Clinical Anatomy of the Back

Question 1

What is a Jefferson Fracture? How does it arise? Whats the best view for looking at it?

Answer 1

Fracture in the anterior and/or posterior arch of the atlas.
It results from axial loading injuries (diving head first)
Best seen on the open mouth view.

Question 2

What is a Hangman’s fracture? How does it occur? What is the best view for looking at it?

Answer 2

• Fracture in the pars interarticularis of C2 (axis)

- Results from hyper-extension of the neck (car accidents)-Best seen on a lateral view

Question 3

What is a herniated disc and how do they occur?

Answer 3

• When the nucleus pulposus prolapses. Can occur from lifting heavy objects incorrectly

Question 4

Where are the most common areas for a herniated disc to occur? What can occur from compression in one of these areas?

Answer 4

• Most common in the lumbar regions (L4-L5 and L5-S1)

- Herniated disc in L5-S1 can compress the sciatic nerve causing sciatica

Question 5

How can you diagnose a herniated disk?

Answer 5

Clinical diagnosis (straight leg test)
MRI scanning (not often needed but the most sensitive investigation)

Question 6

What is the treatment for herniated disks?

Answer 6

• Analgesia and nonsteroidal anti-inflammatory drugs (ibuprofen)
• Keeping active not resting
• Avoid activities that aggregate symptoms
• Physiotherapy
• Steroid injection
• Surgery but this is the last resort

Question 7

What is Spondylolysis? What is it caused by and what does it often lead to?

Answer 7

• A defect or stress fracture in the pars interarticularis (most common in L5)
• Usually due to repetitive hyperexternsion (more common in young athletes)
• Often leads to spondylolisthesis

Question 8

What is spondylolisthesis? Where is it most common and where can is be readily seen?

Answer 8

• Anterior slippage of superior vertebra over inferior vertebra.
• Most common between L5 and S1
• Readily seen on lateral spine X-rays

Question 9

What can be used to treat spondylolysis and spondylolisthesis?

Answer 9

• Analgesia
• Avoiding activities that aggregate injury
• Physiotherpy
• Brace but there is debate over the effectiveness of these
• Surgery (only for high degree of slippage or failure of conservative treatment)

Question 10

What is spondylosis?

Answer 10

Degeneration of the spinal column

Question 11

What is facet joint syndrome? Where is it most common?

Answer 11

Degeneration of the facet joint (intervetebral foramen).

Most common in cervical and lumbar spine regions as they are more mobile (for rotation and lateral flexion)

Question 12

When should you suspect a vertebral fracture? What does treatment of vertebral fractures depend on?

Answer 12

• When there is a history of significant trauma relative to patients age
• Sudden severe central spinal pain that is relieved on lying down
• Structural deformity of spine
• Vertebral tenderness
  The treatment of vertebral fractures depend on the type of fracture and its stability

Question 13

What is a wedge compression fracture?

Answer 13

Fracture in the vertebral body that causes it to have a wedge like appearance on an X-ray

Question 14

What is the most common reasons for cancers in the spine?

Answer 14

Due to metastasis rather than a primary cancer

Question 15

What are the most common cancers that metastasis to the spine?

Answer 15

Prostate, Breast, Renal and Lung

Question 16

When should you suspect spinal cancer?

Answer 16

• Age overs 50
• Gradual onset with no improvement after 4-6 weeks of conservative treatment
• Severe pain that remains on supine
• Pain that desturbs sleep
• Pain aggravated by straining
• Thoracic pain
• Unexplained weight loss
• History of cancer
• Vertebral tenderness

Question 17

How can you visualise spinal cancer?

Answer 17

Scan of the vertebrate - the “winking owl sign”

Question 18

What is Discitis? and what is associated with?

Answer 18

• Infection of the intervertebral disc. It often co-exists with vertebral osteomyelitis (Infection of vertebral body)

Question 19

What is the most common causative organism of Discitis?

Answer 19

Staphylococcus Aureus

Question 20

What are the risk factors, diganosis choice and tratments for discitis?

Answer 20

Risk factors = IV drug user, immunosuppression, diabetes and recent UTI’s.
Diagnosis = MRI scan
Treatment = IV antibiotics

Question 21

What is Pott’s Disease?

Answer 21

Infection of the spine by TB

Question 22

What are some of the causes of cauda equina syndrome?

Answer 22

Compression of the cauda equina by the following pathologies;

• Herniated intervertebral disc
• Metastasis
• Infection leading to an epidural absess
• Spondylolisthesis
• vertebral fracture
• Postoperative haematoma

Question 23

What are the Cauda Equina Syndrome red flags?

Answer 23

• Bilateral sciatica
• Bilateral neurological deficits in the legs
• Difficulty initiating micturition which can lead to irreversible urinary retention and overflow urinary incontinence
• Loss of sensation of rectal fullness which can lead to irreversible faecal incontinence
• Saddle anaesthesia
• Laxity of anal sphincter (test by rectal examination)

Question 24

Describe the diagnosis, treatment of cauda equina syndrome and the consequences if left untreated

Answer 24

Diagnosis - MRI scanning
Treatment - Emergent surgical spinal decompression
Consequences - If left untreated can result in paralysis, bladder/bowl incontinence and sexual dysfunction

Question 25

What is excessive thoracic kyphosis?

Answer 25

When the thoracic region of the back curves out far too much

Question 26

What is a more unusual cause of back pain

Answer 26

An abdominal aortic aneurysm