Spine disorders (Chen) Flashcards
pathogenesis of this disease is due to an autosomal dominant mutation in a gene that is essential for the formation of microfibrils, compromising structural integrity of connective tissues
Marfan’s syndrome
mutated fibrillin in Marfan’s binds poorly to this cytokine, which results in excessive accumulation of it in the lungs, heart valves, and aorta
TGF-β
syndrome caused by an autosomal dominant mutation in genes that are necessary for normal collagen production and presents with a WIDE range of clinical manifestations:
- joint hypermobility
- fragile skin and easy bruising
- poor wound healing
- arterial, uterine, intestinal rupture (pregnancy can be life threatening)
Ehlers-Danlos syndrome
What is the most common spinal presentation in the 2-3% of children that have adolescent idiopathic scoliosis?
right thoracic/left lumbar curve
How is the Cobb angle determined?
X-ray identifies the beginning and end of the abnormal curvature and is reported with the spinal level specified, ie: “Cobb angle is 32 degrees from T12-L4”
fractures of the pars interarticularis, known as spondylolysis or “gymnastics fracture”, usually occurs in kids ages 5-7, mostly at what spinal level?
L5/S1
*rarely at L4/L5 or higher
isthmus fracture (spondylolysis) generally in adults that leads to slippage of vertebrae, usually L5/S1, and results in a deep ache in the low back that worsens with standing, walking, or leaning backwards
spondylolisthesis
*radiculopathy generally begins at Grade 2 or higher, and lumbar fusion at that time may be helpful in reducing leg pain and possibly some back pain - core muscle strength training is otherwise the mechanism of treatment
most common metastases to the spine?
breast, lung, thyroid, prostate, kidney
(BLT, with Pickles and Ketchup)
What is the name of this X-ray finding, that points to spine metastasis?
winking owl sign
*notice the left pedicle is gone, replaced by tumor.
This is the most common level of cervical disc herniation
C6/C7
Bonus: What are the myotome and dermatome effects of a C6/7 herniation that is compressing the C7 nerve root?
myotome: triceps weakness
dermatome: middle finger sensory loss
This is the most common level of lumbar disc herniation
L4/L5
Bonus: What are the myotome and dermatome effects of a L4/5 herniation that is compressing the L5 nerve root?
myotome: extensor hallucis longus weakness
dermatome: 2nd/3rd toe webspace
up to 4-5% of those with chronic low back pain may have this condition, common in younger males (onset < 40); affects spine, SI and other peripheral joints, gets better with exercise and is worse with rest and at night
ankylosing spondylitis
*disc spaces become narrow and calcified:
what are the “3 buckets” of categorization of back pain, as recommended by the American College of Physicians Clinical Practice Guidelines?
- specific spine - fracture, tumor, stenosis, etc
- radiculopathy
- nonspecific - accounts for approximately 85% of chronic back pain!
Which of the following statements is TRUE?
A. there is a wide body of evidence showing the effectiveness of spinal joint injections in the treatment of chronic back pain
B. The biopsychosocial model of pain expalins why structure of the spine correlates with function
C. Opioid treatment is the oldest method of pharmacotherapy for low back pain and is considered generally safe for everyone
D. Not everyone who is a drug user with out-of-proportion pain on exam is a drug seeker - get an MRI
D
A is false: there seems to be a placebo effect associated with injections as evidence does not support them as effective
B is false: structure does not always equal function, ie, a person with advanced scoliosis may not have pain
C is false: opioid-induced hyperalgesia is a known problem that has been recently recongnized, and opioid treatment in general does not take into account the biopsychosocial problems with drug addiction, tolerance, etc.
