Spine Pathology Flashcards
12 topics
nerve compression caused by narrowing of the spinal cord or neural foramina
spinal stenosis
compression of the actual spinal cord
central stenosis
compression of the nerve root as it exits the spinal canal
lateral stenosis
where does spinal stenosis most commonly occur?
lumbar spine > cervical > thoracic
occurs with exacerbation of pain when walking, lumbar pain is relieved by leaning forward, and pain radiates down one or both legs/arms
spinal stenosis
bundle of spinal nerve roots at the end of the spinal cord in the lumbar region that includes the sacral plexus and terminates at L1/L2
cauda equina
where does the cauda equina provide motor/sensory? (2)
lower extremities
pelvis for bowel/bladder function
a patient presents with severe low back pain that radiates down the leg, has asymmetric LE motor weakness/sensory loss, loss of reflexes in LE, saddle anesthesia (L3-L5), has onset of bowel/bladder dysfunction, and recent onset of sexual dysfunction. Dx?
cauda equina syndrome
what is the most consistent sign in cauda equina syndrome?
urinary retention
what is the treatment of cauda equina syndrome?
refer to ER or spine surgeon
surgery within 24-48 hours
what imaging is used to diagnose cauda equina syndrome?
MRI
what is the most common area to have a herniated nucleus pulposus?
lumbar spine
when the annulus fibrosus breaks open or cracks and allows the nucleus pulposus to escape
herniated nucleus pulposus
diagnose?
severe compression of the spinal cord
what spinal levels are the #1 most common areas of a herniated nucleus pulposus?
L4/L5
L5/S1
what spinal levels are the #2 most common areas of a herniated nucleus pulposus?
C4/C5
C5/C6
a patient presents with back pain that radiates, numbness, tingling to arms/legs, positional changes makes symptoms worse, abnormal reflexes, and decreased sensation. Dx?
herniated nucleus pulposus
what imaging gives the definitive diagnosis of herniated nucleus pulposus?
MRI
what is the conservative treatment for a herniated nucleus pulposus? (4)
pain meds/therapies
anti-inflammatories
physical therapy
epidural steroid injections
what is the treatment for a herniated nucleus pulposus for patients that fail cons. treatment or have weakness on exam?
discectomy +/- laminectomy +/- foraminotomy
arthritis of the spine involving changes to the bones, discs, ligaments and joints; the discs of the spine gradually break down, lose fluid, and become stiffer
spondylosis
what is visible on an xray of a patient with spondylosis? what can it lead to? (2)
osteophytes (spurs)
central or lateral stenosis
a patient presents with neck stiffness and pain, headache, pain in shoulder and arms, cannot fully turn their head/bend their neck, has a grinding noise when neck is turned. Dx?
cervical spondylosis
when can spondylosis cause arm/leg pain, weakness, and abnormal reflexes?
if osteophytes press on spinal nerves
a patient presents with lower back stiffness and pain, pain in the hips/legs, worsened with increased activity and long sitting. Dx?
lumbar spondylosis
what is the first line imaging for spondylosis?
xrays
what is the cons. treatment for spondylosis? (4)
NSAIDs
physical therapy
weight loss
epidural steroid injections
what is the surgical treatment for spondylosis in patients who fail cons. treatment or have loss of function with weakness? (3)
laminectomy
foraminotomy
+/- cervical/lumbar fusion
fracture through the pars interarticularis (weakest portion of the vertebra) that most commonly occurs in L4 or L5, and can occur on one side or both sides of the bone
spondylolysis
a small, thin portion of the vertebra that connects the superior and inferior facet joints
pars interarticularis
what is spondylolysis also called?
scotty dog
many times, patients with spondylolysis will also have some degree of _______
spondylolisthesis
a bone in the spinal cerebra slips out of position, either anteriorly or posteriorly
spondylolisthesis
what is the most common location of spondylolisthesis?
lower back (lumbar spine)
what are the 2 causes of spondylolysis?
overuse
genetics
Dx?
spondylolisthesis
what may spondylolisthesis with a high-grade slip present with?
spinal stenosis
what views should an xray be taken for spondylolysis and spondylolisthesis?
flexion/extension views for listhesis
oblique view for spondylosis
diagnose
L5-S1 spondylosis with spondylolisthesis
what is the cons. treatment for spondylolysis and spondylolisthesis? (4)
NSAIDs
physical therapy
bracing for acute
epidural steroid injection for + nerve symptoms
what should be considered for patients with spondylolysis/spondylolisthesis?
referral to ortho spine
when should fusion surgery be considered for patient’s with spondylolysis/spondylolisthesis? (4)
back pain not improved with cons. tx
progressively worsening slippage
severe, persistent symptoms
possible compression of spinal nerves
abnormal lateral curvature of the spine
scoliosis
what spinal levels is scoliosis most common in and what kind of curvature is most common?
T7/T8
right thoracic curve
a patient presents with asymmetry in the shoulder and iliac height, asymmetric scapular prominence, and a flank crease with forward bending showing right thoracic and left lumbar prominence. Dx?
scoliosis
what instrument measures trunk asymmetry for scoliosis?
scoliometer
when should xrays be taken for scoliosis?
when scoliometer is over 5 degrees
what does the cobb’s method angle measurement tell us?
curves >15 degrees are significant
what is the treatment for scoliosis in mild degrees of < 20?
monitor w/ serial xrays between 3-6 months
what is the treatment for scoliosis in moderate-severe degrees > 20?
refer to ortho for monitoring and tx
bracing/spinal fusion
increased convex curvature of the thoracic spine, AKA hunchback > 45 degrees
kyphosis
idiopathic osteochondrosis of the thoracic spine that occurs in children
scheurmann’s disease (juvenile kyphosis)
what imaging should we get for kyphosis?
standing lateral xrays
what is the treatment for kyphosis? (3)
observe q 3-4 months
physical therapy
bracing in children
what is the treatment for kyphosis > 60 degrees or with persistent pain?
Milwaukee brace
what is the treatment for kyphosis that is unresponsive to cons. treatment?
surgery
in which part of the spine do vertebral fractures most commonly occur?
thoracic spine
vertebral fracture that is associated with osteoporosis and no neurological compromise
compression fracture
vertebral fracture that is associated with trauma and possible neurological compromise
burst fracture
what side of the vertebra do compression fractures occur in?
anterior aspect of vertebra
a patient presents with sudden midline back pain that is worse with movement and a thoracic kyphosis deformity. Dx?
compression fracture
what is the treatment for a compression fracture? (4)
nutrition/exercise education
vit D/calcium
osteoporosis tx
pain meds
what is the treatment for compression fractures when there is >50% loss of vertebral height?
kyphoplasty
what side of the vertebra do burst fractures occur in?
both anterior and posterior aspect of vertebrae
burst fractures have a high risk of what?
spinal cord compromise
what is the treatment for a burst fracture?
surgery
inflammatory disease that causes fusion of the vertebra over time, leading to restricted motion of the spine and can cause a hunched forward posture
ankylosing spondylitis
a patient presents with kyphosis, restricted lumbar motion, limited motion of shoulders and hip, synovitis of the knee, plantar fasciitis, and achilles tendinitis. Dx?
ankylosing spondylitis
what labs should we expect to find in a patient with ankylosing spondylitis?
elevated ESR/CRP
HLA-B27 positive
which test can we use to examine spine mobility in a patient with ankylosing spondylitis?
schober’s test
what should we expect to see in imaging of ankylosing spondylitis?
bamboo appearance
on xray, you note disappearance of the pedicle. Dx? what is this appearance also called?
metastatic spine tumor
winking owl sign
