Spine Flashcards
Straight leg raise test?
For lumbar radiculopathy L4-S1
Place pt in seated position with knees bent to 90 degrees over the edge of the table; passively extend knee
Radicular pain is positive sign
Femoral nerve stretch test?
For proximal lumbar radiculopathy (L2-4)
Have pt lie prone; passively flex knee to the thigh and passively extend hip
Anterior thigh pain is positive sign
What is the ASIA Impairment Scale?
Describes functional ability after spinal cord injury (SCI)
A- complete- no motor or sensory function is preserved in the sacral segments S$-S5
B- incomplete- sensory function below neurologic level and in S4-S5 but no motor function
C- incomplete- motor function is preserved below neurologic level and MORE THAN HALF of the key muscle groups below neurologic level have a muscle grade less than 3
D- incomplete- motor function is preserved below neurologic level and AT LEAST HALF of the key muscle groups below neurologic level have a muscle grade 3
E- normal- sensory and motor function normal
What are some complications after C-spine trauma and SCI?
Skin breakdown, VTE, urosepsis, sinus brady, orthostatic hypo, autonomic dysreflexia (HA, agitation, HTN; unchecked visceral stimulation- check foley and disimpact pt), depression
What are some types of degenerative disorders of the C-spine?
Natural degeneration
Disc degeneration- disc bulging, herniation, loss of height
Joint degeneration- uncinate spurring and facet arthrosis
Ligamentous changes- ligamentum flavium thickening and infolding secondary to loss of disc height
Deformity- kyphosis secondary to loss of disc height with resulting transfer of load to the facet and uncovertebral joints, leading to further uncinate spurring and facet arthrosis
Eventually leads to cervical stenosis, radiculopathy and myelopathy
Treatment for degenerative disorders of the C-spine?
Nonoperative- NSAIDs, other multifocal pain regimens, PT, injections, activity modification
Operative- anterior, posterior, combined ASF,PSF, cervical disc replacement
What are some complications of degenerative disorders of the C-spine?
Pseudo arthrosis, recurrent laryngeal nerve injury, dysphagia (can be temporary due to intubation), vertebral artery injury, hypoglossal nerve injury (tongue will deviate toward side of injury), Horner’s Syndrome (damage to nerve pathway from the brain to the face and eye on 1 side of the body- will have smaller pupil, drooping eyelid and decreased sweating on affected side) and adjacent segment disease
What are some postop complications and nursing considerations after lumbar surgery?
Complications- dural tear, blood loss, pneumonia, UTI, confusion from pain meds, vascular catastrophe, pseudoarthrosis, infection, epidural hematoma and recurrent disc herniation
Considerations- prevent resp comp, muscle spasm, urinary retention, constipation, ileus; monitor for sensory/perceptual alterations; impaired physical mobility; and knowledge deficit
Describe pathophysiology, potential causes and who is affected by adolescent idiopathic scoliosis (AIS)?
Patho- unknown
Potential causes- multifactorial, hormonal (melatonin), brain stem issues, proprioception disorder, positive family hx
Who is affected- More females 10-18 yrs (right curvature more common) usually just before periods begin
What are the physical exam findings of AIS?
Uneven hem or different pant lengths, prominent scapula, asymmetric waistline, prominent hip, asymmetry in shoulder level, prominent breast or anterior rib cage, plumb line from C7 doesn’t pass thru gluteal fold
Treatment for AIS? Post op considerations?
Observation- Cobb angle is less than 25 degrees; serial radiographs to watch progression, postural exercises
Bracing- Cobb angle from 25-45 degrees; only effective for flexible deformity in skeletally immature pts; goal is to stop progression, not to correct deformity
Operative- posterior fusion for greater than 45 degree curve, anterior fusion or combined fusion
Postop- assess muscle strength, sensation, s/sx blood loss, urinary incontinence, retention
