T Spine Pathologies Flashcards
why are T1/T8 relatively immobile?
what 2 things are limited at this point of the spine?
where is injury more likely and why?
due to the stabilising and restrictive effect of the ribs rotation and flexion are limited
T9/T10 as ribs no longer have above effect therefore greater degree of flexion and rotation
where do 2/3rds of all thoracic and lumbar #s take place? where are #s relatively uncommon? what can causes these #s? when are #s of T2 and T8 commonly seen? where are #s most common for paed #s?
T11 and L2 mid and upper T spine by convulsions in motorcyclists T4/5
what are compression #s of T/L junction often linked with?
what are traumatic wedge #s associated with?
what is associated with thoracic spine #s?
calcaneal #s
sternal injury (T4) paraspinous haematoma
when do spinal injuries arise?
what do rotational and shearing forces do?
what do compressive forces generate?
name 6 mechanisms of injury
when the head and trunk are moved beyond the limits of vertebral construction
disrupt ligaments
#s
flexion, extension, distraction (tension), compression, shearing, rotation
give the 3 columns of the spine
anterior - ant. longitudinal ligament and ant. 2/3 of vertebral body
middle - post. longitudinal ligament and post. margin of the vertebral body
posterior - post. arch of bone and post. ligaments
when is instability of the spine present
when any 2 of the 3 columns are disrupted
who is mainly affected by an anterior wedge # and through what mechanism of injury?
16-30 yrs males - high velocity impact injuries
older pt’s with less impact injury but bone disorders (OP etc) can be the pre-requisite
stable/unstable?
what if only ant. column affected?
what if ant. and post. columns affected?
what is a serious impact of this?
can be either depending on what columns of spine are affected
stable and treated less invasively
ligament damage therefore unstable and may need surgery
can cause neural deficits in lower extremities, reproductive and urinary systems
how are minor ant. wedge #s treated?
when is surgical intervention used as treatment?
what is done at this point?
without surgery using steroids, analgesia and bracing for immobilisation to ensure no spinal cord injury & gives support for effective rehabilitation
to allow decompression of spinal cord and stabilisation of disrupted vertebral column
interspinous fusion/surgical rods/2 plates used to stabilise # sites
what happens if pt presents as haemodynamically unstable ?
how long can rehab take?
this needs to be treated before any injury - pt hospitalised during recovery & WB’ing introduced as pt can tolerate
up to 2 years for full rehab depending on severity of injury
what is a chance #?
when is this common?
vertebra pulled apart (distraction)
in head on collision when upper body thrown forward while pelvis is stabilised by a lap seat belt
what does a chance # involve?
what damage is caused and where do the #lines fall?
what does the flexion-distraction #involve and what can it cause?
failure of post. column ligament damage - flexion anterior to ant. longitudinal ligament resulting in horizontal # through the post. and middle column
bone/ligament damage caused with # lines through the pedicles, transverse processes & pars interarticularis
flexion posterior to ant. longitudinal ligament and can cause neural deficits in lower extremities, reproductive and urinary systems
what is the treatment for a chance #?
without surgery using steroids, analgesia and bracing for immobilisation to ensure no spinal cord injury & gives support for effective rehabilitation
surgical intervention to allow decompression of spinal cord and stabilisation of disrupted vertebral column
interspinous fusion/surgical rods/2 plates used to stabilise # sites and prevent neural deficits
if haemodynamically unstable this must be treated before any injury
what is a compression #?
vertebra loses height both anteriorly and posteriorly and often there is retropulsion of fragments into the spinal canal
what does a compression # involve and what does this result in?
what occurs in an unstable burst #?
both anterior and middle columns resulting in loss of height of the vertebral body
posterior column = intact, involves displacement, vertebral body/facet dislocation or sublaxation
what may happen from posterior displacement of # fragments into the spinal canal?
what is the treatment for a compression #?
pt may present as haemdynamically unstable with possible cord, nerve root or vascular injury
without surgery using steroids, analgesia and bracing for immobilisation to ensure no spinal cord injury & gives support for effective rehabilitation
surgical intervention to allow decompression of spinal cord and stabilisation of disrupted vertebral column
interspinous fusion/surgical rods/2 plates used to stabilise # sites and prevent neural deficits
if haemodynamically unstable this must be treated before any injury
what does an anterior dislocation involve?
what is the mechanism of injury?
where are the # lines seen?
failure of both posterior & middle columns and varying degrees of anterior column damage
shearing force causing the radiological ‘slice’ appearance
through the pedicles & transverse processes into the pars interarticularis & subsequent sublaxation
what is the treatment for an anterior dislocation?
without surgery using steroids, analgesia and bracing for immobilisation to ensure no spinal cord injury & gives support for effective rehabilitation
surgical intervention to allow decompression of spinal cord and stabilisation of disrupted vertebral column
interspinous fusion/surgical rods/2 plates used to stabilise # sites and prevent neural deficits
if haemodynamically unstable this must be treated before any injury
what does a lateral # dislocation involve?
what is the mechanism of injury?
failure of posterior and middle columns and varying degrees of anterior column damage
rotational force of upper vertebral body causing radiographic ‘slice’ appearance sometimes seen with these types of injuries
where are #lines seen for a lateral # dislocation?
what is the treatment?
through the pedicles & transverse processes into pars interarticularis and subsequent sublaxation
without surgery using steroids, analgesia and bracing for immobilisation to ensure no spinal cord injury & gives support for effective rehabilitation
surgical intervention to allow decompression of spinal cord and stabilisation of disrupted vertebral column
interspinous fusion/surgical rods/2 plates used to stabilise # sites and prevent any neural deficits
if haemodynamically unstable this must be treated before any injury
what is scoliosis?
how does the pt present?
what are the symptoms?
what is the treatment?
lateral bending of the vetebral column
uneven shoulders/hips, 1 scapula more prominent, may lean to one side
chronic back pain & arthritis, breathing problems
back brace/physio/surgery (vertebral fusion and insertion of metal rods & wires)
what occurs in a spinal fusion?
what happens to the vertebral column after this?
what else is inserted whilst fusion takes place and why?
bone is harvested from elsewhere in the body and grafted to the vertebrae
becomes more rigid as it heals in one bone mass
metal rods to correct the curvature
what is kyphosis?
how is it caused?
common in?
increase in the thoracic curve of the vertebral column
by degeneration of intervertebral discs/rickets/TB of spine/poor posture
females with advanced OP
what is congenital kyphosis?
what is Scheuermann's kyphosis? who is this most apparent in? where is most commonly affected? how is it aggravated? what can it cause? how can it be corrected?
due to incorrect foetal development of spinal curvature
form of osteo-chondritis, pt’s cannot consciously correct their posture
teenagers
T7 and T10
with long periods of standing/sitting
may cause spinal damage and put pressure on internal organs
with bracing and/or surgery
what is spondylosis?
what occurs?
OA of spinal joints and foramina causing pressure on nerve roots affecting motor & sensory stimulus causing pain parasthesia & muscle weakness
ageing compromises structure of intervertebral discs and this degeneration weakens structure of annulus fibrosis causing wear & tear - water content of nucleus decreases with age and reduces shock absorbance and decreasing disc height
what is the treatment for spondylosis?
analgesia/anti-inflammtories/physio all help maintain symptoms
pain killing injections may also be administered
severe cases = surgery to remove osteophytes/portions of disc/laminectomy may be performed to relieve pressure on nerve roots
overall what is spondylosis?
what happens as osteophytes progress?
loss of joint space due to decreased disc height causing the facets to move differently - become overly mobile and lead to growth of bony spurs = osteophytes
the ‘out-growths’ fuse together causing osteophytic lipping accompanied by sub-chondral sclerosis (areas of increased density at periphery of vertebral bodies)
what is ankylosing spondylitis?
when is onset most likely?
what is the cause?
what is the treatment?
when is surgery carried out?
chronic inflammatory disease of joints of spine & SIJs
15-25 years
linked to genetics and can lead to complete rigidity of spine - ‘bamboo spine’
no treatment to cure, just med’s to manage condition - analgesia/anti-inflammatories/disease modifying medication (e.g. sulfsalazine)
surgery can involve joint replacement and corrective surgery but only carried out in severe low risk cases
where is the highest incidence of osteoporotic #s?
what is OP and what is a common complication?
what does OP cause?
how can OP cause wedge/compression #s?
mid thoracic spine and thoraco-lumbar junction
diminished bone density where vertebral compression # is most common complication
corticol and trabecular bone loss, disruption of microarchitecture of bone
minimal flexion/axial loading - bone = weak
what is the treatment for OP?
pain med, activity limitation, physical therapy and sometimes bracing
what can metastatic disease produce?
what is characteristic of mets on AP view of lumbar spine and what %?
what is evident where there is osteosclerotic changes?
areas of increased/decreased density
owl-eye erosion of pedicles - observed in 90% of symptomatic pt’s
bone destruction in up to 50% of radiographs
what % of symptomatic lesions found in thoracic region?
at what particular level?
give primary sources of spinal met’s and %s?
70%
T4-T7
lung - 31%, breast - 24%, GIT - 9%, prostate - 8%, lymphoma - 6%, melanoma - 4%, kidney - 1%, others including multiple myeloma - 13%
what are the symptoms of metastatic disease?
what is the treatment?
bone pain due to bone destruction by met’s and pathologic #s as a result of weakened bone, pt suffers from decreased range of movement due to # and bone destruction
initially steroids & non steroidal anti-inflammatory drugs & physio as well as RT
rare = surgery although might not be possible depending on pt’s health given disease progession
what are the symptoms for hemi-vertebra ?
what does it involve and what can it cause?
common location?
likely cause?
most = asymptomatic so need no treatment but some = neurological problems like paralysis, urinary/faecal incontinence
wedge shape vertebra which affects angle of spine causing kyphosis/sclerosis
T8
lack of blood supply causing part or whole vertebra not to form
what is butterfly vertebra?
fusion of lateral halves of vertebral body giving butterfly appearance
