Spine Red Flags Flashcards
MSK based spinal flags
fracture
cervical instability
malignancy
neurological related spine red flags
cervical myelopathy
cauda equina
cardiovascular related spine flags
vertebral basilar insufficiency
abdominal aortic aneurysm
myocardial infarction
pneumothorax
infections of the spine
osteomyelitis
sacroiliitis
what causes spinal fractures
axial loading and trauma
what % of calcaneal fractures are associated with _________
10%
low thoracic or lumbar fx
risk factors to consider in spinal fx
trauma
osteoporosis
hx of spinal fracture
hx of cancer
ages related to spinal fracture risk factors
females >65
males >75
what in a patient’s history would make you suspicious of osteoprosis
history of osteoporosis
late onset menarche (>16 y/o)
early menopause (<45)
corticosteroid use >3 mo
if a superficial bone is tender to palpation after trauma, think
fracture
presentation of cervical fx
neck pain that worsens with motion
instability s/s
possible cord and/or vertebral artery s/s
during flexion, explain the motion of the dens
will push into the spinal cord during flexion
high risk factors in the Canadian C-Spine Rule that indicate a CT scan
65 or older
dangerous mechanism
paresthesia in extremities
dangerous mechanisms can be described as
fall from > 3 feet or 5 stairs
axial load to head
MVC
In the Canadian C-Spine rules, what are factors that would not allow for safe ROM assessment
not a simple MVC
unable to sit up in ER
inability to ambulate
midline c-spine tenderness
immediate onset of neck pain
if cervical AROM is less than ____,
CT scans are indicated
45°
when is the Canadian C-spine rule not applicable
non-trauma cases
glasglow coma scale <15
unstable vitals
age <16
acute paralysis
known vertebral disease
previous C-Spine surgery
pregnancy
what is the sensitivity of the canadian c-spine rule
90-100%
what is the NEXUS criteria?
criteria in which all must be negative for CT scan to not be indicated
what are the criteria in the NEXUS criteria
no posterior midline cervical spine tenderness
no evidence of intoxication
normal level of consciousness
no focal neurological deficit
no painful distraction injury
sensitivity of the NEXUS criteria
83-100%
which criteria has been very successful in identifying odontoid fx
NEXUS
what portion of the body are there more distracting injuries? what are examples
UE>LE
fx, degloving, crush, burns or large visceral injuries
red flags for a vertebral fx in patients presenting with LBP
> 70 y/o
corticosteroid use
trauma
contusion/abrasion
what warrants lumbar radiography? which directions?
lumbar compression
minor traumatic fx
A-P and lateral views
what on an MRI will indicate a pathologic lumbar fracture
abnormal bone marrow signal
what types of scans can be done on a lumbar fx
lumbar radiography
CT w/o contrast
MRI w/o contrast
IFOMPT upper c-spine instability risk factors
history of trauma
infection
congenital collagenous compromise
inflammatory arthritides
recent head/neck/dental surgery
on the beighton scale, what constitutes congenital collagenous compromise
> 4 of 9
how would an infection lead to cervical spine instability
alter connective tissue integrity
- could erode bone
- spondylitis then stenosis
- grisel’s syndrome
s/s of upper cervical spine instability
occipital HA / numbness and neck pain
severe limitation of neck AROM
- all planes
<45° rotation
cervical myelopathy
pupil changes
dizziness
positive ligamentous integrity tests
ligamentous integrity tests related to Upper C-Spine Instability
sharp-purser
alar ligament
aspinall
what films will be taken for those with upper cervical spine instability
open mouth odontoid
- spread of lateral masses of C1/2
lateral c-spine
- flexion and extension views
what distances between C1/2 and atlanto dens interval are significant
<3 mm = normal
>5mm = increased risk of cord compression
>8mm = indicates surgical fixation
film indication for pt with blunt force c-spine trauma
CT scan
when is MRI indicated in the spine
neurological clinical examination findings
suspicion of ligamentous / vascular injury
risk factor of spinal malignancy
hx of cancer
s/s of spinal malignancy
progressive/constant severe pain
night pain w/ minimal relief
systematically unwell
unexplained weight loss
spine tenderness and warmth
neurological s/s
what amount of weight loss in what time frame is significant
5-10% loss over 1-3 mo
what rules out cancer causing LBP
<50 years
no explained weight loss
no hx of cancer
responding to conservative care in a month
if a spinal radiograph shows, _____________ then a contrast MRI is indicated
disc margin destruction
bony lesion suggestive of malignancy / infection
what is the cluster associated with cervical myelopathy
> 45 y/o
ataxic gait
babinski’s, reverse supinator, hoffman’s signs
which gender is cervical myelopathy more prevalent? what is the avg age / what is the most prevalent symptom
male (3:1)
64
UE radicular pain
what film is indicated with myelopathy suggestion
either MRI or CT with contrast
what is a positive Lhermitte sign
sharp shooting sensation in arm and leg when the extended leg is lifted and the c-spine is flexed
what nerve pairs are in the cauda equina
L2-5
S1-5
Coccygeal nerve
risk factors of cauda equina syndrome
disc herniation
spinal stenosis
surgery
tumor
trauma
hematoma
epidural abcess
s/s of cauda equina syndrome
bladder/bowel changes
sexual changes
sensory disturbances
global/progressive LE weakness
reduced anal tone
what sensory disturbances are associated with cauda equina syndrome
saddle anesthesia
LE L4,5 S1
red flags are more so _____ in cauda equina syndrome? which red flags
sensitive
saddle anesthesia
reduced anal tone
bowel incontinence
common cause of vertebral/internal carotid dissections
tear of tunica intima or outer adventitial layer via vaso vasorum damage
intramural hematoma causes blood flow alterations
where is the vertebral artery most commonly injured
C1-2 –> contralateral to rotation
explain VBI testing and its effectiveness
is not very sensitive
instead of normal VBI testing, what should be done when suspecting vascular pathology
peripheral/cranial nerve screen
blood pressure assessment
palpation/auscultation of common and IC arteries
coordination and gait assessment
vertebral artery 5 D, 3 N, 1 A
D:
dizziness, dysphagia, dysarthria, drop attack, diplopia
N:
nausea, numbness in face, nystagmus
A: ataxia
age risk factor for MI males and females
male >40, female >50
female only risk factors of MI
increased testosterone before menopause
increased HTN during menopause
autoimmune disease
stress, depression
what prodromal symptoms may precede an MI in women? what timeline?
unusual fatigue
sleep disturbances
dyspnea
indigestion
anxiety
heart racing
UE/LE weakness
s/s of MI
shortness of breath
substernal chest pain or squeezing pressure
radiating pain in referral distribution
angina >30min that is unrelenting
pallor / perspiration
risk factor of abdominal aortic aneurysm
> 50 y/o
male
smoker
family hx
genetic condition
weight lifting
anticoagulants
what cm measurement is suggestive of an aneurysm
4 or more CM
locations of pain associated with abdominal aortic aneurysm
back
abdominal
groin
posterior thigh
pneumo s/s
dyspnea
dry cough
change in respiratory movements in affected side
neck vein distension
sharp, sudden thoracic wall pain
referred shoulder / abdominal pain
risk factors for spinal infection
IV drug use
recent infection / surgery
immunosuppression
history of TB
s/s of spinal infection
general infection symptoms
unexplained weight loss
neuro s/s
spinal tenderness
if a radiograph shows disc margin destruction/bony lesion what would be indicated? why?
involved MRI without contrast
spinal malignancy or infection
findings associated with vertebral osteomyelitis
deep, constant pain, > with WB
spinal rigidity
fever, malaise
Spondylarthritis
noninfectious inflammatory, rheumatic condition
extraarticular manifestations of SpA
enthesitis
uveitis
dactylitis
s/s ankylosing spondylitis
insidious LBP >3 mo
SI symptoms / buttock pain
awaken in the night
morning stiffness >30 min
what is the nickname of ankylosing spondylitis
bamboo spine with a dagger sign
