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MBBS Orthopedics > Spine > Flashcards

Spine Flashcards

1
Q

what are the lines on lateral spine x ray

A
  • anterior vertebral
  • posterior vertebral
  • spinolaminar
  • posterior spinous
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2
Q

what is the normal prevertebral space measurements

A

<6mm at C2 (above trachea)

<22mm or 1 vertebral body at C6 (below trachea)

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3
Q

How to localise nerve in radiculopathy

A

Sensory distribution of pain - dermatomal
distribution of tingling and numbness
motor weakness - myotome
screening - squat and rise (L4), heel walking (L5), toe walking (S1)
reflexes - knee jerk, ankle jerk

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4
Q

Clinical exam findings in scoliosis

A

Adam forward bend test

  • imbalance in height of shoulders
  • asymmetrical limb waist distance
  • prominence of hips
  • truncal shift (plum line from C7 spinous process)
  • tilting of shoulder and pelvis
  • limb shortening
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5
Q

Causes of radiculopathy

A
  • PID
  • spondylosis
  • spondylolisthesis
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6
Q

Spondylosis findings on x ray

A
  • narrowing of neural foramen
  • facet joint hypertrophy/ arthritis - bony spurs, syndesmophyte
  • degeneration of intervertebral disc (loss height, bulge)
  • thickening of ligamentum flavum (calcification)
  • end plate sclerosis
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7
Q

causes of myelopathy

A

Degenerative changes
1. degenerative cervical spondylosis
>anterior: protruding disc, posterior syndesmophyte, osteophytes
>anterolateral: jts of luschka
> lateral: cervical facet thickening/ bony spurs
> posterior: ligamentum flavum, spondylolisthesis
2. ossification of posterior longitudinal ligament (OPLL)
3. cervical kyphosis
4. prolapsed intervertebral disc

VITAMINC
- infection (epidural abscess), trauma, tumor, demyelinating disorders, vascular disease, autoimmune (RA)

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8
Q

mgx of myelopathy

A 
Conservative:
- analgesia, collar, physio, gait training
Canal widening/ surgical decompression
- laminectomy, disectomy
Fusion if instability present
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9
Q

Mgx of spinal stenosis

A

education on spine posture

sx:

  • wide laminectomy (decompression)
  • segmental fusion (for spinal instability)
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10
Q

Causes of cauda equina syndrome

A 
central PID 
infection - abscess
neoplasm - tumor, lymphoma
vascular - spinal epidural hematoma, spinal anaesthesia, IVC thrombosis
Trauma
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11
Q

Presentation of cauda equina

A
  • saddle anesthesia
  • bowel, bladder dysfunction
  • bilateral LL weakness
  • radiating pain
  • low back pain and tenderness
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12
Q

Mgx of cauda equina

and potential cx if tx delayed

A

Surgical cx within 48 hours

  • residual weakness
  • permanent urinary/ bowel incontinence
  • impotence
  • sensory abnormalities
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13
Q

PID pathology

- extents of herniation

A

acute posterior or postero-lateral herniation of nucleus pulpous through annulus fibrosis

bulge > extrusion > protrusion > sequestration

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14
Q

Central vs posterolateral vs foraminal prolapse

A

Central

  • only back pain
  • without leg pain
  • bilateral radiculopathy (if prolapse significant)
  • beware cauda equina

Postero-lateral:

  • most common
  • compress transversing nerve root (i.e. L5 in L4/5)

Foramina

  • rare
  • compress exitting nerve root (i.e L4 in L4/5)
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15
Q

Cervical vs lumbar PID

A

for both posterolateral herniation:

  • EXITTING cervical nerve root
  • TRANSVERSING lumbar root

for both, lower level affected

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16
Q

signs for PID on examination

A
  • listing (to relieve pain from nerve compression)
  • paravertebral muscle spasm
  • protective scoliosis
  • loss of lumbar lordosis
  • midline tenderness
  • pain worse on flexion, decreased ROM
  • SLR positive
  • segmental myotomal and dermatomal deficits
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17
Q

Mgx of PID

A 
REST: + physio and analgesia and NSAIDs
REDUCE: traction
SX: removal + rehab
for: cauda equina, failure of conservative tx
- discectomy
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18
Q

Causes of spondylolisthesis

A

SPOTED

  • Spodylolytic: break in pars interarticularis
  • Pathological: neoplasm or infection (TB)
  • Operative: laminectomy for decompression
  • Trauma
  • Elderly: OA (spondylosis)
  • Dysplasia: congenital lumbosacral facet joint dysplasia
19
Q

Classification of spondylolisthesis

A 
Meyerding classification - % translation of VB
I: 0-25%
II: 25-50%
III: 50-75%
IV: 75-100%
20
Q

Mgx of spondylolisthesis

A

Conservative: bed rest and supportive corset
Operastive: spinal fusion (TLIF: transforaminal lumbar interbody fusion)

21
Q

Why does spondylosis cause radiculopathy

A
  • loss of disc height
  • syndesmophyte
  • facet joint hypertrophy
22
Q

Why does spondylosis cause spinal stenosis

A
  • facet hypertrophy
  • thickening of ligamentum flavum
  • bulging of degenerate disc
  • spur formation
  • listhesis
23
Q

Mgx of spondylolysis

A

Conservative

  • activity modification: weight loss, stop bending, lifting, climbing
  • physio
  • intermittent traction
  • collar
  • analgesia

SX
- anterior disc removal with fusion of most painful level

24
Q

Types of scoliosis

A

Postural

Structural

  1. Idiopathic :
    - adolescent thoracic (>10)
    - infantile thoracic (<4)
  2. Osteopathic: due to congenital vertebral anomalies (hemivertebrae, wedge vertebra, block vertebrae)
  3. Neuropathic
  4. Myopathic: in rare muscular dystrophies, spinal muscular atrophy
  5. Syndromic: Ehler danlos, marfan, NF, VACTERL
25
Q

Impt history for idiopathic scoliosis

A
  • menarche
  • family hx
  • when it start
  • severity and progression
  • previous x rays and treatment
  • associated symptoms (back pain, neurological symptoms, clumsiness/ weakness, bladder/ bowel function)
26
Q

What is the Risser sign grading and its significance

A

Extent of ossification and fusion of iliac apophysis of pelvis
- suggests skeletal maturity and provides indication for curve progression

0 - premenarchal
1/2 - pubertal
3/4/5 - post pubertal

Grade I: 25%
II: 50%
III: 75% (passed peak of growth spurt)
IV: 100%
V: iliac apophysis fused to iliac crest
27
Q

What is the management of scoliosis

A

Dependent on cobb’s angle

<20deg: 4mthly observation with full length spine x ray

20-40deg:

  • 0/1/2: brace therapy
  • 3/4/5: observation
>40deg:
- 0/1/2: sx + post op support
>50deg:
- 3/4/5: sx
50% correction regarded as satisfactory
28
Q

How to measure Cobb angle

A

lines projected from uppermost and lowermost vertebral bodies in the curve

29
Q

Types of kyphosis

A 
Postural
Structural
- elderly: degenerative
- Ankylosing spondylitis
- trauma
- TB spondylitis
- Adolescents: scheurmann disease
30
Q

Deficit in brown sequard syndrome

A

Ipsilateral

  • LCS: motor
  • Dorsal: vibration, propioception

Contralateral:
- pain, temperature
(spinothalamic tracts cross at spinal cord level)

31
Q

What is Denis 3 column theory

- what are the columns

A

Ant column: anterior longit lig, ant annulus, ant 2/3 vert body

Mid column: pos 1/3 vert body, post longit lig

Pos column: posterior elements (pedicles, facets, lamina, spinous process), pos ligaments

1 column: stable
2 column: +/-
3 column: unstable

32
Q

What is a

  • compression #/ wedge
  • burst #
  • chance #
A

Compression: anterior stress failure (tumour, infx, osteoporotic)

Burst: both ant and mid column (trauma)

  • neuro involvement is common (retropulsion of fragments into spinal canal)
  • increase in interpedicular distance

Chance: all 3 columns affected
- neuro damage uncommon
- unstable
-

33
Q

What is ASIA impairment scale

A

A: complete: no motor and sensory

B: incomplete: no motor, sensory preserved

C: incomplete: some motor (< grade 3)

D: incomplete: some motor (> grade 3)

E: motor and sensory normal

34
Q

How to differentiate complete vs incomplete spinal cord injury

A

complete: no fx below lvl of injury (neuro deficit persists after spinal shock ends)
incomplete: some degree of function retained (SACRAL SPARING: perianal sensation, sphincter tone, big toe flexion)

35
Q

Cervical spine management in trauma after radiological Ix

A

if film neg, remove collar and complete exam

  • palate from occiput to T1
  • any tenderness, swelling, step off
  • if symptomatic: replace collar
  • if neg - do active ROM (should be full and pain free) > C spine clear
  • if ROM unable but rest is clear: replace collar and x ray in 2w (flexion-extension views)

NOT reliable if patient is obtunded, other distracting injury

36
Q

What is a whiplash injury

  • s/s
  • x ray findings
  • mgx
A

Sprained neck: hyeprflexion/ extension of neck > soft tissue sprain

  • pain and stiffness appear 12-48 hours after injury
  • x ray normal
  • mgx: analgesia, physio
37
Q

Mgx of compression injury

A

mild: bed rest + physio
marked wedging: thoracolumbar brace
else
posterior spinal fusion

38
Q

Spinal shock

  • what is it
  • when it ends?
  • how to test?
A

complete spinal areflexia
physiological dysfunction of spinal cord (complete paralysis and anaesthesia, loss of anal reflex) - loss of basal excitatory stimulus from brain to neurons

  • flaccid areflexic paralysis
  • bradycardia and hypotension
  • absent bulbocav reflex

bulb-cavernous reflex - signifies end
- monitor anal sphincter contraction in response to squeezing the glans penis/ clitoris

39
Q

General management of spine injuries

A

if incomplete transection: emergency surgical decompression and stabilisation of spine

acute mgx
reduction: acute closed reduction with axial traction
if no sx, bracing and observation
rehab

general:

  • skin: prevent pressure sores
  • bladder: catheterise, bladder training subsequently
  • bowel: enemas, abdominal exercises
  • muscles, joints - prevent contractors: physio
  • reversing contractures: tenotomy
  • DVT prophylaxis
  • cardiopulmonary mgx
40
Q

Complication of spinal cord injuries

A
  • skin problems (ulcers)
  • venous thromboembolism
  • urosepsis
  • sinus bradycardia
  • orthostatic hypotension (no sympathetic tone)
  • autonomic dysreflexia (by unchecked visceral stimulation): headache, agitation, HTN
  • MDD
41
Q

features of central cord syndrome

A

MUD
motor more than sensory
upper limb > LL
distal > proximal

42
Q

ddx of radiculopathy

A

thoracic outlet syndrome
carpal tunnel syndrome or ulnar nerve entrapment
rotator cuff lesions
cervical tumor

43
Q

what are the causes of lumbar stenosis

A
  • degenerative changes from spondylosis (facet joint hypertrophy, syndesmophytes)
  • spondylolisthesis
  • space occupying lesions - abscess, infections
  • trauma
  • inflammatory: ankylosing spondylitis, RA

MBBS Orthopedics (13 decks)

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