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ortho-rheum > Spine Pathology > Flashcards

Spine Pathology Flashcards

12 topics

1
Q

nerve compression caused by narrowing of the spinal cord or neural foramina

A

spinal stenosis

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2
Q

compression of the actual spinal cord

A

central stenosis

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3
Q

compression of the nerve root as it exits the spinal canal

A

lateral stenosis

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4
Q

where does spinal stenosis most commonly occur?

A

lumbar spine > cervical > thoracic

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5
Q

occurs with exacerbation of pain when walking, lumbar pain is relieved by leaning forward, and pain radiates down one or both legs/arms

A

spinal stenosis

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6
Q

bundle of spinal nerve roots at the end of the spinal cord in the lumbar region that includes the sacral plexus and terminates at L1/L2

A

cauda equina

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7
Q

where does the cauda equina provide motor/sensory? (2)

A

lower extremities
pelvis for bowel/bladder function

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8
Q

a patient presents with severe low back pain that radiates down the leg, has asymmetric LE motor weakness/sensory loss, loss of reflexes in LE, saddle anesthesia (L3-L5), has onset of bowel/bladder dysfunction, and recent onset of sexual dysfunction. Dx?

A

cauda equina syndrome

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9
Q

what is the most consistent sign in cauda equina syndrome?

A

urinary retention

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10
Q

what is the treatment of cauda equina syndrome?

A

refer to ER or spine surgeon
surgery within 24-48 hours

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11
Q

what imaging is used to diagnose cauda equina syndrome?

A

MRI

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12
Q

what is the most common area to have a herniated nucleus pulposus?

A

lumbar spine

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13
Q

when the annulus fibrosus breaks open or cracks and allows the nucleus pulposus to escape

A

herniated nucleus pulposus

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14
Q

diagnose?

A

severe compression of the spinal cord

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15
Q

what spinal levels are the #1 most common areas of a herniated nucleus pulposus?

A

L4/L5
L5/S1

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16
Q

what spinal levels are the #2 most common areas of a herniated nucleus pulposus?

A

C4/C5
C5/C6

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17
Q

a patient presents with back pain that radiates, numbness, tingling to arms/legs, positional changes makes symptoms worse, abnormal reflexes, and decreased sensation. Dx?

A

herniated nucleus pulposus

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18
Q

what imaging gives the definitive diagnosis of herniated nucleus pulposus?

A

MRI

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19
Q

what is the conservative treatment for a herniated nucleus pulposus? (4)

A

pain meds/therapies
anti-inflammatories
physical therapy
epidural steroid injections

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20
Q

what is the treatment for a herniated nucleus pulposus for patients that fail cons. treatment or have weakness on exam?

A

discectomy +/- laminectomy +/- foraminotomy

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21
Q

arthritis of the spine involving changes to the bones, discs, ligaments and joints; the discs of the spine gradually break down, lose fluid, and become stiffer

A

spondylosis

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22
Q

what is visible on an xray of a patient with spondylosis? what can it lead to? (2)

A

osteophytes (spurs)

central or lateral stenosis

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23
Q

a patient presents with neck stiffness and pain, headache, pain in shoulder and arms, cannot fully turn their head/bend their neck, has a grinding noise when neck is turned. Dx?

A

cervical spondylosis

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24
Q

when can spondylosis cause arm/leg pain, weakness, and abnormal reflexes?

A

if osteophytes press on spinal nerves

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25
Q

a patient presents with lower back stiffness and pain, pain in the hips/legs, worsened with increased activity and long sitting. Dx?

A

lumbar spondylosis

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26
Q

what is the first line imaging for spondylosis?

A

xrays

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27
Q

what is the cons. treatment for spondylosis? (4)

A

NSAIDs
physical therapy
weight loss
epidural steroid injections

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28
Q

what is the surgical treatment for spondylosis in patients who fail cons. treatment or have loss of function with weakness? (3)

A

laminectomy
foraminotomy
+/- cervical/lumbar fusion

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29
Q

fracture through the pars interarticularis (weakest portion of the vertebra) that most commonly occurs in L4 or L5, and can occur on one side or both sides of the bone

A

spondylolysis

30
Q

a small, thin portion of the vertebra that connects the superior and inferior facet joints

A

pars interarticularis

31
Q

what is spondylolysis also called?

A

scotty dog

32
Q

many times, patients with spondylolysis will also have some degree of _______

A

spondylolisthesis

33
Q

a bone in the spinal cerebra slips out of position, either anteriorly or posteriorly

A

spondylolisthesis

34
Q

what is the most common location of spondylolisthesis?

A

lower back (lumbar spine)

35
Q

what are the 2 causes of spondylolysis?

A

overuse
genetics

36
Q

Dx?

A

spondylolisthesis

37
Q

what may spondylolisthesis with a high-grade slip present with?

A

spinal stenosis

38
Q

what views should an xray be taken for spondylolysis and spondylolisthesis?

A

flexion/extension views for listhesis
oblique view for spondylosis

39
Q

diagnose

A

L5-S1 spondylosis with spondylolisthesis

40
Q

what is the cons. treatment for spondylolysis and spondylolisthesis? (4)

A

NSAIDs
physical therapy
bracing for acute
epidural steroid injection for + nerve symptoms

41
Q

what should be considered for patients with spondylolysis/spondylolisthesis?

A

referral to ortho spine

42
Q

when should fusion surgery be considered for patient’s with spondylolysis/spondylolisthesis? (4)

A

back pain not improved with cons. tx
progressively worsening slippage
severe, persistent symptoms
possible compression of spinal nerves

43
Q

abnormal lateral curvature of the spine

A

scoliosis

44
Q

what spinal levels is scoliosis most common in and what kind of curvature is most common?

A

T7/T8
right thoracic curve

45
Q

a patient presents with asymmetry in the shoulder and iliac height, asymmetric scapular prominence, and a flank crease with forward bending showing right thoracic and left lumbar prominence. Dx?

A

scoliosis

46
Q

what instrument measures trunk asymmetry for scoliosis?

A

scoliometer

47
Q

when should xrays be taken for scoliosis?

A

when scoliometer is over 5 degrees

48
Q

what does the cobb’s method angle measurement tell us?

A

curves >15 degrees are significant

49
Q

what is the treatment for scoliosis in mild degrees of < 20?

A

monitor w/ serial xrays between 3-6 months

50
Q

what is the treatment for scoliosis in moderate-severe degrees > 20?

A

refer to ortho for monitoring and tx
bracing/spinal fusion

51
Q

increased convex curvature of the thoracic spine, AKA hunchback > 45 degrees

A

kyphosis

52
Q

idiopathic osteochondrosis of the thoracic spine that occurs in children

A

scheurmann’s disease (juvenile kyphosis)

53
Q

what imaging should we get for kyphosis?

A

standing lateral xrays

54
Q

what is the treatment for kyphosis? (3)

A

observe q 3-4 months
physical therapy
bracing in children

55
Q

what is the treatment for kyphosis > 60 degrees or with persistent pain?

A

Milwaukee brace

56
Q

what is the treatment for kyphosis that is unresponsive to cons. treatment?

A

surgery

57
Q

in which part of the spine do vertebral fractures most commonly occur?

A

thoracic spine

58
Q

vertebral fracture that is associated with osteoporosis and no neurological compromise

A

compression fracture

59
Q

vertebral fracture that is associated with trauma and possible neurological compromise

A

burst fracture

60
Q

what side of the vertebra do compression fractures occur in?

A

anterior aspect of vertebra

61
Q

a patient presents with sudden midline back pain that is worse with movement and a thoracic kyphosis deformity. Dx?

A

compression fracture

62
Q

what is the treatment for a compression fracture? (4)

A

nutrition/exercise education
vit D/calcium
osteoporosis tx
pain meds

63
Q

what is the treatment for compression fractures when there is >50% loss of vertebral height?

A

kyphoplasty

64
Q

what side of the vertebra do burst fractures occur in?

A

both anterior and posterior aspect of vertebrae

65
Q

burst fractures have a high risk of what?

A

spinal cord compromise

66
Q

what is the treatment for a burst fracture?

A

surgery

67
Q

inflammatory disease that causes fusion of the vertebra over time, leading to restricted motion of the spine and can cause a hunched forward posture

A

ankylosing spondylitis

68
Q

a patient presents with kyphosis, restricted lumbar motion, limited motion of shoulders and hip, synovitis of the knee, plantar fasciitis, and achilles tendinitis. Dx?

A

ankylosing spondylitis

69
Q

what labs should we expect to find in a patient with ankylosing spondylitis?

A

elevated ESR/CRP
HLA-B27 positive

70
Q

which test can we use to examine spine mobility in a patient with ankylosing spondylitis?

A

schober’s test

71
Q

what should we expect to see in imaging of ankylosing spondylitis?

A

bamboo appearance

72
Q

on xray, you note disappearance of the pedicle. Dx? what is this appearance also called?

A

metastatic spine tumor
winking owl sign

ortho-rheum (27 decks)

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