Spine

Question 1

What bones make up the spine

Answer 1

7 cervical 
12 thoraic 
5 lumbar 
sacrum
coccyx

Question 2

What is each vertebra composed of

Answer 2

vertebral body 
pedicles
laminae
transverse process 
spinous process

Question 3

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

Answer 3

Intervertebral discs

Question 4

What makes up a motion segment

Answer 4

two vertebrae and the disc between them

Question 5

What do motion segments allow

Answer 5

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

Question 6

What limits the movement in the thoracic region

Answer 6

ribs and sternum

Question 7

What is lordotic

Answer 7

curve convex anteriorly

Question 8

What is kyphotic

Answer 8

convex posterior

Question 9

What is the function of the sagittal curves

Answer 9

they assist in maintaining balance

Question 10

Why are vertebrae subject to blood born diseases

Answer 10

the marrow retains its blood-forming capacity throughout life

Question 11

Where does the spinal cord finish approximately

Answer 11

L1

Question 12

At what vertebral level is cauda equina

Answer 12

L2-S2

Question 13

Describe what kind of nerves are in the spinal cord

Answer 13

Upper motor neurone

Question 14

Describe what kind of nerves are in the cauda equina

Answer 14

Lower Motor Neurones

Question 15

What is cauda equina syndrome

Answer 15

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

Question 16

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

Answer 16

Lower motor neurones

Question 17

What are some red flags in a spinal history

Answer 17

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

Question 18

What feature is suggestive of a subluxation or spondylolisthesis

Answer 18

A step in the spine

Question 19

What might lower back pain on forward flexion suggest

Answer 19

the disc is the pain source

Question 20

What might extension suggest

Answer 20

the facet joints

Question 21

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

Answer 21

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

Question 22

What does the anterior complex of the spine consist of

Answer 22

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

Question 23

What does the posterior complex consist of

Answer 23

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

Question 24

What does an anterior complex injury involve

Answer 24

vertebral body fracture

Question 25

How is stabilisation of the spine most commonly achieved

Answer 25

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

Question 26

What is an indication for stabilisation and possibly decompression

Answer 26

Deteriorating neurological function following an injury

Question 27

What is the most common cause of a spinal cord injury

Answer 27

fracture

Question 28

How can we avoid further spinal cord injury

Answer 28

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

Question 29

Why might a patient need a urinary catheter

Answer 29

The patient will be in urinary retention

Question 30

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

Answer 30

no recovery and the level of their injury determines the function

Question 31

What do thoracic spine injuries result in

Answer 31

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

Question 32

What do cervical spine injuries result in

Answer 32

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

Question 33

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

Answer 33

diaphragmatic function is lost and there is no voluntary respiratory function

Question 34

When should cervical spine injuries always be considered

Answer 34

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

Question 35

What is the first line investigation for the cervical spine

Answer 35

lateral radiograph and the C7/T1 junction must be visible

Question 36

What other images should be taken of the cervical spine

Answer 36

AP and open mouth

Question 37

Describe the appearance of a fractured atlas

Answer 37

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

Question 38

How stable are atlas fractures

Answer 38

surprisingly stable - spinal cord damage is uncommon

Question 39

How is a diagnosis of a fractured atlas made

Answer 39

CT

Question 40

How is non-union of an odontoid peg fracture managed

Answer 40

C1/C2 posterior fusion

Question 41

What are most whiplash injuries

Answer 41

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

Question 42

What is the treatment for whiplash

Answer 42

Conservative - analgesia and early mobilisation

Question 43

What is the treatment for a fracture dislocation

Answer 43

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

Question 44

What are the most common spinal fractures

Answer 44

thoracolumbar spine

Question 45

What is the usual treatment for a lumbar spine fracture

Answer 45

Usually stable and normally doesn't need decompression

Question 46

What does infection of the spine involve

Answer 46

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

Question 47

What is the most common organism to cause an infection

Answer 47

staph aureus

Question 48

What investigation confirms the diagnosis of a spinal infection

Answer 48

MRI

Question 49

What is the treatment of a spinal infection

Answer 49

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

Question 50

Where is degenerative spinal disease most common in

Answer 50

the cervical and lumbar spine

Question 51

What is the general treatment for low back and neck pain

Answer 51

conservative - analgesics physio and general stay active advice

Question 52

What are some non-spinal causes for low back pain

Answer 52

abdominal aortic aneurysm pancreatitis urinary tract infection / pyelonephritis

Question 53

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

Answer 53

Spinal fusion

Question 54

What does spinal fusion involve

Answer 54

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

Question 55

What is radicular pain | Give an example of it

Answer 55

Limb pain that comes from a nerve root | Sciatica

Question 56

What is the commonest cause of radicular pain in young patients

Answer 56

a disc protrusion

Question 57

What does S1 radicular pain result in

Answer 57

absent ankle reflex

Question 58

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

Answer 58

Lumbar micro-discectomy

Question 59

What are the signs of upper motor neurone signs

Answer 59

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

Question 60

What does slow compression of the cauda equina result in

Answer 60

lumbar spinal stenosis

Question 61

How does lumbar spinal stenosis present

Answer 61

with leg pain on walking or prolonged standing

Question 62

What does rapid compression of the cauda equina result in

Answer 62

cauda equina syndrome

Question 63

What is the commonest type of spinal deformity

Answer 63

scoliosis - lateral curvature of the spine associated with rotation

Question 64

Where is the commonest curve site for scoliosis

Answer 64

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

Question 65

What are some other causes of scoliosis

Answer 65

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

Question 66

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

Answer 66

Osteoporosis

Question 67

What spinal joint does A tend to involve in the spine

Answer 67

C1/2

Question 68

What does ankylosing spondylitis result in

Answer 68

bony ankylosis of the spine including the sacroiliac joints