Spine Pathology

Question 1

note: Reassessment is critical— they must leave their first office with a clear picture about how their treatments and progress are going to be measured, and when they are going to see the doc again to rule out other things if the pain continues

Question 2

T/F you should do imaging for lower back pain.

Answer 2

False. We should not do imaging for back pain unless there are red flags— neurological issues,masses on palaption etc. Can cause even more harm

Abnormalities on imaging does not correlate with the pain that they are feeling. Their scan might show a degeneration of a disc in middle age (normal progression) but that is not why they have pain.

Question 4

there are lots of physical treatents out there, but what should you consider when looking at a treatment for a patient for their LBP

Answer 4

there are reams of data of these interventions, but it’s not only about the right/superior one. its important that it’s SUSTAINABLE–if there are financial barriers, that will be difficult to sustain.

Question 5

T/F low dose oxycodone or opioids can be used as an analgesic when you have backpain.

Answer 5

FALSE. opioids are not first line for non-cancer chronic pain. Consider NSADIS and acetaminophen.

Question 7

one of the biggest yellow flag

Answer 7

depression and fear that exerise will make the pain worse.

Question 8

broad overview of spine pathology of CNS and PNS

Answer 8

Question 9

most common cause of radiculopathy

Answer 9

disc herniation. usually affects one nerve root at a specific dermatome on a specific side of the body.

Question 10

what nerve does a posterolateral herniation affect?

Answer 10

can cause presure on the nerve roods exiting below it.

Question 11

what nerve does a right or left lateral herniation affect

Answer 11

affcts the nerve at the same level.

Question 12

outline the myotomes of the L4, L5 and S1 nerve roots

Answer 12

L4 = knee extension/ankle dorsiflexion, medial calf

L5= ankle dorsiflexion and first toe extension, lateral calf

S1 = ankle plantar flexion.

Question 13

what physical test can you do to test for radiculopathy

Answer 13

straight leg test– done passively. can test for sciatic nerve radiculopathy because moving the leg up passively will stretch the nerve.

this is different than the straight leg test for quad and hamstring viability.

Question 14

Answer 14

Question 15

T/F id you suspect a lumbar radicuolopathy because of disc herniation, you sohuld do imaging.

Answer 15

false. it may resolve spontaneously. no need to image early!!

you should start to worry if it gets worse or unable to cope or more neurological symptoms surface though.

management of radiculopathy is education, analgesia, follow up

Question 16

what is spinal stenosis

Answer 16

can compress the nerve roots, spinal cord or cauda equina. spinal stenosis is a narrowing of the spinal canal.

Question 17

What Mri is showing spinal stenosis

Answer 17

the right one. smaller triangular opening.

Question 18

Answer 18

spinal stenosis of L5 vertebrae

Question 19

How does the pain differ between PNS radiculopathy and stenosis CNS?

Answer 19

radiculopathy often is more painful and more acute. in spinal stenosis, it might resolve on its own and might not even be painful== but it can have worse side effects if it is painful– can be nerugenic or vascular.

Question 20

two different types of stenosis-stemming claudication

Answer 20

1. neurogenic. heaviness in BOTH legs and better going up hill. must sit for relief because leaning forward slightly opens the spinal canal a bit.
2. vascular: heaviness in one or both legs, and worse going uphill becuase ischemia. must STOP for relief.

Question 21

why does sitting sometimes help neurogenic claudication of spinal stenosis

Answer 21

must sit for relief because leaning forward slightly opens the spinal canal a bit.

Question 22

natural history of stenosis

Answer 22

Question 23

treatment options for spinal stenosis caludication

Answer 23

acitivy modification

pharmaceutical mangement (NSAIDS)

injections (epidural steroid)

Decompression– laminectomy or failure of non-operative therapy

for spinal stenosis myelopathy, you need surgical intervention.

Question 24

what is spondylolithesis

Answer 24

a slip of the vertebra– can cause displacement.

classified into degenerative or isthmic.

Question 25

what is the red part

Answer 25

pars interarticularis

Question 26

spondylolysis or spondylolisthesis

Answer 26

the vertebrae is actually displaced so it’s a listehsis.

Question 27

most common vertebrae for a spondylolysis/listhesis to occur

Answer 27

Typically at L5. can cause radiculopatahy. Often asymptomatic, but in some patients it can cause the L5 to slip anterior over the sacrum

Question 28

Answer 28

Isthmic spondylolisthesis

where the spine has translated forard. L5.

Question 29

cervical stenosis causes ____ which includes loss of hand function, numbness, bladder disturbance.

Answer 29

myelopathy.

Question 30

T/F steroids and physiotherapy can help with myelopathy stenosis.

Answer 30

false.non surgical methods don’t really help. need surgery.

Question 31

myelopathy vs radiculopathy

Answer 31

Myelopathy ; compression of spinal cord vs

Radiculopathy compression of nerve.

Question 32

spinal stenosis can cause claudication or myelopathy. contrast the two in terms of symptoms and management.

Answer 32

Question 33

this is a Rare condition in younger people associated with large sudden disc herniations

Answer 33

Cauda equina syndrome.

• Between L3 and L4 there is a large herniated discs, cutting across the spinal canal.
• Even though many herniations (radiculopathy) have some pain and doens’t require surgical intervention, this situation can be an emergency because it affects a lot of lumbar nerves including the nerves that innervate the bowel and colon— those emerge from the sacrum— part of the caudate equina

Question 34

what physical exam is essential when you suspect cauda eequina syndrome.

Answer 34

Critical to do DRE to identify compromised rectal areas and to look at which dermatomes are affected. Look to see if the patient has ability to contract the rectal sphincter.

Question 35

which sex is more affected by scoliosis

Answer 35

more in women than men.

Question 36

an 11 year old kid comes to the clinic with back pain. you notice there is a bump on the lateral flank that is consistent with a rib hump. what do you suspect?

Answer 36

idiopathic scoliosis

Question 37

what is degenerative scoliosis

Answer 37

a PROGRESSIVE DEFORMITY that causes loss of normal lordosis and kyphosis. may be painful or not painful.

Question 38

a ___ gracture often occurs when the spine is overloaded and it occurs in a high energy siutation.

Answer 38

a burst fracture.

Question 39

red flags of spine pain.

Answer 39

Question 40

what part of the spine is affected primarily in an infection? Why?

Answer 40

infections can cause discitis, vertebral osteomyelitis, or epidural abscesses (outside the bones)

• but the most common is the infections that start in the disc. it’s an avascular and immune priciledged structure.

Question 41

infection symptoms that might indicate a spinal infection.

Answer 41

Question 42

surgical goals for infection or tumors?

Answer 42

1. relieve neural element compression when deficits are present and progressive.

2. achieve stability if instability it present.

• source ontrol when an infection remains uncontrolled
• biopsy for unusual infections or tumours