Spine Flashcards
conditions that cause disc degeneration
- nicotine exposure = vasoconstrictive process
- atherosclerosis = vaso-occlusive
- end plate sclerosis
mri of healthy vs desiccated disc
- healthy: disc is hydrated, clear demarcation between annulus and nucleus
- desiccated: darker signals and homogenous
components of spine pe
- inspection
- gait
- palpation
- rom
- neurologic function
- special tests
progress of degenerative cascade
- loading joints = progressive collapse of disc
- loading joints = spondylotic changes = dec joint motion, spinal cord compromise, spondylolisthesis/instability
- failure of anterior support -> shift load transmission -> post column compensates -> spondylosis
types of herniated nuleus pulposus
- soft disc herniation: posterolateral
- hard disc herniation: disc-osteophyte spurs
neuropathy vs radiculopathy vs myelopathy
neuro: peripheral nerve
- sx: weakness, numbness
radiculopathy: spinal nerve root
- sx: weakness, numbeness
myelopathy: spinal cord
- sx: stiffness, incoordination, weakness
nerve root exposure to chemicals of the nucleus + compression = ___
radicular pain & dorsal root ganglion apoptosis
conus medullaris vs cauda equina
conus medullaris: terminal end of spinal cord (l1-l2)
cauda equina: bundle of spinal nerves that taper out after conus medullaris
differences between conus medullaris syndrome and cauda equina syndrome
read
clinical presentation of conus med./cau eq.
- bilateral buttock and le pain
- bowel and bladder dysfunction
- saddle anes
- varying degrees of lower limb dysfunction
regions involved in conus medullaris
- above l2
- damage to sacral spinal cord: bladder/bowel dysfunction, impotence, saddle anes, loss of achilles reflex
- no loss of patellar knee reflex
typical symptoms of myelopathy
- numbness, weakness, stiffness, clumsiness
- paresthesia of ue/le
- difficulty in fine motor control
- ataxia and wide based gait
- leg heaviness
- inability to perform tandem walk
- urinary retention, urgency, or frequency
moderate s/sx: poor prognosis
hand signs for myelopathy
- finger escape sign
- positive ten second test (20x/10s)
- hoffman’s sign
what is spondylolisthesis
- hen one of your vertebrae slips out of place onto the vertebra below it
- segmental instability = low back pain
- > 4.5 mm displpacement
- 15 deg sagittal displacement on flexion extension views
grading of spondylolisthesis
1 0-25%
2 25-50%
3 51-75%
4 76-99%
significance of mri in back pain
- discs can protrude: bulging nucleus with intact nucleus
- extruded discs: goes through annulus, confined by pll
- sequestrated discs: disc material is free inside the canal
- sensitive to changes
non-surgical treatment for back pain
- immobilization
- analgesics
- nerve blocks
- epidural steroid injections
- patient education
indications for surgical treatment for back pain
- progressive neurologic deficits (motor weakness, unremitting radicular pain)
- failure of conservative management
- positive study results and persistent unacceptability
- bowel and bladder dysfunction
t/f spine is the most common bony site for msk tumors
true, most are metastatic
most common primary benign tumors
- osteoid osteoma
- osteoblastoma
- abc
- eosinophilic granuloma
- osteochondroma
- giant cell tumor
- hemangiom
most common primary malignant tumors
- solitary plasmacytoma!!
- chondroma
- chordosarcoma
- lymphoma
- ewing’s sarcoma
- osteosarcoma
most common type of malignant spine lesion
metastatic tumors
- breast and prostate, thyroid, lung, kidney
t/f the spine is the last source to manifest symptoms of metastasis
false, first source of symptoms. workup is warranted to know spread and grading
variables in treating tumors
- tumor diagnosis
- stage
- neuro status
- prognosis of the tumor
- spinal stability (surgery)
- intractable pain (surgery)
most common consult among deformities
scoliosis (idiopathic)
spinal growth in children with scoliosis
- birth to 5 years: spine gains 10 cm in length
- 5 years to adolescent: growth of 5 cm, 10 cm during growth spurt
location of idiopathic scoliosis
- right thoracic curve!!
- left thoracic curve
incidence of idiopathic sclerosis
- 3% 10-20 deg
- 0.3% >30 deg
- 10:1 f to m >30 deg
- positive fhx
- pain in adults if not treated
- > 90 deg = cardiopulmonary dysfunction, early death, pain
t/f scoliosis causes back pain
false, mostly asymptomatic
postural changes in scoliosis
- uneven shoulders or hips
- rib hump
- ill fitting clothes
diagnosis of scoliosis
- inspection of back = asymmetry
- leg length discrepancies
- trunk shift and head centered
- adams forward bending test
- scoliometer
- forward bending sitting test
angle measured in scoliosis xrays
cobb’s angle
most current and widely used scoliosis classification system
lenke classification
treatment options for scoliosis
- observation
- bracing (mild to moderate progressive curves)
- operative (>50 deg)
types of bracing for scoliosis
- milwaukee = apex above t6
- boston underarm brace = apex below t7 and above l2
- cheneau brace
- boston brace
what is spondylolysis
- defect in pars intecularis
- leads to spondylolisthesis
- common in children and adolescents
- fatigue fracture
- tx: surgery
s/sx of spodyloslisthesis
- back pain
- hamstring tightness
- palpable step-off
- alteration in gait
what is the denis three column theory
- destruction of >2 columns = spinal instability
anterior column (denis)
ant longitudinal ligament
ant annulus
ant 2/3 vertebral body
middle column (denis)
post 1/3 of vertebral body
post annulus
post longitudinal ligament
post column (denis)
posterior elements: pedicles, facets, lamina, spinous process
post ligaments
primary damage in spinal cord injury
- caused by mechanical forces imparted to the spinal column at the time of trauma
- result: failure of osteoligamentous spinal column
secondary damage in spinal cord injury
- injury of adjacent neural tissue that was initially spared
- affected by patho processed from primary injury
components of spinal shock
- hypotension
- bradycardia
- transient loss of function below level of injury
voluntary anal contraction or anal wink tests ___
s4-s5 and if complete or incomplete
what is incomplete cord injury
- most caudal segment with motor function at least 3/5
- pain and temp are present
OR
lowest level of completely normal function
prognosis of spinal cord injury
- asia a = 90% incapable of ambulation
- asia b = 72% unable to ambulate
- asia c/d = 13% can ambulate after 1 year
