What repetitive motions commonly lead to disc herniation?

A

lifting, forward bending, twisting, driving

62
Q

Pts presenting with acute lumbar disc dysfxn may have muscle ____.

A

spasm

63
Q

Clinical presentation for pts with lumbar disc dsyfxn:

A

May see (lateral) shift of lumbar spine, or forward bent position, gait deviations
+ SLR, Slump tests
+ cervical quadrant tests in neck

64
Q

What pathology is more likely than any other pathology to have neurological sxs below the knee?

A

Lumbar disc dsyfxn

65
Q

Clinical findings for pts with lumbar disc dsyfxn:

A

LBP/neck pain with/without radiculopathy

Myotomal, dermatomal, reflex changes possible

66
Q

Describe the most to least comfortable positions for patients with lumbar disc dysfxn:

A

Lying>walking>standing>sitting

67
Q

Diagnostic evidence for lumbar disc dysfxn:

A 
Plain films – not helpful
MRI  - most common 
Myelography/CT  
EMG
CT discography – painful but can help distinguish between scar tissue and recurrent HNP
68
Q

Conservative management of acute disc lesion:

A 
Limited bedrest – 2 days
Meds -  NSAIDS, muscle relaxants
Exercise programs, modalities etc
Pt ed re postures and positions
Epidural steroid injections
69
Q

Common spinal procedures:

A

Decompression:
Microdiscectomy – usually for HNP
Laminectomy for HNP or stenosis

70
Q

Describe a Posterior Gutter fusion:

A

place graft strips along the lamina , often now done with pedicle screw fixation

71
Q

Describe Interbody Fusions:

A

Can be anterior (ALIF) or Posterior (PLIF) use cages

72
Q

Describe post fusion recovery:

A

braces, no movement in spine for 2-3 months as graft heals

73
Q

Describe post Discectomy/laminectomy recovery

A

patient mobile very quickly , early spinal mobility

Musculoskeletal Pathophysiology (14 decks)

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