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Y2 MSK > Spine Conditions > Flashcards

Spine Conditions Flashcards

1
Q

What is mechanical back pain?

A

back pain with no neurological symptoms that is worse when moving and relieved by rest

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2
Q

What is spondylosis?

A

osteoarthritis in the spine

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3
Q

How does spondylosis develop?

A

Intervertebral discs lose water with age which puts extra load on the facet joints -> this leads to OA in these joints

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4
Q

Will it be more painful to lean forwards or backwards in spondylosis and why?

A

more painful to lean backwards bc putting even more load onto the facet joints

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5
Q

What is spinal stenosis?

A

Compression of nerve roots leaving the spinal cord due to Osteoarthritis

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6
Q

What causes spinal stenosis?

A

osteophytes and thickened ligaments in the vertebrae due to osteoarthritis (spondylosis)

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7
Q

How does spinal stenosis present?

A

Neurogenic claudication -> burning pain in legs when exercising

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8
Q

What makes neurogenic claudication in spinal stenosis better/worse?

A 
better = walking uphill
worse = walking downhill
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9
Q

What happens in an intervertebral disc prolapse?

A

the nucleus pulposus pops out of the annulus fibrosis and compresses nerve roots

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10
Q

Which regions in the back are lumbar intervertebral disc prolapses most likely to occur in?

A

L4/5

L5/S1

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11
Q

Back pain that is worse when coughing is a sign of what?

A

Intervertebral disc prolapse

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12
Q

How long does it take most disc prolapses to get better by?

A

3 months

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13
Q

Which nerve root would be affected in:
Lateral L4/5 disc prolapse
Posterior L4/5 disc prolapse

A 
Lateral = exiting L4 nerve root 
Posterior = transverse L5 nerve root
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14
Q

What is altered bladder and bowel function a red flag for?

A

Cauda equina syndrome

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15
Q

What investigation should always be done if cauda equina syndrome is suspected? What would be found?

A

PR exam - loss of anal tone

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16
Q

What is cauda equina syndrome?

A

compression of all sacrolumbar nerve roots due to a prolapsed disc

17
Q

Management of cauda equina syndrome?

A

Urgent surgical decompression

18
Q

What is scoliosis?

A

lateral spinal curvature with secondary vertebral rotation, Cobbs angle >10

19
Q

Give 3 causes of scoliosis?

A

idiopathic (most common)
congenital (wedges of vertebra don’t develop properly)
neuromuscular (muscles dont work so spine is pulled to the side)

20
Q

What is Cobbs angle?

A

Measurement of curvature of the spine in degrees

21
Q

Does growth make scoliosis better or worse?

A

Worse - it will accentuate the curve

22
Q

How can mild scoliosis be made more obvious on examination?

A

asking the patient to lean forward

23
Q

Management of scoliosis?

A

conservative: physio, bracing, corrective exercises
surgery: for cosmetics and breathing difficulties

24
Q

What is kyphosis?

A

excessive curvature in the saggital plane of the spine (>40 degrees) - hunchback

25
Q

Give 3 things that can cause kyphosis?

A 
Spinal TB (developing world v common)
Congenital deformity 
Severe osteoporosis
26
Q

When is kyphosis operated on and why?

A

when the curve gets to 70 degrees or worse - surgery is v risky and has lots of complications so want to avoid if possible

27
Q

What is spondylolysis?

A

Stress fracture of the isthmus of the vertebral arch

28
Q

What can spondylolysis progress to?

A

Spondylolisthesis

29
Q

what is spondylolisthesis?

A

anterior displacement of one lumbar vertebrae on the one below - basically a slipped vertebrae

30
Q

At what level do spondylolisthesis usually occur?

A

L5/S1

31
Q

A patient presents with sudden onset lower back pain, sciatica and a waddling gait. Their lumbar spine looks flat. Most likely diagnosis?

A

Spondylolisthesis

32
Q

Why do people present with a waddling gait in spondylolisthesis?

A

their hamstrings are tight due to supporting the lower back and compensating for the slipped vertebrae

33
Q

Management of spondylolisthesis?

A

conservative management first

if unsuccessful then spinal fusion (happens in 50%)

34
Q

What is cervical spondylosis?

A

OA in facet joints of the cervical spine

35
Q

Typical presentation of cervical spondylosis?

A

slow onset stiffness and pain in the neck

pain can radiate to shoulders

36
Q

What can cause upper limb nerve problems in patients with cervical spondylosis?

A

nerve impingement due to osteophytes

37
Q

What 2 conditions can atraumatic cervical spine instability occur in and which joint does it occur in?

A

Down syndrome
rheumatoid arthritis
Atlanta/axial joint (C1/C2)

38
Q

Management of cervical spine instability?

A 
mild = collar 
severe = spinal fusion

Y2 MSK (35 decks)

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