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18 ORR > Spine > Flashcards

Spine Flashcards

1
Q

conditions that cause disc degeneration

A
  • nicotine exposure = vasoconstrictive process
  • atherosclerosis = vaso-occlusive
  • end plate sclerosis
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2
Q

mri of healthy vs desiccated disc

A
  • healthy: disc is hydrated, clear demarcation between annulus and nucleus
  • desiccated: darker signals and homogenous
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3
Q

components of spine pe

A
  • inspection
  • gait
  • palpation
  • rom
  • neurologic function
  • special tests
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4
Q

progress of degenerative cascade

A
  • 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
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5
Q

types of herniated nuleus pulposus

A
  • soft disc herniation: posterolateral

- hard disc herniation: disc-osteophyte spurs

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6
Q

neuropathy vs radiculopathy vs myelopathy

A

neuro: peripheral nerve
- sx: weakness, numbness

radiculopathy: spinal nerve root
- sx: weakness, numbeness

myelopathy: spinal cord
- sx: stiffness, incoordination, weakness

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7
Q

nerve root exposure to chemicals of the nucleus + compression = ___

A

radicular pain & dorsal root ganglion apoptosis

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8
Q

conus medullaris vs cauda equina

A

conus medullaris: terminal end of spinal cord (l1-l2)

cauda equina: bundle of spinal nerves that taper out after conus medullaris

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9
Q

differences between conus medullaris syndrome and cauda equina syndrome

A

read

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10
Q

clinical presentation of conus med./cau eq.

A
  • bilateral buttock and le pain
  • bowel and bladder dysfunction
  • saddle anes
  • varying degrees of lower limb dysfunction
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11
Q

regions involved in conus medullaris

A
  • above l2
  • damage to sacral spinal cord: bladder/bowel dysfunction, impotence, saddle anes, loss of achilles reflex
  • no loss of patellar knee reflex
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12
Q

typical symptoms of myelopathy

A
  • 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

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13
Q

hand signs for myelopathy

A
  • finger escape sign
  • positive ten second test (20x/10s)
  • hoffman’s sign
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14
Q

what is spondylolisthesis

A
  • 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
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15
Q

grading of spondylolisthesis

A

1 0-25%
2 25-50%
3 51-75%
4 76-99%

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16
Q

significance of mri in back pain

A
  • 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
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17
Q

non-surgical treatment for back pain

A
  • immobilization
  • analgesics
  • nerve blocks
  • epidural steroid injections
  • patient education
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18
Q

indications for surgical treatment for back pain

A
  • progressive neurologic deficits (motor weakness, unremitting radicular pain)
  • failure of conservative management
  • positive study results and persistent unacceptability
  • bowel and bladder dysfunction
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19
Q

t/f spine is the most common bony site for msk tumors

A

true, most are metastatic

20
Q

most common primary benign tumors

A
  • osteoid osteoma
  • osteoblastoma
  • abc
  • eosinophilic granuloma
  • osteochondroma
  • giant cell tumor
  • hemangiom
21
Q

most common primary malignant tumors

A
  • solitary plasmacytoma!!
  • chondroma
  • chordosarcoma
  • lymphoma
  • ewing’s sarcoma
  • osteosarcoma
22
Q

most common type of malignant spine lesion

A

metastatic tumors

- breast and prostate, thyroid, lung, kidney

23
Q

t/f the spine is the last source to manifest symptoms of metastasis

A

false, first source of symptoms. workup is warranted to know spread and grading

24
Q

variables in treating tumors

A
  • tumor diagnosis
  • stage
  • neuro status
  • prognosis of the tumor
  • spinal stability (surgery)
  • intractable pain (surgery)
25
Q

most common consult among deformities

A

scoliosis (idiopathic)

26
Q

spinal growth in children with scoliosis

A
  • birth to 5 years: spine gains 10 cm in length

- 5 years to adolescent: growth of 5 cm, 10 cm during growth spurt

27
Q

location of idiopathic scoliosis

A
  • right thoracic curve!!

- left thoracic curve

28
Q

incidence of idiopathic sclerosis

A
  • 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
29
Q

t/f scoliosis causes back pain

A

false, mostly asymptomatic

30
Q

postural changes in scoliosis

A
  • uneven shoulders or hips
  • rib hump
  • ill fitting clothes
31
Q

diagnosis of scoliosis

A
  • inspection of back = asymmetry
  • leg length discrepancies
  • trunk shift and head centered
  • adams forward bending test
  • scoliometer
  • forward bending sitting test
32
Q

angle measured in scoliosis xrays

A

cobb’s angle

33
Q

most current and widely used scoliosis classification system

A

lenke classification

34
Q

treatment options for scoliosis

A
  • observation
  • bracing (mild to moderate progressive curves)
  • operative (>50 deg)
35
Q

types of bracing for scoliosis

A
  • milwaukee = apex above t6
  • boston underarm brace = apex below t7 and above l2
  • cheneau brace
  • boston brace
36
Q

what is spondylolysis

A
  • defect in pars intecularis
  • leads to spondylolisthesis
  • common in children and adolescents
  • fatigue fracture
  • tx: surgery
37
Q

s/sx of spodyloslisthesis

A
  • back pain
  • hamstring tightness
  • palpable step-off
  • alteration in gait
38
Q

what is the denis three column theory

A
  • destruction of >2 columns = spinal instability
39
Q

anterior column (denis)

A

ant longitudinal ligament
ant annulus
ant 2/3 vertebral body

40
Q

middle column (denis)

A

post 1/3 of vertebral body
post annulus
post longitudinal ligament

41
Q

post column (denis)

A

posterior elements: pedicles, facets, lamina, spinous process
post ligaments

42
Q

primary damage in spinal cord injury

A
  • caused by mechanical forces imparted to the spinal column at the time of trauma
  • result: failure of osteoligamentous spinal column
43
Q

secondary damage in spinal cord injury

A
  • injury of adjacent neural tissue that was initially spared

- affected by patho processed from primary injury

44
Q

components of spinal shock

A
  • hypotension
  • bradycardia
  • transient loss of function below level of injury
45
Q

voluntary anal contraction or anal wink tests ___

A

s4-s5 and if complete or incomplete

46
Q

what is incomplete cord injury

A
  • most caudal segment with motor function at least 3/5
  • pain and temp are present

OR

lowest level of completely normal function

47
Q

prognosis of spinal cord injury

A
  • asia a = 90% incapable of ambulation
  • asia b = 72% unable to ambulate
  • asia c/d = 13% can ambulate after 1 year

18 ORR (21 decks)

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