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

15. Back problems - Robson Flashcards

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
Q

Two muscular causes of lumbar lordosis are?

A

Weakened trunk muscles

Weakened hip flexors

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26
Q

What happens to the body weight during lumbar lordosis?

A

The body weight shifts anteriorly

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27
Q

How is the shift in body weight during lumbar lordosis compensated for and what affected does this have on the lordosis?

A

Via an increased pelvic tilt (anterior pelvic tilt) and this further increases the lumbar lordosis

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28
Q

When does a lumbar lordosis commonly occur?

A

During late pregnancy or obesity

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29
Q

What is lumbar lordosis also commonly known as?

A

Hollow-back, sway-back

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30
Q

What are the symptoms of lumbar lordosis?

A

Back ache

Sciatica - symptoms along dermatomal distribution of the sciatic nerve

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31
Q

What is the dermatomal distribution of the sciatic nerve?

A

Around L5 and S1 - lower back and back of leg

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32
Q

What structures can lumbar lordosis cause damage to?

A

IV discs - stretched anteriorly and compressed posteriorly

Impinge on nerve roots passing through IV foramina

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33
Q

What is the role of the psoas in lumbar lordosis?

A

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

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34
Q

What is flat back syndrome?

A

This is where the is a backward and posterior pelvic tilt resulting in a flat back - very flat lumbar lordosis

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35
Q

What is flat back syndrome usually a result of?

A

Usually due to tight paraspinal muscles between the ribs

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36
Q

What is the other presentation of flat back syndrome other than a flat back?

A

Usually will have a slight bend in their knees due to bent thighs

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37
Q

What is scoliosis?

A

Development of a new curve

The vertebrae move laterally and rotate on top of one another - no longer aligned as they should be

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38
Q

What is the prevalence of scoliosis?

A

3% of the population

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39
Q

Who is scoliosis most prevalent in?

A

Girls around the age of puberty

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40
Q

What is one possible cause of scoliosis?

A

May be linked to hormonal changes of the ligaments - causes softening of the ligaments

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41
Q

In the majority of the population, how does scoliosis present?

A

In the majority of these individuals - scoliosis is present but causes no symptoms

42
Q

What is the most common cause of scoliosis?

What are some other causes?

A

Majority of these are idiopathic

Developmental defects
Asymmetric muscle strength
Poor posture

43
Q

What vertebral region is scoliosis usually present in?

A

In the thoracic-lumbar regions - mostly in the thoracic and then a compensatory curve in the lumbar region

44
Q

What is the impact of scoliosis on the scapulae?

A

Causes one scapula to be higher than the other

45
Q

What is the treatment for scoliosis?

A

Curve less than 20 degrees - leave it
Curve between 20-40 degrees - wear a brace
Curve greater than 50 degrees - surgical options

46
Q

What are the surgical treatment options for scoliosis?

A 
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
Q

What are osteophytes in the vertebral body known as?

A

Syndesmophytes

48
Q

What is a syndesmophyte?

A

This is an osteophyte that is present in the vertebral body - change in name depending on location

49
Q

What is the location of an ‘osteophyte’?

A

Osteophytes grow around the synovial joints

50
Q

How can you recognised degenerative spine disorders on a scan?

A 
Syndesmophytes
Loss of disc height
Loss or increase in curves
Spinal stenosis
Ossification of vertebral ligaments
51
Q

What is spinal stenosis?

A

Abnormal narrowing (stenosis) of the spinal canal

52
Q

What are the two components of the IV disc?

A

Annulus fibrosus - outer

Nucleus pulposus - central

53
Q

What is the annulus fibrosus composed of?

A

Alternating layers of collagen type 1

54
Q

What is the innervation to the annulus fibrosus?

A

The outer third is innervated

55
Q

What happens to the annulus fibrosus as we age?

A

Becomes more brittle and not as resilient - tears and damages - results in a loss of height

56
Q

What is the nucleus pulposus composed of?

A

70-90% water

Proteoglycans

57
Q

What is the purpose of the nucleus pulposus?

A

Acts to absorb shock

58
Q

What happens to the nucleus pulposus with increasing age?

A

Dries out and becomes less resilient at absorbing shock

59
Q

What is the innervation of the nucleus pulposus?

A

Central nucleus pulposus has no innervation - is completely dependent on the outer annulus fibrosus

60
Q

Which out of the annulus fibrosis and the nucleus pulposus is avascular?

A

Nucleus pulposus - remember this is completely dependent on the outer annulus fibrosus

61
Q

At what age does the annulus fibrosus start to dry out?

A

At the age of 30

62
Q

Which of the vertebrae dry out faster than the others and why?

A

Lumbar vertebrae - because they are the largest in size

63
Q

Where along the vertebral column does a herniation/prolapse occur?

A

Can occur along the whole length of the column

64
Q

Where along the vertebral column does a herniation/prolapse most commonly occur?

A

The IV disc between L4 and L5 or L5 and S1

65
Q

In which direction does a disc herniation/prolapse generally occur and why?

A

Posteriorly because the anterior longitudinal ligament is very strong and broad running down the whole of the anterior aspect of the column

66
Q

What is the adverse effect associated with IV disc herniation/prolapse?

A

Nerve root compression - radiculopathy so pain and irritation - OR spinal nerve compression

67
Q

What is cauda equina syndrome?

A

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
Q

What is the cauda equina?

A

Series of nerve roots that come down to exit through the sacrum

69
Q

What IV herniation is associated with the cauda equina?

A

Cauda equina syndrome

70
Q

Which nerves are affected in cadua equina syndrome? x4

A

Sciatic
Obturator
Femoral
Pudendal

71
Q

What are the clinical presentations of cauda equina syndrome?

A

Low back pain
Sciatica - unilateral or bilateral
Bowel and bladder disturbances
Reduced or absent lower extremity reflexes

72
Q

What are the two treatment options for cauda equina syndrome?

A

Discetomy

Laminectomy

73
Q

What is a discetomy?

A

Removal of the IV disk - replaced with a bone graft

74
Q

What is a laminectomy?

A

Remove the lamina of the spinous process

75
Q

What is a burst fracture and how does this relate to cauda equina syndrome?

A

The vertebra bursts - if this then moves posteriorly then can result in cauda equina syndrome

76
Q

What is the later impact of a burst fracture on the IV disc?

A

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
Q

What is the conus meddalris?

A

This is the tapered, lower end of the spinal cord

78
Q

What is the significance of syndesmocytes during ageing?

A

With increasing age, syndesmocytes develop around the margins of the vertebral body

79
Q

What is the impact on the brain of syndesmocytes with age?

A

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
Q

What is diffuse idiopathic skeletal hyperostosis (DISH)?

A

Ossification of the anterior longitudinal ligament - often seen with osteoarthritis

81
Q

At what age does DISH occur?

A

50-75 year olds

82
Q

What is the cause of DISH?

A

Idiopathic

83
Q

Do syndesmocytes occur with DISH?

A

Yes (in some instances no)

84
Q

What is ankylosing spondylitis?

A

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
Q

At what age does ankylosing spondylitis typically occur?

A

19-25 years

86
Q

In which sex does ankylosing spondylitis typically occur?

A

Male

87
Q

Is ankylosing spondylitis an autoimmune disease?

A

Yes

88
Q

Which joint is commonly involved in ankylosing spondylitis?

A

Both sacroiliac joints

89
Q

Is there a loss of disc space in ankylosing spondylitis?

A

No

90
Q

What is the main structure that is at risk from ankylosing spondylitis?

A

The vertebral canal - because it has so many ligaments surrounding it

91
Q

What is ‘ankylosis’?

A

Abnormal stiffening and immobility of a joint due to stiffening

92
Q

What genetic variant is associated with ankylosing spondylitis?

A

HLA-B27

93
Q

What is the association of HLA-B27 on the gut?

A

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
Q

What is subluxation?

A

Partial dislocation of the vertebral column

95
Q

What is the most common place for subluxation and why?

A

The pivot joint between C1 and C2 due to erosion from pannus formation

96
Q

What is eroded in the C2 vertebra during subluxation and what impact does this have?

A

The dens - become thinner and more unstable

97
Q

Anterior pelvic tilt associated with which back condition?

A

Lumbar lordisis - anterior pelvic tilt froms as compensation

98
Q

Posterior pelvic tilt associated with which back condition?

A

Flat back syndrome

99
Q

Flat back syndrome relates to what tow muscle groups and how?

A

Tight hamstrings

Weak hip flexors

100
Q

What is the radiological feature seen in ankylosing spondylitis?

A

Bamboo spine

101
Q

The two joints involved in ankylosing spondylitis are?

A

Both sacroiliac joints

102
Q

Most common subluxation of the vertebrae is where?

A

Atlantoaxial subluxation (C1 and C2)

Year 2 Loco (31 decks)

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