Spine Pathology Flashcards
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
T/F you should do imaging for lower back pain.
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.
there are lots of physical treatents out there, but what should you consider when looking at a treatment for a patient for their LBP
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.
T/F low dose oxycodone or opioids can be used as an analgesic when you have backpain.
FALSE. opioids are not first line for non-cancer chronic pain. Consider NSADIS and acetaminophen.
one of the biggest yellow flag
depression and fear that exerise will make the pain worse.
broad overview of spine pathology of CNS and PNS
most common cause of radiculopathy
disc herniation. usually affects one nerve root at a specific dermatome on a specific side of the body.
what nerve does a posterolateral herniation affect?
can cause presure on the nerve roods exiting below it.
what nerve does a right or left lateral herniation affect
affcts the nerve at the same level.
outline the myotomes of the L4, L5 and S1 nerve roots
L4 = knee extension/ankle dorsiflexion, medial calf
L5= ankle dorsiflexion and first toe extension, lateral calf
S1 = ankle plantar flexion.
what physical test can you do to test for radiculopathy
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.
T/F id you suspect a lumbar radicuolopathy because of disc herniation, you sohuld do imaging.
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
what is spinal stenosis
can compress the nerve roots, spinal cord or cauda equina. spinal stenosis is a narrowing of the spinal canal.
What Mri is showing spinal stenosis
the right one. smaller triangular opening.
spinal stenosis of L5 vertebrae
How does the pain differ between PNS radiculopathy and stenosis CNS?
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.
two different types of stenosis-stemming claudication
- neurogenic. heaviness in BOTH legs and better going up hill. must sit for relief because leaning forward slightly opens the spinal canal a bit.
- vascular: heaviness in one or both legs, and worse going uphill becuase ischemia. must STOP for relief.
why does sitting sometimes help neurogenic claudication of spinal stenosis
must sit for relief because leaning forward slightly opens the spinal canal a bit.
natural history of stenosis
treatment options for spinal stenosis caludication
acitivy modification
pharmaceutical mangement (NSAIDS)
injections (epidural steroid)
Decompression– laminectomy or failure of non-operative therapy
for spinal stenosis myelopathy, you need surgical intervention.
what is spondylolithesis
a slip of the vertebra– can cause displacement.
classified into degenerative or isthmic.
what is the red part
pars interarticularis
spondylolysis or spondylolisthesis
the vertebrae is actually displaced so it’s a listehsis.
most common vertebrae for a spondylolysis/listhesis to occur
Typically at L5. can cause radiculopatahy. Often asymptomatic, but in some patients it can cause the L5 to slip anterior over the sacrum
Isthmic spondylolisthesis
where the spine has translated forard. L5.
cervical stenosis causes ____ which includes loss of hand function, numbness, bladder disturbance.
myelopathy.
T/F steroids and physiotherapy can help with myelopathy stenosis.
false.non surgical methods don’t really help. need surgery.
myelopathy vs radiculopathy
Myelopathy ; compression of spinal cord vs
Radiculopathy compression of nerve.
spinal stenosis can cause claudication or myelopathy. contrast the two in terms of symptoms and management.
this is a Rare condition in younger people associated with large sudden disc herniations
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
what physical exam is essential when you suspect cauda eequina syndrome.
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.
which sex is more affected by scoliosis
more in women than men.
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?
idiopathic scoliosis
what is degenerative scoliosis
a PROGRESSIVE DEFORMITY that causes loss of normal lordosis and kyphosis. may be painful or not painful.
a ___ gracture often occurs when the spine is overloaded and it occurs in a high energy siutation.
a burst fracture.
red flags of spine pain.
what part of the spine is affected primarily in an infection? Why?
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.
infection symptoms that might indicate a spinal infection.
surgical goals for infection or tumors?
- 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
