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Orthopaedics > Spine > Flashcards

Spine Flashcards

1
Q

What are the functions of the spine

A

Supports the head and neck
Enables ambulation
Protects the spinal cord

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2
Q

The anatomy of the spinal cord

Bones

A 
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
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3
Q

Features of the cervical vertebrae

A

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

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4
Q

Features of the thoracic vertebrae

A

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

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5
Q

Features of the lumbar vertebrae

A

Vertical transverse processes

Pedicel and lamina protect the spinal cord

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6
Q

What is the intervertebral disc and its features

A

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

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7
Q

Ligaments in the spine

A

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

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8
Q

Musculature of the spine

A

3 layers
Superficial - trapeziums and the latissmus dorsi
Intermediate - unusual configurations - serrated muscles
Deep layer important in surgery due to contains bleeding vessels

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9
Q

Features of the nerve roots

A

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

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10
Q

Blood supply to the spinal cord

A

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

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11
Q

What is a radiculopathy

A

Root problem - LMN + pain

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12
Q

What is a myelopathy

A

Cord problem - UMN

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13
Q

What is quadriplegia

A

Loss of function of the UL and LL

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14
Q

What is paraplegia

A

Loss of function of the LL

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15
Q

What is paraparesis

A

Weakness due to cord or root compression

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16
Q

Implication of a above c4 compression

A

Death or loss of ventilation

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17
Q

Implication of C5 compression

A

Quadriplegia

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18
Q

Implication fo c5-T1 compression

A

Dec arm function

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19
Q

Implication so T1-L1 neural compression

A

Paraplegia and autonomic dysfunction

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20
Q

implication of L2-5 neural compression

A

Dec leg function

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21
Q

Implication of L5 and below neural compression

A

Impaired sphincter an sexual function

22
Q

Classification of spinal deformity

A

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

23
Q

Scoliosis define

A

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

24
Q

Tx scoliosis

A

Brace/cast
3 point fixation to guide the spine in a brace
Also fuse or fixate the spine
With rods and screws

25
Q

What to do when the child is still growing

A

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

26
Q

What is cervical stenosis

A

Tightening of the spinal canal
Cervical myelopathy
Myelopathy clinical syndrome caused by the compression of the spinal cord
Complete damage is rare

27
Q

Consequences of a cervical stenosis

A 
Loss of fine motor skills 
Broad based shuffling game 
Spasticity 
UL radioculopathy 
Brisk reflexes extensor plantars
Rare urinary symptoms
28
Q

Pathophysiological causes of cervical stenosis

A

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

29
Q

What is myelomalacia

A

Hyperdense region in the spinal cord MRI due to compression

30
Q

What is lumbar spinal stenosis

A

Reduction in the dimension of of central or lateral lumbar spinal cord
Circumferential compression which is progressive

31
Q

Causes of lumbar spinal stenosis

A

Bone - facets, osteophytes, listhesis compression

Not bone - disc, ligamentum flavum

32
Q

Symptoms of lumbar stenosis

A 
Back pain 
Buttock pain 
Claudication
Leg pain 
Weakness
33
Q

Neurogenic vs vascular claudication

A

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

34
Q

What is vascular claudication

A

Is a mismatch between metabolic demands and the vascular provision

35
Q

What is neurogenic claudication

A

Mechanical effect of pressure on the nerve

36
Q

What is a transversing nerve root

A

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.

37
Q

What is an exiting nerve root

A

Exiting nerve root. The nerve root that exits the spine at a particular level is referred to as the “exiting” nerve root

38
Q

What are radicular symptoms

A

Pain, numbness, motor weakness
In distribution of the dermatome
Many settle spontaneously

39
Q

Tx of radiculopathy

A 
Con 
- physio
- inc core strength
- weight loss
- smoking cessation 
-analgesia
- CBT
- epidural steroid 
Surg -
40
Q

What are absolute indication for surgery in radiculopathy

A

Sphincter compromise

Major motor radiculopathy - dec MRC3

41
Q

What are relative indication for radiculopathy surg tx

A

Failed con mx
6 weeks longer
Neurological deficit

42
Q

What are red flags for serious underlying pathology

A 
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
43
Q

What are the serious pathology red flag symptoms can point towards

A

Causative equine
Malignancy
Dissecting aneurysm
Infection

44
Q

What is cauda equine syndrome features

A

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

45
Q

Spinal trauma/MSCC tx and features

A

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

46
Q

MSCC tx objective

A 
Inc QualOL
Dec pain 
Mechanical instability 
Local trauma control 
Minimise adverse events 
Preserve dignity 
- bladder, bowel, continence
47
Q

Inflamma spine conditions

A

RA - cervical neck - can be v unstable imp in anaesthesia

Ank spond - fuses spine so a minor fracture can have a devastating effect

48
Q

What in spondylolysis

A

Spondylitis = vertebrae
Lysis = break
Uni bilateral pars interarticularis deject
L3-L5 L5 commonest

49
Q

What is spondylolithesis

A

Spondyl - vertebrae
Lithesis - slip
One vertebrae slips over the other
causes - dysplastic, isthmic, degen, traumatic, other than pars defect, pathological

50
Q

What happens when you compress the cord

A

Pain
LNM at the site of the lesion
UMN. Signs and sensory loss below
Or bladder and bowel dysfunction

51
Q

Hat are long tract signs

A

Spasticity
Hyperreflexia
Abnormal reflexes - babinski

Orthopaedics (7 decks)

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