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Year 2 Loco > 15. Back problems - Robson > Flashcards

15. Back problems - Robson Flashcards

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1
Q

What is the order of the vertebrae in the vertebral column?

A

Cervical
Thoracic
Lumbar
Sacral

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2
Q

What is a kyphosis curve?

A

Excessive outward curvature of the spine

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3
Q

What is a lordosis curve?

A

Excessive inward curvature of the spine

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4
Q

What are the primary curves in the vertebral column?

A

Kyphoses - thoracic and sacral

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5
Q

What are the secondary curves in the vertebral column?

A

Lordoses - cervical and lumbar

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6
Q

Which curves of the vertebral column are more movable?

A

The secondary curve

Lordoses - cervical and lumbar

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7
Q

Why are the kyphoses less movable?

A

Thoracic - ribs holding them in place

Sacrum - fused so not as much movement

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8
Q

What is an abnormal curvature in terms of the vertebral column?

A

An increase or a decrease in one of the normal curves OR a new curve (scoliosis)

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9
Q

What is meant by scoliosis?

A

The presence of a new curve - if the vertebae move laterally to each other

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10
Q

When might an abnormal curve arise?

A

If any of the 24 vertebrae develop abnormally

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11
Q

What are common causes of an increased thoracic kyphoses?

A

Osteoporosis
Erosion
Fracture to the anterior part of the vertebrae

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12
Q

How will an increased thoracic kyphosis present?

A

Humpback/hunchback

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13
Q

What happens during an osteoporosis kyphosis?

A

There is a reduced trabecular bone and so there is compression of the vertebra - get a wedged shaped vertebra
This causes the vertebra to move anteriorly

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14
Q

What typically happens alongside an increased thoracic kyphosis?

A

There will usually be a compensatory cervical lordosis to keep the head looking up and forwards

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15
Q

How can you treat a osteoporosis kyphosis?

A

Want to reinflate the deflated vertebra via ‘vertebral augmentation’ - inject bone cement which will push up the cortical bone of the vertebra

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16
Q

What is vertebral augmentation?

A

Treatment for osteoporosis in the vertebrae causing them to wedge
Inject bone cement into the vertebra to push up the cortical bone

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17
Q

What is the main advantage of vertebral augmentation on the spinal cord

A

Increases the space of the IV foramina - reduced compression of the spinal cord

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18
Q

How can you tell if a vertebra is osteoporotic from a scan?

A

Look at the posterior, central and anterior height - if they are drastically decreasing - wedging is occurring

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19
Q

What is adolescent kyphosis/Sheuermann’s disease?

A

Disease of the epiphyseal growth plates or vertebrae (usually thoracic)
Wedging of the bone

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20
Q

Who is affected by adolescent kyphosis/Sheuermann’s disease?

A

Adolescents all the through adulthood

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21
Q

What is the prevalence of adolescent kyphosis/Sheuermann’s disease in children?

A

Affected 1% of children

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22
Q

What are the symptoms of adolescent kyphosis/Sheuermann’s disease?

A

Pain

Difficulty breathing

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23
Q

How can adolescent kyphosis/Sheuermann’s disease be recognised in a scan?

A

Schmall’s nodes - these are depressions in the centre of the vertebra at the nucleus propulses of the IV disk

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24
Q

What is the treatment for adolescent kyphosis/Sheuermann’s disease?

A

Wear a brace to help straighten and correct the curvature

Ensure future growth is in the correct alignment

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25
Two muscular causes of lumbar lordosis are?
Weakened trunk muscles | Weakened hip flexors
26
What happens to the body weight during lumbar lordosis?
The body weight shifts anteriorly
27
How is the shift in body weight during lumbar lordosis compensated for and what affected does this have on the lordosis?
Via an increased pelvic tilt (anterior pelvic tilt) and this further increases the lumbar lordosis
28
When does a lumbar lordosis commonly occur?
During late pregnancy or obesity
29
What is lumbar lordosis also commonly known as?
Hollow-back, sway-back
30
What are the symptoms of lumbar lordosis?
Back ache | Sciatica - symptoms along dermatomal distribution of the sciatic nerve
31
What is the dermatomal distribution of the sciatic nerve?
Around L5 and S1 - lower back and back of leg
32
What structures can lumbar lordosis cause damage to?
IV discs - stretched anteriorly and compressed posteriorly | Impinge on nerve roots passing through IV foramina
33
What is the role of the psoas in lumbar lordosis?
In some individuals, psoas dysfunction e.g. shortened or weakened psoas can push the hip further into extension - muscle imbalance will result in lumbar lordosis
34
What is flat back syndrome?
This is where the is a backward and posterior pelvic tilt resulting in a flat back - very flat lumbar lordosis
35
What is flat back syndrome usually a result of?
Usually due to tight paraspinal muscles between the ribs
36
What is the other presentation of flat back syndrome other than a flat back?
Usually will have a slight bend in their knees due to bent thighs
37
What is scoliosis?
Development of a new curve | The vertebrae move laterally and rotate on top of one another - no longer aligned as they should be
38
What is the prevalence of scoliosis?
3% of the population
39
Who is scoliosis most prevalent in?
Girls around the age of puberty
40
What is one possible cause of scoliosis?
May be linked to hormonal changes of the ligaments - causes softening of the ligaments
41
In the majority of the population, how does scoliosis present?
In the majority of these individuals - scoliosis is present but causes no symptoms
42
What is the most common cause of scoliosis? What are some other causes?
Majority of these are idiopathic Developmental defects Asymmetric muscle strength Poor posture
43
What vertebral region is scoliosis usually present in?
In the thoracic-lumbar regions - mostly in the thoracic and then a compensatory curve in the lumbar region
44
What is the impact of scoliosis on the scapulae?
Causes one scapula to be higher than the other
45
What is the treatment for scoliosis?
Curve less than 20 degrees - leave it Curve between 20-40 degrees - wear a brace Curve greater than 50 degrees - surgical options
46
What are the surgical treatment options for scoliosis?
``` Vertebral fusion (causes flat back so not used much now) Harrington rods - on either side of the vertebrae and inserted into the bodies - act as a rigid support ```
47
What are osteophytes in the vertebral body known as?
Syndesmophytes
48
What is a syndesmophyte?
This is an osteophyte that is present in the vertebral body - change in name depending on location
49
What is the location of an 'osteophyte'?
Osteophytes grow around the synovial joints
50
How can you recognised degenerative spine disorders on a scan?
``` Syndesmophytes Loss of disc height Loss or increase in curves Spinal stenosis Ossification of vertebral ligaments ```
51
What is spinal stenosis?
Abnormal narrowing (stenosis) of the spinal canal
52
What are the two components of the IV disc?
Annulus fibrosus - outer | Nucleus pulposus - central
53
What is the annulus fibrosus composed of?
Alternating layers of collagen type 1
54
What is the innervation to the annulus fibrosus?
The outer third is innervated
55
What happens to the annulus fibrosus as we age?
Becomes more brittle and not as resilient - tears and damages - results in a loss of height
56
What is the nucleus pulposus composed of?
70-90% water | Proteoglycans
57
What is the purpose of the nucleus pulposus?
Acts to absorb shock
58
What happens to the nucleus pulposus with increasing age?
Dries out and becomes less resilient at absorbing shock
59
What is the innervation of the nucleus pulposus?
Central nucleus pulposus has no innervation - is completely dependent on the outer annulus fibrosus
60
Which out of the annulus fibrosis and the nucleus pulposus is avascular?
Nucleus pulposus - remember this is completely dependent on the outer annulus fibrosus
61
At what age does the annulus fibrosus start to dry out?
At the age of 30
62
Which of the vertebrae dry out faster than the others and why?
Lumbar vertebrae - because they are the largest in size
63
Where along the vertebral column does a herniation/prolapse occur?
Can occur along the whole length of the column
64
Where along the vertebral column does a herniation/prolapse most commonly occur?
The IV disc between L4 and L5 or L5 and S1
65
In which direction does a disc herniation/prolapse generally occur and why?
Posteriorly because the anterior longitudinal ligament is very strong and broad running down the whole of the anterior aspect of the column
66
What is the adverse effect associated with IV disc herniation/prolapse?
Nerve root compression - radiculopathy so pain and irritation - OR spinal nerve compression
67
What is cauda equina syndrome?
This is a more serious form of a herniated IV disc The disc herniates posteriorly and also slightly to the side of the spinal nerve root - hits the cauda equina - compression of multiple nerve roots - serious neurological condition
68
What is the cauda equina?
Series of nerve roots that come down to exit through the sacrum
69
What IV herniation is associated with the cauda equina?
Cauda equina syndrome
70
Which nerves are affected in cadua equina syndrome? x4
Sciatic Obturator Femoral Pudendal
71
What are the clinical presentations of cauda equina syndrome?
Low back pain Sciatica - unilateral or bilateral Bowel and bladder disturbances Reduced or absent lower extremity reflexes
72
What are the two treatment options for cauda equina syndrome?
Discetomy | Laminectomy
73
What is a discetomy?
Removal of the IV disk - replaced with a bone graft
74
What is a laminectomy?
Remove the lamina of the spinous process
75
What is a burst fracture and how does this relate to cauda equina syndrome?
The vertebra bursts - if this then moves posteriorly then can result in cauda equina syndrome
76
What is the later impact of a burst fracture on the IV disc?
Causes a fracture haematoma and blood can enter into the IV disc - haematoma within the disc Results in degeneration and necrosis of the IV disc as there is nowhere for the blood to go
77
What is the conus meddalris?
This is the tapered, lower end of the spinal cord
78
What is the significance of syndesmocytes during ageing?
With increasing age, syndesmocytes develop around the margins of the vertebral body
79
What is the impact on the brain of syndesmocytes with age?
Syndesmocytes can block the blood flow through the vertebral/basilar artery when the head turns and can block the blood supply to the brain
80
What is diffuse idiopathic skeletal hyperostosis (DISH)?
Ossification of the anterior longitudinal ligament - often seen with osteoarthritis
81
At what age does DISH occur?
50-75 year olds
82
What is the cause of DISH?
Idiopathic
83
Do syndesmocytes occur with DISH?
Yes (in some instances no)
84
What is ankylosing spondylitis?
Chronic inflammatory disorder of the axial skeleton - affects the ligaments Arthritis of the joints of the spine and sclerosis and ossification and akylosis of the ligaments
85
At what age does ankylosing spondylitis typically occur?
19-25 years
86
In which sex does ankylosing spondylitis typically occur?
Male
87
Is ankylosing spondylitis an autoimmune disease?
Yes
88
Which joint is commonly involved in ankylosing spondylitis?
Both sacroiliac joints
89
Is there a loss of disc space in ankylosing spondylitis?
No
90
What is the main structure that is at risk from ankylosing spondylitis?
The vertebral canal - because it has so many ligaments surrounding it
91
What is 'ankylosis'?
Abnormal stiffening and immobility of a joint due to stiffening
92
What genetic variant is associated with ankylosing spondylitis?
HLA-B27
93
What is the association of HLA-B27 on the gut?
This impacts the gut flora - predisposes to a leaky gut (this could potentially result in the release of the inflammatory mediators to the joints)
94
What is subluxation?
Partial dislocation of the vertebral column
95
What is the most common place for subluxation and why?
The pivot joint between C1 and C2 due to erosion from pannus formation
96
What is eroded in the C2 vertebra during subluxation and what impact does this have?
The dens - become thinner and more unstable
97
Anterior pelvic tilt associated with which back condition?
Lumbar lordisis - anterior pelvic tilt froms as compensation
98
Posterior pelvic tilt associated with which back condition?
Flat back syndrome
99
Flat back syndrome relates to what tow muscle groups and how?
Tight hamstrings | Weak hip flexors
100
What is the radiological feature seen in ankylosing spondylitis?
Bamboo spine
101
The two joints involved in ankylosing spondylitis are?
Both sacroiliac joints
102
Most common subluxation of the vertebrae is where?
Atlantoaxial subluxation (C1 and C2)

Year 2 Loco (31 decks)

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