The Spine Flashcards
Describe the vertebral column
Vertebral column:
33 vertebrae organized in 5 sections: 7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccygeal (fused)
4 curves of the healthy spine
Helps maintain posture & balance
Describe the atypical vertebra
Atypical vertebra
C1 + C2 Atlas & axis
Allow head rotation
Vertebra prominens (C7)
No foramena transeverse process (veretbral artery)
What are the two types of joint in the spine?
Fibrocartilaginous (secondary) Joints- These are the intervertebral discs
Facet joints
Describe facet joints
These are synovial plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment.
What is spondylosis?
Basically osteoarthritis in the intervertebral discs which lose water content with ageing.
Why is MRI not necessarily diagnostic with back pain and spondylosis?
60% asymptomatic people over 45 years old have bulging discs on MRI. Not all of these have symptoms!
Motor neurons originate ____1____– bodies in anterior grey horn, sensory neurons originate___2____ – bodies in dorsal root ganglion
1) anteriorly (ventral)
2) dorsally (posterior)
Where does the spinal cord end?
L1
What is the cauda equina?
Bundle of spinal nerve rootlets at the end of the spinal cord
What can disc prolapse cause? What other things can cause this?
Nerve root compression
compressed by osteophytes and hypertrophied ligaments in OA – known as Spinal Stenosis (neurogenic claudication)
Explain what nerve root compression causes
Nerve root compression causes a radiculopathy resulting in pain down the sensory distribution of the nerve root (dermatome), which in the lower leg is known as Sciatica. Also weakness in any muscle supplied (myotome) and reduced or absent reflexes (LMN signs).
Describe the erector spinal muscles
Group of 3 muscles Iliocostalis Longissimus thoracis Spinalis thoracis 3 columns each running parallel on either outer side of the Vertebra and extending from the lower back of the skull all the way down to the Pelvis.
What is scoliosis?
Complex 3D deformity involving sideways curvature of the spine
Causes of scoliosis?
May be secondary to a condition e.g. NM disease, birth defects, injury or infection.
Can be idiopathic
Presentation of scoliosis?
Typically the patient or someone else notices rib asymmetry
Idiopathic is usually pain free and occurs in adolescents
Treatment of scoliosis? Indications for surgery?
All about charting people over time to check they don’t develop a respiratory problem etc. not everyone needs surgery even if they are deformed.
Sometimes it corrects itself
Indications for surgery: High likelihood of curve progression, cosmetically unacceptable as an adult, secondary condition that needs treatment, breathing difficulties.
Causes of kyphosis?
Osteoporotic collapse
Congential
Post infectious kyphosis
Describe acute disc tear?
An acute tear can occur in the outer annulus fibrosis of an intervertebral disc which classically happens after lifting a heavy object (eg lawnmower). The periphery of the disc is richly innervated and pain can be severe.
Pain is characteristically worse on coughing (which increases disc pressure).
Symptoms usually resolve but can take 2‐3 months to settle.
Analgesia and physiotherapy are the mainstay of treatment
Explain what sciatica is?
Disc material impinges on an exciting nerve root and this usually occurs low in the spine with L4,5 and S1 which contribute to the sciatic nerve (hence sciatica). Pain is felt down the back of thigh and below the knee. (Common mistake is to suspect sciatica with pain in gluteal region but that is likely radiated mechanical pain from the back).
What is the difference between neurogenic claudication pain and vascular claudication pain?
the claudication distance is inconsistent
the pain is burning (rather than cramping)
pain is less walking uphill (spine flexion creates more space for the cauda equina)
pedal pulses are preserved
Any patient with bilateral leg symptoms/signs with any suggestion of altered bladder or bowel function is …
Cauda equina syndrome until proven otherwise
Describe mechanical back pain?
Most common type of back pain. It is relapsing and remitting with no neurological symptoms and is relieved by rest. No red flags. Treatment is analgesia and physio.
What causes cauda equina syndrome?
A very large central disc prolapse that compresses all nerve roots of the cauda equina.
Explain why cauda equina syndrome is a medical emergency?
Nerve roots of the cauda equina contribute to control of defection and urination. Prolonged compression can result in permanent damage so must be caught early.
Symptoms of cauda equina syndrome?
Bilateral leg pain, paraesthesia, numbness, saddle anaesthesia, altered urinary function (typically urinary retention but incontinence can occur). Faecal incontinence and constipation can also occur. Need urgent MRI to determine level or prolapse and urgent diseconomy is required once confirmed diagnosis.
What are 11 back pain red flags?
1) age under 20
2) New presentation in over 60
3) non-mechanical constant pain that isn’t better lying down
4) history of cancer- particularly breast, renal or lung
5) history of steroids
6) genreal malaise, fever, unexplained weight loss
7) structural deformity
8) Saddle anaesthsia/ paraesthesia
9) Loss of bowel or bladder control
10) Haematuria
11) Severe pain longer than 6 weeks
Mimickers of Back Problems?
AAA, retroperitoneal tumours, pancreatitis, spinal infection
