Spine Flashcards
What are the functions of the spine
Supports the head and neck
Enables ambulation
Protects the spinal cord
The anatomy of the spinal cord
Bones
Cervical - 7 Atlas and the axis 5 typical vertebrae LORDOSIS Thoracic 12 typical vertebrae KYPHOSIS Lumbar 5 typical lumbar vertebrae LORDOSIS Sarum 5 fused vertbrae KYPHOSIS Coccyx Fused typically 4
Features of the cervical vertebrae
Axis is a ring
Atlas has the dens
5 typical have a bifid spinous process
Have holes in the transfer processes the transverse foramen which the vertebral artery go through
Features of the thoracic vertebrae
Has a heart shaped vertebral body
Has lots of articulation point due to the articulation with the ribs the ribs articulate with the vertebrae on the level and the one below
There’s the costotranverse and the costovertebral articulation areas
Features of the lumbar vertebrae
Vertical transverse processes
Pedicel and lamina protect the spinal cord
What is the intervertebral disc and its features
It forms a fibrocartilagenous joint with the vertebrae
It is a pad of fibrocartilagenous tissue
Allows for a small amount of movement and acts as a shock absorber
It is concentric layers of fibrocartilage on the outside forming the annulus fibrosis
And the central jelly like substance called the nucleus pulposis
On the top and bottom of the disc is a cartilaginous end plate
Ligaments in the spine
Anterior of the spine along the vertebral body - anterior longitudinal ligament
Posterior of the vertebral body - posterior longitudinal ligament
In between the spinous process - interspinous ligament
Anterior to the spinous processes is the ligamentum flavum
Posterior to the spinous processes is the supraspinous ligament
Musculature of the spine
3 layers
Superficial - trapeziums and the latissmus dorsi
Intermediate - unusual configurations - serrated muscles
Deep layer important in surgery due to contains bleeding vessels
Features of the nerve roots
They exit the spinal cord through the intervertebral foramen
They are covered in meninges - pia, arachnoid and dura
They leave the spinal cord and synapse and the DRG - then they split into the ventral and dorsal root
Blood supply to the spinal cord
Segmental vessels come form the aorta
They supply to intercostal region and supply the spinal cord by the vertebral arteries
Can get a spinal stroke they are similar to cerebral strokes in the their clinical presentation and cause - ischaemic and haemorrhagic
Venous drainage is by the batson plexus
Important the site of metastatic haemtogenous spread
What is a radiculopathy
Root problem - LMN + pain
What is a myelopathy
Cord problem - UMN
What is quadriplegia
Loss of function of the UL and LL
What is paraplegia
Loss of function of the LL
What is paraparesis
Weakness due to cord or root compression
Implication of a above c4 compression
Death or loss of ventilation
Implication of C5 compression
Quadriplegia
Implication fo c5-T1 compression
Dec arm function
Implication so T1-L1 neural compression
Paraplegia and autonomic dysfunction
implication of L2-5 neural compression
Dec leg function
Implication of L5 and below neural compression
Impaired sphincter an sexual function
Classification of spinal deformity
Idiopathic - infantile 0-3 IIS
Juvenile 3-10 JIS
Adolescent 10-18 AIS
Congenital failure of formation and failure of segmentation
Neuromuscular - DMD, CP - cerebral palsy, CMT, Charcot Marie tooth, SMA - spinal muscular atrophy
Lots of conditions which cause spinal deformity and they differ in severity
Scoliosis define
Evidence of a 10 degree lateral curvature with vertebra rotation on standing upright radiograph of the spine
Now known that scoliosis is a 3D rotational abnormality
Tx scoliosis
Brace/cast
3 point fixation to guide the spine in a brace
Also fuse or fixate the spine
With rods and screws
What to do when the child is still growing
Insert growing rods as the spine cannot be fused due to vertical growth but also growth of the chest wall which would dec heart and lung size if fused and stopped growing
These can be expanded as the patient grows
What is cervical stenosis
Tightening of the spinal canal
Cervical myelopathy
Myelopathy clinical syndrome caused by the compression of the spinal cord
Complete damage is rare
Consequences of a cervical stenosis
Loss of fine motor skills Broad based shuffling game Spasticity UL radioculopathy Brisk reflexes extensor plantars Rare urinary symptoms
Pathophysiological causes of cervical stenosis
Cervical spondylitis (CSM)
Compression usually caused by anterior degenerative changes - osteophytes of discophyte complex
Degenerative spondylolithesis - hypertrophy of the ligamentum flavum
Congenital stenosis
- symptoms usually begin when congenital narrowing combined with spondylitis degeneration changes in older adults
What is myelomalacia
Hyperdense region in the spinal cord MRI due to compression
What is lumbar spinal stenosis
Reduction in the dimension of of central or lateral lumbar spinal cord
Circumferential compression which is progressive
Causes of lumbar spinal stenosis
Bone - facets, osteophytes, listhesis compression
Not bone - disc, ligamentum flavum
Symptoms of lumbar stenosis
Back pain Buttock pain Claudication Leg pain Weakness
Neurogenic vs vascular claudication
N. Y
Postural changes Yes. No
Walking upright Inc symp. Inc symp
Standing stationary inc symp. Dec symp
Sitting Dec symp. Dec symp
Stair climbing. Up easier Down easier
Pulses Normal. Abnormal
What is vascular claudication
Is a mismatch between metabolic demands and the vascular provision
What is neurogenic claudication
Mechanical effect of pressure on the nerve
What is a transversing nerve root
Traversing nerve root. Another nerve root goes across the disc and exits the spine at the next level below. It is called the “traversing” nerve root.
What is an exiting nerve root
Exiting nerve root. The nerve root that exits the spine at a particular level is referred to as the “exiting” nerve root
What are radicular symptoms
Pain, numbness, motor weakness
In distribution of the dermatome
Many settle spontaneously
Tx of radiculopathy
Con - physio - inc core strength - weight loss - smoking cessation -analgesia - CBT - epidural steroid Surg -
What are absolute indication for surgery in radiculopathy
Sphincter compromise
Major motor radiculopathy - dec MRC3
What are relative indication for radiculopathy surg tx
Failed con mx
6 weeks longer
Neurological deficit
What are red flags for serious underlying pathology
Night pain Prior malignancy Constitutional symptoms Sphincter symptoms Neuro abnormalities Age <20 >55 Non-mechanical back pain Thoracic back pain Structural deformity Recent unexplained weightloss
What are the serious pathology red flag symptoms can point towards
Causative equine
Malignancy
Dissecting aneurysm
Infection
What is cauda equine syndrome features
Bilateral leg pain
Saddle anaesthesia
Impotence
Sensorimotor loss in lower extremities - progressive
Neurogenic bladder dysfunction
Unwary retention and overflow incontinence due to loss of sensation and sphincter control
Rare bowel involvement
Spinal trauma/MSCC tx and features
Thoracic back pain as this area most likely to have it
Not affected by mechanical back pain due to being largely immobilised by the ribs
MRI hole spine
Dexamethasone
Spinal surgeons
onc
Surg or radio or chemo depending on cancer and prognosis
Palliative care
MSCC tx objective
Inc QualOL Dec pain Mechanical instability Local trauma control Minimise adverse events Preserve dignity - bladder, bowel, continence
Inflamma spine conditions
RA - cervical neck - can be v unstable imp in anaesthesia
Ank spond - fuses spine so a minor fracture can have a devastating effect
What in spondylolysis
Spondylitis = vertebrae
Lysis = break
Uni bilateral pars interarticularis deject
L3-L5 L5 commonest
What is spondylolithesis
Spondyl - vertebrae
Lithesis - slip
One vertebrae slips over the other
causes - dysplastic, isthmic, degen, traumatic, other than pars defect, pathological
What happens when you compress the cord
Pain
LNM at the site of the lesion
UMN. Signs and sensory loss below
Or bladder and bowel dysfunction
Hat are long tract signs
Spasticity
Hyperreflexia
Abnormal reflexes - babinski
