The vertebral column and common back problems Flashcards
Why do abnormal curves happen?
Due to developmental abnormalities or pathological conditions (missing half vertebrae and osteoporosis)
What is kyphosis
Humpback
Excessive thoracic kyphosis
Why does kyphosis happen
Erosion/ fracture of anterior part of one or more vertebrae
What are the aims of kyphoplasty
Effective at providing pain relief
Preventing further collapse
What is adolescent kyphosis also known as
Sheuermanns disease
What happens in adolescent kyphosis
- Epiphyseal growth plates of vertebral bodies more affected in one or more thoracic vertebrae
- Causes wedging of bone and kyphosis
Symptoms of adolescent kyphosis
Pain, difficult breathing
What % of children are affected by adolescent kyphosis
1%
How is adolscent kyphosis treated
Brace
Surgery for curves >60 degrees
What is lordosis
Hollow back/ sway back
Anterior rotation of the pelvic produces increased lumbar curvature
When can lordosis occur (3)
- Late pregnancy
- Obesity
- Weak hip flexor
Symptoms of lordosis
Back ache
Sciatica
Shortness and weakening of which muscle is associated with lordosis
Psoas
Describe how shortening/ tightening of the psoas can lead to lordosis
- Alterations in body mechanics alignment resulting in excessive and inappropriate muscle exertion
- Increase in normal forward curve or hollow is most common postural defect
- Muscles in lower back shortern and tighten (thoracolumbar fascia and erector spinae muscles)
- Hamstrong and gluteal muscles tightened and often hypertonic
What is flat back syndrome
Tight musculature between ribs makes breathing shallow
Hamstrings are tight
Hip flexors weak
Pelvis tilts backwards, pulling column flat
What are the 3 consequences of flat back syndrome
- Ankylosing spondylitis
- Degeneratiev disc
- Spinal fusion
What is scoliosis
Abnormal lateral curvature of the back
What % of the population have scoliosis? What group is it most commonly seen in
3%
Girls around puberty
What does scoliosis result from
- Developmental defects
- Asymmetric muscle strength
- Poor posure
- Idiopathic
Between what degrees of curvature can a brace be used for scoliosis
20-40
What are the options for scoliosis curves of >50 degrees
Vertebral fusion
Harrington rods
What should you look for when considering age related degenerative spine disorders (5)
- Osteophytes
- Loss of disc height
- Loss/ increase in curves
- Spinal steonosis
- Ossification of vertebral ligaments
What kind of joint in an IV disc
Cartilaginous
What is the make up of the nucleus pulposus
70-90% water
Proteoglycans
(avascuclar and aneural)
Describe the structure of the annulus fibrosus
alternating layers of type 1 collagen
outer 1/3 innervated
firmly attached to outer margin of vertebral body
Which disc is most commonly herniated
L4/5
L5/S1
Why do herniated/ prolapsed discs cause pain
Nucleus pulposus irritates compresses spinal nerve root
What are the symptoms of cauda equina syndrome
Low back pain Unilateral/ bilateral sciatica Saddle or perineal hypothesia Bowel bladder disturbances Motor and sensory deficit Reduced or absent lower extremity reflexes
Treatment for cauda equina syndrome
Laminectomy or discetomy
What are the acute complications of a burst disc
Compression of the spinal cord or nerve roots
Instability
What are the late complications of a burst disc
Haematoma
Necrosis
Where do osteophytes develop around as we age
Margins of the vertebral body
Zygrapophysial joints
What is a vascular consequence of OA/ degenerative disc disease
vertebral-basilar artery insufficiency
What is diffuse idiopathic skeletal hyperostosis
Ossification of anterior longitudinal ligament with or without osteophytes
Is disc height maintained in diffuse idiopathi skeletal hyperostosis
Yes
Is the sacroiliac joint involved in diffuse idiopathic skeletal hyperostosis
Nah
What is ankylosing spondylitis
Chronic inflammatory disease mainly involving axial skeleton
What are the features of ankylosing spondylitis
- Narrowing and sclerosis of both sacroiliac joints
- Slerosis and ankylosis of vertebral bodies with no loss of disc space
- Bone formation extends across anterior and lateral margins of IV discs
What gene is related to ankylosing spondylitis
HLA-B27
What is enthescopathy
Attachments of tendons and ligaments into bone
Describe the relationship between anklylosing spondylitis and the gut
- HLA B27 influences composition of the endogenous gut flora
- B27 predisposes to leaky gut
- Leaky gut allows substances trigger cascades of inflammatory reactions
