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Lecture Notes- Orthopaedics and Fractures > Spine > Flashcards

Spine Flashcards

1
Q

What bones make up the spine

A 
7 cervical 
12 thoraic 
5 lumbar 
sacrum
coccyx
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2
Q

What is each vertebra composed of

A 
vertebral body 
pedicles
laminae
transverse process 
spinous process
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3
Q

What lie between each vertebrae in the cervical, lumbar and thoracic region

A

Intervertebral discs

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4
Q

What makes up a motion segment

A

two vertebrae and the disc between them

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5
Q

What do motion segments allow

A

differing amounts of flexion/ extension, lateral bending and rotation with the total movement being considerable

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6
Q

What limits the movement in the thoracic region

A

ribs and sternum

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7
Q

What is lordotic

A

curve convex anteriorly

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8
Q

What is kyphotic

A

convex posterior

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9
Q

What is the function of the sagittal curves

A

they assist in maintaining balance

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10
Q

Why are vertebrae subject to blood born diseases

A

the marrow retains its blood-forming capacity throughout life

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11
Q

Where does the spinal cord finish approximately

A

L1

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12
Q

At what vertebral level is cauda equina

A

L2-S2

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13
Q

Describe what kind of nerves are in the spinal cord

A

Upper motor neurone

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14
Q

Describe what kind of nerves are in the cauda equina

A

Lower Motor Neurones

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15
Q

What is cauda equina syndrome

A

Compression of the sacral nerve roots supplying the bladder, bowel and sexual function

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16
Q

Decompression of spinal routes may regain function in what kind of nerves

A

Lower motor neurones

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17
Q

What are some red flags in a spinal history

A

new onset of back pain if under 10 or over 60
Previous carcinoma
History of osteoporosis or prolonged steroid use
History of HIV or immunosuppression
Back pain with new systemic sinister features e.g. weight loss, unexplained appetite
Non-mechanimcal low back pain
Rapid onset lower limb neurological symptoms suggesting spinal cord or cauda equina compression
Bladder or bowel dysfunction

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18
Q

What feature is suggestive of a subluxation or spondylolisthesis

A

A step in the spine

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19
Q

What might lower back pain on forward flexion suggest

A

the disc is the pain source

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20
Q

What might extension suggest

A

the facet joints

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21
Q

What are some upper neurone signs (long tract signs) that suggest pathology

A

increased muscle tone,
brisk reflexes,
extensor Babinski reflex
ankle clonus

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22
Q

What does the anterior complex of the spine consist of

A

vertebral bodies and intervertebral discs and the posterior longitudinal ligament being its posterior border

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23
Q

What does the posterior complex consist of

A 
pedicles
laminae
facet joints
spinous processes
paravertebral muscles 
inter and supra-spinous ligaments
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24
Q

What does an anterior complex injury involve

A

vertebral body fracture

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25
Q

How is stabilisation of the spine most commonly achieved

A

posterity by placing pedicle screws in the vertebra above and below the level of injury and connecting them with a rod on each side to bridge the unstable level

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26
Q

What is an indication for stabilisation and possibly decompression

A

Deteriorating neurological function following an injury

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27
Q

What is the most common cause of a spinal cord injury

A

fracture

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28
Q

How can we avoid further spinal cord injury

A

in-line spinal immobilisation - log rolling and rigid cervical collar

29
Q

Why might a patient need a urinary catheter

A

The patient will be in urinary retention

30
Q

Describe the prognosis for a patient with a complete spinal cord injury

A

no recovery and the level of their injury determines the function

31
Q

What do thoracic spine injuries result in

A

paraplegia (loss of function and sensation in the lower limbs, including bladder and bowel movements)

32
Q

What do cervical spine injuries result in

A

paralysis with a varying degree of upper limb involvement depending on the level (quadriplegia)

33
Q

Why do patients with complete spinal cord injuries above C4 seldom survive

A

diaphragmatic function is lost and there is no voluntary respiratory function

34
Q

When should cervical spine injuries always be considered

A

unconscious patients
patients with significant trauma (high speed RTA)
fall from a height

35
Q

What is the first line investigation for the cervical spine

A

lateral radiograph and the C7/T1 junction must be visible

36
Q

What other images should be taken of the cervical spine

A

AP and open mouth

37
Q

Describe the appearance of a fractured atlas

A

Usually in 4 places as a result of a vertical compression force

38
Q

How stable are atlas fractures

A

surprisingly stable - spinal cord damage is uncommon

39
Q

How is a diagnosis of a fractured atlas made

A

CT

40
Q

How is non-union of an odontoid peg fracture managed

A

C1/C2 posterior fusion

41
Q

What are most whiplash injuries

A

soft-tissue injuries to the neck or lo w back from RTA usually when hit from behind

42
Q

What is the treatment for whiplash

A

Conservative - analgesia and early mobilisation

43
Q

What is the treatment for a fracture dislocation

A

stabilisation - if left untreated the format is often painful and fixation is thought to reduce the risk of ascending syrinx

44
Q

What are the most common spinal fractures

A

thoracolumbar spine

45
Q

What is the usual treatment for a lumbar spine fracture

A

Usually stable and normally doesn’t need decompression

46
Q

What does infection of the spine involve

A

the disc space with destruction of the disc and the vertebral body end plates

47
Q

What is the most common organism to cause an infection

A

staph aureus

48
Q

What investigation confirms the diagnosis of a spinal infection

A

MRI

49
Q

What is the treatment of a spinal infection

A

IV antibiotics and then step down to oral antibiotics for 3 months

50
Q

Where is degenerative spinal disease most common in

A

the cervical and lumbar spine

51
Q

What is the general treatment for low back and neck pain

A

conservative - analgesics physio and general stay active advice

52
Q

What are some non-spinal causes for low back pain

A

abdominal aortic aneurysm
pancreatitis
urinary tract infection / pyelonephritis

53
Q

What is the fold standard treatment for low back pain in suitable patients and who have failed to improve with conservative treatment for 6 months

A

Spinal fusion

54
Q

What does spinal fusion involve

A

permanent immobilisation of the presumed painful spinal segment and can be done from the front

55
Q

What is radicular pain

Give an example of it

A

Limb pain that comes from a nerve root

Sciatica

56
Q

What is the commonest cause of radicular pain in young patients

A

a disc protrusion

57
Q

What does S1 radicular pain result in

A

absent ankle reflex

58
Q

What procedure can be done to improve the leg pain in most patients if the radicular pain is severe

A

Lumbar micro-discectomy

59
Q

What are the signs of upper motor neurone signs

A

imbalance on eye closing
increased muscle tone
hyper-reflexia
ankle clonus extensor plantar responses

60
Q

What does slow compression of the cauda equina result in

A

lumbar spinal stenosis

61
Q

How does lumbar spinal stenosis present

A

with leg pain on walking or prolonged standing

62
Q

What does rapid compression of the cauda equina result in

A

cauda equina syndrome

63
Q

What is the commonest type of spinal deformity

A

scoliosis - lateral curvature of the spine associated with rotation

64
Q

Where is the commonest curve site for scoliosis

A

Thoracic resulting in a rib prominence to the side of the curve

65
Q

What are some other causes of scoliosis

A 
Infantile and juvenile idiopathic scoliosis 
Adolescent idiopathic scoliosis 
Neuromusclular causes - DMD, CP
Syndromatic 
Congenital - hemi vertebrae
66
Q

What is the most common form of metabolic bone disease affecting the spine

A

Osteoporosis

67
Q

What spinal joint does A tend to involve in the spine

A

C1/2

68
Q

What does ankylosing spondylitis result in

A

bony ankylosis of the spine including the sacroiliac joints

Lecture Notes- Orthopaedics and Fractures (23 decks)

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