Spine clinical correlations Flashcards
What is Lhermitte’s sign?
- passive anterior cervical flexion elicits “electric” sensation down the spine or extremities
- implies cervical spinal cord pathology
What is Spurling’s test?
- cervical spine extension + rotation (towards affected side) + lateral flexion
- pain/”electric” feeling upon compression implies cervical nerve root pathology
- e.g. herniated disc
What is hoffmann’s sign?
- flick the patient’s middle finger
- positive= flexion-adduction of ipsilateral thumb and index finger
- implies upper motor neuron process affecting cervical spine or brain
What is the straight leg raising (SLR) test?
- also called Lasegue sign
- positive test= leg pain reproduced at 30-70 degrees
- implies lumbar nerve root pathology (L5 or S1)
What is the femoral nerve stretch test?
- patient is placed in prone position with flexed knee and examiner lifts the leg (hip extension)
- positive test= reproduction of patient’s pain in anterior thigh
- implies upper lumbar nerve root pathology (L2-L4)
What are the common symptoms of an upper motor neuron injury?
- spasticity/hypertonicity
- increased reflexes
- extensor plantar (+ babinski) response
**spinal cord injury, brain injury/stroke, myelopathy, CNS lesion
What are the common symptoms of a lower motor neuron injury?
- flaccid weakness
- loss of reflexes
- muscle wasting/atrophy
**peripheral nerve entrapment or radiculopathy (nerve root problem)
What are 2 red flags for malignancy?
- history of cancer
- unexplained weight loss
What are 5 red flags for spinal fracture?
- major trauma
- minor trauma or strenuous lifting in an older individual
- prolonged corticosteroid use
- osteoporosis
- advanced age (>70 years)
What are 4 red flags for infection?
- constitutional symptoms (fever, chills)
- recent bacterial infection (UTI, skin infection, pneumonia)
- immunosuppression
- IV drug use
What are 4 red flags for cauda equina syndrome?
- acute onset of urinary incontinence/retention
- fecal incontinence, loss of anal sphincter tone
- saddle anesthesia
- global/progressive weakness in lower limbs
Define lumbar strain
- muscle disruption from excessive stretch or tension
- pain worse with movement, better at rest
- localized muscle tenderness, reduced ROM, normal neuro exam
What makes the symptoms of a herniated disc better/worse?
- worse
- lumbar= sitting, bending, coughing/sneezing
- cervical= ROM
- better
- lumbar= standing, walking
- cervical= lying
What are the most common causes of radiculopathy?
**disc herniation (posterolateral herniation through the posterior longitudinal ligament)
- cervical= C6, C7
- lumbar= L5, S1
Describe the pathophysiology of radiculopathy
- mechanical compression
- neural ischemia/increased intraneural pressure
- edema of nerve root/DRG
- dura is mechanically sensitive
- biochemical irritation
- nucleus pulposis (inner core of the vertebral disc) contains cytokines, leukotrienes, Cox2, IL1, TNF alpha
- can cause apoptosis of DRG cells
What is the sensation and pain radiation associated with C5?
- sensation= lateral arm
- radiation= shoulder blade, lateral arm
What is the sensation and pain radiation associated with C6?
- sensation= radial distal arm/forearm, thumb
- radiation= shoulder blade, radial arm and forearm
What is the sensation and pain radiation associated with C7?
- sensation= posterior arm/dorsal forearm, middle finger
- radiation= posterior arm and forearm
What is the sensation and pain radiation associated with C8?
- sensation= medial forearm, 4th/5th fingers
- radiation= medial arm and forearm
What is the sensation and pain radiation associated with L4?
- sensation= anterior thigh, medial calf/foot
- radiation= anterior thigh and kness, medial calf
What is the sensation and pain radiation associated with L5?
- sensation= lateral leg and dorsum of foot
- radiation= buttocks, lateral thigh/calf, dorsal foot, great toe
What is the sensation and pain radiation associated with S1?
- sensation= posterior calf, lateral foot
- radiation= posterior thigh/calf, lateral/plantar foot
What is the reflex and motor weakness associated with C5?
- reflex= biceps
- weakness= shoulder flexion/abduction, elbow flexion
What is the reflex and motor weakness associated with C6?
- reflex= brachioradialis
- weakness= elbow flexion, forearm pronation, wrist extension
What is the reflex and motor weakness associated with C7?
- reflex= triceps
- weakness= elbow extension, wrist flexion
What is the reflex and motor weakness associated with C8?
- no associate reflex
- weakness= finger flexion/abduction
What is the reflex and motor weakness associated with L4?
- reflex= patellar
- weakness= knee extension, ankle dorsiflexion
What is the reflex and motor weakness associated with L5?
- reflex= medial hamstring
- weakness= ankle dorsiflexion, great toe extension
What is the reflex and motor weakness associated with S1?
- reflex= achilles
- weakness= ankle plantar flexion
What is sacroilitis?
an inflammation of one or both of your sacroiliac (SI) joints
**common sign of ankylosing spondylitis
What is spondylolysis?
a defect or stress fracture in the pars interarticularis of the vertebral arch
**aka scotty dog fracture
What is spondylolisthesis?
A spinal disorder in which a bone (vertebra) slips forward onto the bone below it
What are the early and late signs of ankylosing spondylitis?
- early
- widening of SI joints (with adjacent sclerosis)
- posterior longitudinal ligament sclerosis L1-L3
- late
- fusion of both SI joints
- bridging of vertebral bodies; “bamboo spine”
- ossification of the anterior, posterior, and interspinous longitudinal ligaments
**also see systemic effect (upper lobe lung fibrosis, iritis, CV abnormalities)
Define lumbar stenosis
- narrowing of the spinal canal
- disc (NOT herniation)
- thickening of bone, facet joints, spondylolisthesis
- thickening of ligamentum flavum
- worse when standing/walking, relieved with lumbar flexion and sitting (temporarily opens canal; note disc herniations are worse with sitting)
Describe cervical myelopathy
- Compression of the cervical spinal cord (multifactorial)
- subtle and varied presentation which required a high index of suspicion
- loss of fine motor skills
- gait disturbance/motor weakness
- bladder/bowel dysfunction
- LE numbness, weakness, pain
- **Upper motor neuron findings
**treat with surgical laminectomy
