Spine Flashcards
What bones make up the spine
7 cervical 12 thoraic 5 lumbar sacrum coccyx
What is each vertebra composed of
vertebral body pedicles laminae transverse process spinous process
What lie between each vertebrae in the cervical, lumbar and thoracic region
Intervertebral discs
What makes up a motion segment
two vertebrae and the disc between them
What do motion segments allow
differing amounts of flexion/ extension, lateral bending and rotation with the total movement being considerable
What limits the movement in the thoracic region
ribs and sternum
What is lordotic
curve convex anteriorly
What is kyphotic
convex posterior
What is the function of the sagittal curves
they assist in maintaining balance
Why are vertebrae subject to blood born diseases
the marrow retains its blood-forming capacity throughout life
Where does the spinal cord finish approximately
L1
At what vertebral level is cauda equina
L2-S2
Describe what kind of nerves are in the spinal cord
Upper motor neurone
Describe what kind of nerves are in the cauda equina
Lower Motor Neurones
What is cauda equina syndrome
Compression of the sacral nerve roots supplying the bladder, bowel and sexual function
Decompression of spinal routes may regain function in what kind of nerves
Lower motor neurones
What are some red flags in a spinal history
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
What feature is suggestive of a subluxation or spondylolisthesis
A step in the spine
What might lower back pain on forward flexion suggest
the disc is the pain source
What might extension suggest
the facet joints
What are some upper neurone signs (long tract signs) that suggest pathology
increased muscle tone,
brisk reflexes,
extensor Babinski reflex
ankle clonus
What does the anterior complex of the spine consist of
vertebral bodies and intervertebral discs and the posterior longitudinal ligament being its posterior border
What does the posterior complex consist of
pedicles laminae facet joints spinous processes paravertebral muscles inter and supra-spinous ligaments
What does an anterior complex injury involve
vertebral body fracture
How is stabilisation of the spine most commonly achieved
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
What is an indication for stabilisation and possibly decompression
Deteriorating neurological function following an injury
What is the most common cause of a spinal cord injury
fracture
How can we avoid further spinal cord injury
in-line spinal immobilisation - log rolling and rigid cervical collar
Why might a patient need a urinary catheter
The patient will be in urinary retention
Describe the prognosis for a patient with a complete spinal cord injury
no recovery and the level of their injury determines the function
What do thoracic spine injuries result in
paraplegia (loss of function and sensation in the lower limbs, including bladder and bowel movements)
What do cervical spine injuries result in
paralysis with a varying degree of upper limb involvement depending on the level (quadriplegia)
Why do patients with complete spinal cord injuries above C4 seldom survive
diaphragmatic function is lost and there is no voluntary respiratory function
When should cervical spine injuries always be considered
unconscious patients
patients with significant trauma (high speed RTA)
fall from a height
What is the first line investigation for the cervical spine
lateral radiograph and the C7/T1 junction must be visible
What other images should be taken of the cervical spine
AP and open mouth
Describe the appearance of a fractured atlas
Usually in 4 places as a result of a vertical compression force
How stable are atlas fractures
surprisingly stable - spinal cord damage is uncommon
How is a diagnosis of a fractured atlas made
CT
How is non-union of an odontoid peg fracture managed
C1/C2 posterior fusion
What are most whiplash injuries
soft-tissue injuries to the neck or lo w back from RTA usually when hit from behind
What is the treatment for whiplash
Conservative - analgesia and early mobilisation
What is the treatment for a fracture dislocation
stabilisation - if left untreated the format is often painful and fixation is thought to reduce the risk of ascending syrinx
What are the most common spinal fractures
thoracolumbar spine
What is the usual treatment for a lumbar spine fracture
Usually stable and normally doesn’t need decompression
What does infection of the spine involve
the disc space with destruction of the disc and the vertebral body end plates
What is the most common organism to cause an infection
staph aureus
What investigation confirms the diagnosis of a spinal infection
MRI
What is the treatment of a spinal infection
IV antibiotics and then step down to oral antibiotics for 3 months
Where is degenerative spinal disease most common in
the cervical and lumbar spine
What is the general treatment for low back and neck pain
conservative - analgesics physio and general stay active advice
What are some non-spinal causes for low back pain
abdominal aortic aneurysm
pancreatitis
urinary tract infection / pyelonephritis
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
Spinal fusion
What does spinal fusion involve
permanent immobilisation of the presumed painful spinal segment and can be done from the front
What is radicular pain
Give an example of it
Limb pain that comes from a nerve root
Sciatica
What is the commonest cause of radicular pain in young patients
a disc protrusion
What does S1 radicular pain result in
absent ankle reflex
What procedure can be done to improve the leg pain in most patients if the radicular pain is severe
Lumbar micro-discectomy
What are the signs of upper motor neurone signs
imbalance on eye closing
increased muscle tone
hyper-reflexia
ankle clonus extensor plantar responses
What does slow compression of the cauda equina result in
lumbar spinal stenosis
How does lumbar spinal stenosis present
with leg pain on walking or prolonged standing
What does rapid compression of the cauda equina result in
cauda equina syndrome
What is the commonest type of spinal deformity
scoliosis - lateral curvature of the spine associated with rotation
Where is the commonest curve site for scoliosis
Thoracic resulting in a rib prominence to the side of the curve
What are some other causes of scoliosis
Infantile and juvenile idiopathic scoliosis Adolescent idiopathic scoliosis Neuromusclular causes - DMD, CP Syndromatic Congenital - hemi vertebrae
What is the most common form of metabolic bone disease affecting the spine
Osteoporosis
What spinal joint does A tend to involve in the spine
C1/2
What does ankylosing spondylitis result in
bony ankylosis of the spine including the sacroiliac joints
