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Ortho AM > Spine and back > Flashcards

Spine and back Flashcards

1
Q

What are the indications for imaging in non specific back pain?

A

Likely pathology e.g. malignancy

Result of imaging likely to change management

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2
Q

What imaging is used for back pain?

A

MRI

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3
Q

What is the management of non specific back pain?

A

Encourage self management
1st line= NSAIDs- co-prescribe PPI if >45
Exercise

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4
Q

What is myelopathy?

A

Compression of spinal cord

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5
Q

What are common causes of myelopathy?

A

Spondylosis

Spinal stenosis

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6
Q

Where is the most common area for myelopathy

A

CErvical spine

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7
Q

What is the presentation of myelopathy?

A

UMN signs

Back pain > limb pain

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8
Q

What investigation is done fr myelopathy?

A

MRI

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9
Q

What is radiculopathy?

A

Compression of nerve root

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10
Q

What is the presentation of radiculopathy?

A

Limb pain>back pain
Root tension- using muscles supplied exacerbates pain
Root compression- weakness and changes in sensation

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11
Q

What is the management of radiculopathy?

A

Analgesia and physio

Referral if persistent

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12
Q

What is spinal stenosis?

A

Central canal of spinal cord narrowed

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13
Q

What can cause spinal stenosis?

A

Degenerative= most common
Tumour
Disc prolapse
Congenital

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14
Q

What is the presentation of lumbar spinal stenosis?

A 
Back pain
Neuropathic pain of legs- better when leaning forward or walking uphill
Weakness and numbness
Gradual onset
Severe= incntinence
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15
Q

What is the investigation of spinal stenosis?

A

MRI

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16
Q

What is the management of lumbar spinal stenosis?

A

Laminectomy

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17
Q

What is the most common cervical stenosis?

A

Degenerative cervcal myelopathy

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18
Q

What are the risk factors for degenerative cervical myelopathy?

A

Smoking
Occupation
FH

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19
Q

What is the presentation of degenerative cervical myelopathy?

A 
Pain in neck and all 4 limbs 
Loss of dexterity, weakness, gait imbalance 
Numbness, paraestoesia 
Severe= incontinence 
Hoffman's sign
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20
Q

What is Hoffman’s sign?

A

Flick 1 finger and other fingers will move in response

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21
Q

What investigation is done for cervical degenerative myelopathy?

A

MRI= disc degeneration, ligament hypertrophy, spinal cord change

22
Q

What is the management of degenerative cervical myelopathy?

A

Urgent referral for assessment

Decompressive surgery

23
Q

What is spondylosis?

A

Degenerative changes of spine, essentially OA

Very common

24
Q

What is disc prolapse?

A

Tearing of annulus fibrosis, causing nucleus pulposis to protrude, compression the cord or nerve root

25
Q

What are th types of disc prolapse?

A

Bulge= common, majority asymptomatic
Protrusion
Extrusion
Sequestration= desiccated disc material free in canal

26
Q

Where is disc prolapse common?

A

C5/6
T11/12
L4/5
S1

27
Q

What is the presentation of disc prolapse?

A

Asymptomatic
Often produces clear dermatomal pattern
CEntral= myelopathy
Lateral= radiculopathy

28
Q

What is the management of disc prolapse?

A

Analgesia, physiotherapy

Persistent= refer for MRI

29
Q

Who are the most spinal cord injuries seen in?

A

Males > females

20-29yo

30
Q

What are the common causes of spinal cord injury?

A 
Trauma- most comon= fall, RTC, sports 
Degenerative orthopaedic 
Spinal cord infarct
Transverse myelitis
Thoracoadbsominal aortic aneurysm
31
Q

What is the classification used for spinal cord injury?

A

ASIA

32
Q

What are the ASIA classifications?

A 
A= no sensory/motor in S4/5
B= sensory but no motor below neurological level
C= Motor function preserved below level but grade <3
D= Motor function preserved below level and grade >3
E= normal
33
Q

What are some patterns of spinal cord injury?

A 
Quadraplegia
Paraplegia
Central cord syndrome
Anterior crd syndrome
Brown-Sequard syndrome
34
Q

What is quadriplegia?

A

Loss of motor/sensory function in cervical segments of spinal cord
Partial or total loss of use of all 4 limbs and trunk- spastic weakness in all limbs
Resp failure if above C5

35
Q

What is paraplegia?

A

Impaired or loss of motor/sensory function in T/L or S spine
Partial or total loss of use of lower limbs, arms spared but trunk may be involved
Spastic weakness if Above L1
Bladder and bowel can be affected

36
Q

What is central cord syndrome?

A

Hypertextension injury to neck where cervical tracts are more involved

37
Q

What is the presentation of central cord syndrome?

A

Older patient

Weakness of arms, with perianal and lower extremities power preserved

38
Q

What is anterior cord syndrome?

A

Hyperflexion injury causes anterior compression fracture and damaged anterior spinal artery

39
Q

What is the presentation of anterior cord syndrome?

A

Profound weakness

Vibratory sense, fine discrimination ad proprioception preserved

40
Q

What is Brown-Sequard syndrome?

A

Paralysis and loss of proprioception and fine discrimination ipsilateral below lesion
Loss of pain and temperature sensation on contralateral below lesion

41
Q

What causes Brown-Sequard?

A

Hemisection of cord, out often due to penetrating injury

42
Q

What are the types of shock affecting the spine?

A

Neurogenic shock

Spinal shock

43
Q

What is neurogenic shock?

A

Injury above T6 causing disruption to sympathetic outflow –> hypotension, bradycardia and hypothermia

44
Q

What is spinal shock?

A

Transient depression of cord function below level of injury
Flaccid paralysis and areflexia
Can last hours to days

45
Q

What is the urgent management of spinal cord injury?

A

ABCD

Imaging- MRI and XR

46
Q

What is the long term management of spinal cord injury?

A 
Spinal cord injury unit
Physio
OT
Psych
Urological and sexual counselling
47
Q

What is the management of unstable spinal fractures?

A

Usually pedicle screws from posterior

48
Q

What is cauda equina syndrome?

A

Compression of caudal equina

49
Q

What can cause cauda equina?

A 
Central lumbar disc prolaps= most common
Tumours
Trauma
Spinal stenosis
Infection
Iatrogenic- epidural, spinal surgery
50
Q

What is the presentation of cauda equina?

A

Bilateral buttock and leg pain
Varying dysaethesia and weakness
Saddle anaesthesia
Urinary retention +/- incontinence

51
Q

What is the management of cauda equina?

A

Urgent MRI

Operation within 48 hours of onset

52
Q

What are some complications of cauda equina?

A

Delay= permanent bladder and anal sphincter dysfunction

~30% never go back to “normal”

Ortho AM (23 decks)

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