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MSK SOH > Spine pathologies > Flashcards

Spine pathologies Flashcards

1
Q

Curvatures of the spine

A

Lordosis - cervical, lumbar

Kyphosis - thoracic, sacral

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2
Q

Cervical vertebrace - C1

A

Atlas
No body, no spinner process
Has an anterior and posterior arch instead

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3
Q

Cervical vertebrae - C2

A

Axis

Has an odontoid process which projects superiorly from body

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4
Q

Cervical vertebrae - C7

A

Vertebrae prominens

First palpable spinous process

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5
Q

What kind of joints are intervertebral disc?

A

Secondary cartilagenous joints

Fibrocartilagenous

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6
Q

Function of intervertebral discs

A

Cushion the vertebral bodies from spinal stresses

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7
Q

Intervertebral disc components

A

Outer annulus fibrosis

Inner nucleus pulposus

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8
Q

Intervertebral disc degeneration

A

Degeneration occurs due to ageing

usually at L4/L5 level or L5/S1 level

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9
Q

Facet joints

A

Found between each vertebrae
At cervical level they are horizontal - allows lots of movement
At lumbar level they are vertical - allows limited movement

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10
Q

Motor neurones arise from anterior/posterior aspect of spinal cord

A

Anterior

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11
Q

Sensory neurones arise from anterior/posterior aspect of spinal cord

A

Posterior

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12
Q

What do anterior and posterior nerve roots join to form?

A

Mixed spinal nerve

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13
Q

Cauda equina region

A

Spinal cord ends at L1 where it becomes the caudal equine region

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14
Q

Red flags in history

A 
constant back pain for over 6 weeks 
pain troublesome at night
systemic upset
history of cancer
history of steroid use
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15
Q

x-ray overview

A

Usually normal

Most x-ray abnormalities are degenerative changes which may not be the cause of the patient’s presenting symptoms

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16
Q

MRI overview

A

Common to get false +ves

Only required if red flags in Hx present or if considering surgery

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17
Q

Mechanical back pain - definition

A

Recurrent relapsing and remitting back pain

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18
Q

Mechanical back pain - who gets it

A

Middle aged

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19
Q

Mechanical back pain - cause

A

Obesity
Poor posture
Poor lifting technique
Degenerative disc prolapse

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20
Q

Mechanical back pain - clinical features

A

Pain worse with movement

Pain worse at the end of the day

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21
Q

Mechanical back pain - management

A

Analgesia
Physio
Severe: spinal stabilisation surgery

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22
Q

Nerve root back pain - definition

A

Motor loss, sensory loss

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23
Q

Nerve root back pain - clinical features

A

Affects the leg more than the back
Unilateral pain
Paraesthesia (tingling, burning sensation)
Pain occurs when nerve is stretched

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24
Q

Nerve root back pain - management

A

Physio
Analgesia - but this is not effective as pain is neuropathic
Amitriptyline, gabapentin, pregablin

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25
Q

Complete spinal cord injury

A

No sensory or voluntary motor functions below the level of the injury
- (reflexes are unaffected as these are an involuntary motor function)

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26
Q

Incomplete spinal cord injury

A

Some sensory and motor functions are still present distal to the level of the injury

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27
Q

Sciatica - definition

A

Pain produced due to compression or irritation of the sciatic nerve

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28
Q

Sciatica - cause

A

Prolapsed disc

Degenerative disc disease

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29
Q

Sciatica - commonly affected areas

A

Lower lumbar spine
Buttocks
Thigh
Leg

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30
Q

Sciatica - nerve roots affected

A

L4
L5
S1

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31
Q

Sciatica - clinical features

A

Usually affects one side of the lower body
Pain originates in lower back
Pain radiates along the path of the sciatic nerve in a dermatomal distribution
- [thigh, leg, foot]
Pain is described as tingling or burning sensation
Pain relieved when lying down or walking
Pain worsened when standing still or sitting

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32
Q

Sciatica - L4 root entrapment symptoms

A

Pain worse in thigh region
Pain down to medial ankle
Reduced knee jerk

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33
Q

Sciatica - L5 root entrapment symptoms

A

Pain down to the dorsum of the foot
Numbness at the web between the big toe
Foot drop

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34
Q

Sciatica - S1 root entrapment symptoms

A

Pain down to plantar surface of foot
Reduced plantar flexion
- unable to raise heel off of the ground
Reduced ankle jerk reflex

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35
Q

Sciatica - examination

A

Reduced reflexes

Positive sciatic stretch test

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36
Q

Sciatica - investigations

A

MRI scan

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37
Q

Sciatica - management

A

Analgesia
Severe: Gabapentin
If pain doesn’t subside over time: surgery

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38
Q

Prolapsed disc - definition

A

AKA slipped disc.
Acute tear in the outer annulus fibrosis of an intervertebral disc which causes the inner nucleus pulposus to rupture out of its enclosed space.
The prolapsed disc material can enter the spinal canal, squashing the spinal cord or spinal nerves (sciatica)

39
Q

Prolapsed disc - cause

A

Usually after lifting a heavy object

Falling from a height and landing on buttocks

40
Q

Prolapsed disc - commonly affected areas

A

Cevical spine

Lumbar spine

41
Q

Prolapsed disc - who gets it

A

Young/middle aged adults

42
Q

Prolapsed disc - clinical features

A

Patient may be completely asymptomatic
Episodic back pain - worse on coughing
Sciatica like pain - as described elsewhere
Neck pain
Weakness
Cauda equina signs and symptoms (described elsewhere)

43
Q

Prolapsed disc - investigations

A

CT

MRI

44
Q

Prolapsed disc - management

A

Most settle themselves
Conservative management - bed rest, NSAIDs, muscle relaxants, physic
Surgical management - if patient isn’t improving by 3 months

45
Q

Cauda equina syndrome - definition

A

Clinical emergency
Compression of the cauda equine nerve roots (which are located at the lumbrosacral spinal level)
If the nerve roots are compressed for a long period of time, permanent damage can be caused

46
Q

Cauda equina syndrome - causes

A

Prolapsed disc
Spinal stenosis
Tumour

47
Q

Cauda equina syndrome - clinical features

A

Bilateral sciatica leg pain
Loss of bladder and bowel function
- incontinence, urgency
Saddle anaesthesia (numbness around sitting area)

48
Q

Cauda equina syndrome - examination

A

PR exam

Check reflexes

49
Q

Cauda equina syndrome - investigations

A

Clinical diagnosis but imaging helps identify the cause

  • MRI
  • CT scan
  • Myelogram X-ray of SC after injection of contrast
50
Q

Cauda equina syndrome - management

A

Surgical decompression

- must treat and get pressure off the nerves as soon as possible

51
Q

Spinal stenosis - definition

A

Narrowing of the spaces within mainly the cervical and lumbar spine.
This can put pressure on the nerves that travel through the spine

52
Q

Spinal stenosis - cause

A 
Osteoarthritis due to wear and tear via the formation of osteophytes 
Prolapsed discs
Tumours
Spinal injuries
Manual workers
Obese people
53
Q

Spinal stenosis - clinical features

A

Pain, tingling, numbness
Symptoms gradually worsen over time
Difficulty walking down a hill as patient is leaning over and making the space even narrower

54
Q

Spinal stenosis - Investigations

A

X-ray

MRI

55
Q

Spinal stenosis - management

A

Analgesia
Physio
Steroid injections
Decompression surgery if symptoms persist

56
Q

Spondylothesis - definition

A

The forward slip of one vertebrae over the vertebrae below it

57
Q

Spondylothesis - areas of the spine commonly affected

A

L4, L5, S1

58
Q

Spondylothesis - cause

A

Physical activity
Developmental defect
Recurrent stress fracture

59
Q

Spondylothesis - who gets it

A

Adolescents

Obesity

60
Q

Spondylothesis - clinical features

A

Lower back pain - especially after exercise

Waddeling gait

61
Q

Spondylothesis - investigations

A

X-ray

62
Q

Spondylothesis - management

A

Rest

63
Q

Scoliosis - definition

A

Sideways curvature of the spine due to spinous processes drifting off to the side

64
Q

Scoliosis - cause

A

Cerebral palsy
Muscular dystrophy
Idiopathic

65
Q

Scoliosis - who gets it

A

Adolescents

Females commonly affected

66
Q

Scoliosis - clinical features

A

Uneven shoulder height and hip height

67
Q

Scoliosis - investigations

A

X-ray

68
Q

Scoliosis - management

A

If mild; leave it

If severe; surgery

69
Q

Spinal osteoarthritis (spondylosis)

A

Osteophytes can impinge on exiting nerve roots and it can result in sciatica

70
Q

Spinal osteoarthritis (spondylosis) - cause

A

Disc degeneration

Wear and tear due to old age

71
Q

Spinal osteoarthritis (spondylosis) - clinical features

A

slow onset stiffness and back pain

Pain may radiate to shoulders and occiput

72
Q

Spinal osteoarthritis (spondylosis) - management

A

Physio

Analgesia

73
Q

Cervical spine fracture - definition

A

High C-spine fractures may be fatal (especially if above C3 level)

74
Q

Cervical spine fracture - cause

A

Usually high energy injury

75
Q

Cervical spine fracture - risks

A

May be missed in an unconscious patient which could result in spinal cord injury
Must put unconscious patient in a C-spine collar and perform X-ray to check for C-spine injury to be safe

76
Q

Cervical spine fracture - investigations

A

X-ray (3 views are required)

- AP view, lateral view, peg open mouth view

77
Q

Cervical spine fracture - management

A

Stable: firm cervical collar
Unstable: immobilisation in a halo vest (external fixator)

78
Q

Thoraco lumbar spine fracture - cause

A

Young: High energy injury
Old: Low energy injury (osteoporotic wedge fracture)

79
Q

Thoraco lumbar spine fracture - clinical features

A

Back pain that is worsened with movement

Possible brain injury

80
Q

Thoraco lumbar spine fracture - investigations

A

X-ray

81
Q

Thoraco lumbar spine fracture - management

A

Stable, thoracic - brace
Stable, lumbar - plaster jacket
Unstable thoracic/lumbar - surgery

82
Q

Crush fracture - definition

A

Vertebral compression fracture

83
Q

Crush fracture - cause

A

Osteoporosis

84
Q

Crush fracture - clinical features

A

Spine curves so height of patient decreases

85
Q

Crush fracture - management

A

Usually conservative: analgesics

86
Q

Chance fracture - definition

A

seatbelt fracture, from a seatbelt in a car crash

87
Q

Chance fracture - investigations

A

X-ray
MRI
CT

88
Q

X-rays

A

Show some fractures

89
Q

Can you see ligaments on X-rays?

A

No

- but if vertebral alignment is normal this implies intact ligaments and stable spine

90
Q

Can you see intervertebral discs on x-ray?

A

No

91
Q

Can you see spinal cord on x-ray?

A

No

92
Q

What is CT scan used for in MSK conditions?

A

To look for fractures the x-ray has missed

Shows intervertebral discs

93
Q

Investigation of choice for viewing disc prolapse? (2)

A

CT scan

MRI scan

94
Q

What is the best mode of imaging to view soft tissue disorders?

A

MRI scan

MSK SOH (24 decks)

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