The Spine Flashcards
Name of outer fibrous portion of intervertebral disc?
Inner portion?
annulus fibrosus
nucleus pulposus
Grading Muscle Function
0/5 - no function (rare, means nerve is severed) 1/5 - minimal contraction 2/5 - moves with gravity eliminated 3/5 - resists gravity 4/5 - moves against gravity 5/5 - normal strength
Anything less than 5/5 is abnormal
Degenerative processes cause problems divided into two categories:
Mechanical causes
Pinched nerve causes
Causes of low back pain
spondylogenic vs. non-spondylogenic
Spondylogenic
- disc degeneration
- spondylolisthesis
- fxs
- inflammatory
- infection
- tumor
Non-Spondylogenic
- vasculogenic
- viscerogenic
- neurogenic
Degenerative Spine Disorders
Pathology
Aggravating Factors
Pathology
- dehydration of nucleus pulposus–>fissures in annulus fibrosis
There is NO CORRELATION between severity of pain and the amount of disc degeneration
Aggravating Factors
- repetitive bending, lifting, twisting
- vibration (i.e. truck drivers)
- smoking
- osteoporosis
- genetic
- occupational
- anxiety/stress/depression (inactivity)
Red Flags (2)
Back pain in the Elderly
- compression fracture (can be spontaneous)
- tumor
- infection
Back Pain in Children
- rare compared to adults
- must be evaluated
- painful scoliosis (typically is not painful–indicates that it is pushing on something)
Radiculopathy
Sxs
Patho
Characterized by pain which seems to radiate from the spine to extend outward to cause symptoms away from the source of spinal nerve root irritation
Results from nerve root compression
Pt will complain of pain, numbness, tingling or weakness
Acute low back sprain/strain
Patho
Eval
Tx
Patho
- Muscles surround spine are stretched too far, lift too much weight, or move in such a way that they sustain very small tears
- Because of tearing of the muscles, small microscopic bleeding occurs which in turn results in pain and muscle spasm.
Evaluation
- complete and thorough H&P
- AP and Lat films if warranted
Tx
- NSAIDs
- brief period of rest, gradually return to full activity
- always consider weight loss and PT
Herniated Disc
AKA
Sxs
Eval
Tx
Other names
- slipped/bulging disc, disc protrusion, ruptured disc, torn disc
Sxs
- sharp, shooting pain
- MC in pts 30-40 y.o. and in the lumbar spine L4-L5 or L5-S1
Evaluation
- H&P emphasizing neurologic evaluation (deep tendon reflexes, sensory deficits, straight leg raise)
- severe pain +/- neurologic deficit warrants MRI, MRI myelogram, CT, EMG
Tx
- majority of first time herniations will resolve within 3 months
- initial tx is short term bed rest with gradual return to normal activity +/- PT, chiro, acupuncture, pilates, yoga etc (conservative tx)
- Surgical tx is warranted when all conservative measures fail or neuro deficit is present
Sponylosis
Definition
degenerative process of the spine
arthritis of the spine
Spondylolysis
Definition
Defect in pars interarticularis
Essentially a stress fracture
Spondylolithesis
Definition
Occurs when one vertebrae slips forward on another resulting in a scotty dog fracture
Spondylolysis causes spondylolithesis
Spondylosis
MC populations
Sxs
Rad
Tx
Common cause of back pain in children (RED FLAG)
MC in football linemen and gymnasts
Sxs
- low back pain, esp. with activities that put back in extended position
Rad
- Dx is made with imaging studies: plain films (oblique views), MRI, CT, bone scan
- difficult to spot positive “Scotty Dog” sign without displacement aka spondylolisthesis
Tx
- rest and possible bracing with hopes of fx healing
- progress into core strengthening
- return to normal activity
Spondylolisthesis
Patho
Patho
- one vertebrae slips forward on another, producing a gradual deformity of the spine, narrowing the spinal canal
- “Scotty Dog” fx – dog’s “neck” is fx’d
Compression Fx
Causes
- osteoporosis
- trauma
- tumor
- infection
Common in elderly females, but is often misdiagnosed as arthritis (RED FLAG)
Sxs
- acute onset of mid back pain pain
- traumatic or non-traumatic
- usually with muscle spasm
- inc’d pain with standing, walking, bending
- improves with rest
Rad
- typically with plain x-rays
- can also do MRI, CT, bone scan
Tx
- usually conservative with immobilization for 6-12 weeks
- surgery: kyphoplasty/vertebroplasty (cavity in vertebral body is filled with cement) or surgical stabilization
