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Orthopaedics and Rheumatology on the Move > Thoracic and Lumbar Spine > Flashcards

Thoracic and Lumbar Spine Flashcards

1
Q 
Put the parts of the vertebrae in oder from anterior to posterior 
Spinous process 
Lamina
Pedicle 
Body
A

Body
Pedicle
Lamina
Spinous process

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2
Q

What do 6 or more cafe au lait spots suggest

A

Neurofibromatosis which is associated with scoliosis and kyphosis

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3
Q

What might hairy patches at the base of the spine suggest

A

spina bifida

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4
Q

What imaging technique is useful for identifying structural bone changes and disc prolapse

A

CT scan

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5
Q

What imaging technique is useful for identifying spinal cord and canal as well as the intervertebral discs and bodies

A

MRI

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6
Q

What is scoliosis

A

AN apparent lateral curvature of the spine and deformity is the usual presenting feature

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7
Q

Who is scoliosis more commonly seen in and where in the spine does it occur

A

Girls

thoracic curve convex to the right

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8
Q

What is postural scoliosis

A

an apparent scoliosis often due to a leg length discrepancy - appears on sitting

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9
Q

What is structural scoliosis

A

A lateral angulation of the spine of >10 degrees with rotation of the vertebrae
This can be congenital, neuromuscular or metabolic

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10
Q

What is the most common type of scoliosis

A

Idiopathic adolescent scoliosis

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11
Q

What are the clinical features of scoliosis

A

A posterior abdominal hump or a rib hump secondary to the rotational aspect of the scoliosis is the most visible sign

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12
Q

What investigations are carried out for scoliosis

A

Angle of the curve on standing PA radiograph (Cobb’s angle)
Lateral spine radiograph for kyphosis and lordosis
Gait
True and apparent limb lengths

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13
Q

What is the management of scoliosis

A

Spontaneous resolution may occur

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14
Q

What is the treatment for scoliosis

A

Stop a curve from progressing further or correct an existing curve
Corrective casting: prevents the scoliosis from progressing
Bracing: stop progression of scoliosis but controversial
Surgery: severe and worsening curves. Involves posterior spinal fusion in combination with spinal instrumentation

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15
Q

What are some risks of surgery for scoliosis

A

spinal cord injury which could lead to paraplegia

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16
Q

What is kyphosis

A

Exaggeration of the normal convexity seen in the thoracic spine. >45 degrees

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17
Q

What are some causes of a child with kyphosis

A 
Congenital vertebral defect
achondroplasia 
osteogenesis imperfecta
TB
Muscular dystrophy
Polio
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18
Q

What is the most common cause of kyphosis in adults

A

Sheuermann’s disease

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19
Q

What happens in Scheuermann’s disease

A

Anterior wedging of the vertebrae occurs due to a failure in the thoracic vertebral bodies to grow as they should

20
Q

What is the mot common cause of kyphosis in the elderly

A

degeneration of the intervertebral discs with slight wedging of some of the thoracic vertebral bodies

21
Q

What is bacterial discitis

A

a bacterial infection of the vertebral disc

22
Q

How does bacterial discitis usually occur

A

Through haematogenous spread from a distant site or through the introduction of bacteria during an invasive procedure on the spine

23
Q

What is the most causative organism of bacterial discitis

A

Staph aureus

24
Q

What are the clinical features of bacterial discitis

A

Constant, severe back pain with CRP
Afebrile and systemically well
Neurological deficit may be present

25
Q

What are the investigations for suspected bacterial discitis

A

Blood cultures
AP and lateral radiographs for disc space narrowing
MRI
Biopsy

26
Q

What is the management for bacterial discitis

A

Prolonged course of IVAB (6-8 weeks)

Immobilisation with a brace

27
Q

What is spinal TB

A

extra pulmonary TB affecting the spine - aka Pott’s disease

The spine is the most common MSK site for TB

28
Q

How does spinal TB result

A

Haematogenous spread from other affected sites

29
Q

What are the clinical features of spinal TB

A

slow onset back pain with longstanding ill health
neurological signs relevant to the level of disease
fever, night sweats and weight loss

30
Q

What investigations are required for spinal TB

A

elevated inflammatory markers (CRP)
Mantoux test
MRI of the spine
CT guided biopsy for acid-alcohol fast bacilli and TB culture

31
Q

What is the management for spinal TB

A 
antiTB chemotherapy (RIPE)
Surgical drainage of any abscess
32
Q

What is an acute prolapse of an intervertebral disc

A

Herniation of the nucleus pulpous through the annulus fibrosus which has ruptured

33
Q

Who is most commonly affected by an acute prolapse of an intervertebral disc

A

Active, well individuals that may be associated with heavy exercise

34
Q

What discs are most commonly involved in a prolapse

A

L5/S1
L4/L5
L3/L4

35
Q

What are the clinical features of an acute prolapse of an intervertebral disc

A

Pain in the buttock, posterior thigh and calf (sciatica) and the patient will have a restricted straight leg raise on affected side
paraesthesia and numbness in the relevant dermatomal distribution if the nerve root is directly compressed

36
Q

What investigations are performed for a suspected disc prolapse

A

Straight leg raise
MRI
Nerve conduction studies if deficit is suspected

37
Q

What is the management for a disc prolapse

A

analgesia (NSAIDs)
Gentle exercise
Surgery if: conservative treatment fails or symptoms of cauda equina syndrome are present

38
Q

What are some complications of a disc prolapse

A

The nucleus may press on the cauda equina - medical emergency

39
Q

Why does spinal stenosis occur

A

narrowing of the spinal canal, often due to the degeneration of the spine vertebrae seen with raging

40
Q

What are the symptoms of spinal stenosis

A

Vague backache as well as pain, weakness and paraesthesia in the legs
Sometimes called spinal claudication due to similar symptoms

41
Q

What is meant by spondylolisthesis

A

A slipped vertebra which involves the forward displacement of one vertebral body on the vertebra below

42
Q

At what vertebral level does spondylolisthesis usually occur

A

L5/S1 or

L4/L5

43
Q

What can spondylolisthesis be due to

A

Osteoarthritis (elderly) or a congenital defect in the pars interarticularis (young adults)

44
Q

What is the treatment for spondylolisthesis

A

Conservative or surgical

45
Q

How do thoracolumbar fractures usually arise

A

Insufficiency fractures: low-energy fractures occurring in osteoporotic bone
Burst fractures
High energy: the vertebral column may fracture if exposed to significant twisting and flexion forces

Orthopaedics and Rheumatology on the Move (4 decks)

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