Back pain

Question 1

Name 2 main causes of abnormal spinal curves

Answer 1

1- Developmental anomalies

2- Pathological conditions (missing half vertebrae/ osteoporosis)

Question 2

What would someone look like if they had kyphosis?

What are some main cause of the condition?

Answer 2

Increased thoracic curvature
Erosion/fracture of anterior part of one or more vertebrae
Osteoporosis

Question 3

How does kyphosis affect the vertebrae?

Answer 3

Erosion/fracture of anterior part of one or more vertebrae

Question 4

Name the surgical procedure used to treat Kyphosis?

Answer 4

Kyphoplasty (vertebroplasty, vertebral augmentation)

Question 5

Describe the process of a kyphoplasty procedure

Answer 5

1. Tube is inserted into the damaged vertebrae
2. A special balloon is inserted through the tube and inflated
3. As the balloon inflates it returns the vertebra to a more normal size and creates a cavity
4. The balloon is removed and the cavity is filled with polymethylmethacrylate (cement like)
5. PMMA hardness and stabilises the bone

Question 6

Outside of kyphosis, what else can a kyphoplasty be used to treat?

Answer 6

Compression fractures

Question 7

What is Adolescent kyphosis (Sheuermann’s disease)

Answer 7

Affects epiphyseal growth plates of one or more vertebral bodies. The back side of the vertebral body grows normally and the front grows more slowly or abnormally. This leads to a vertebra with a distinct wedge shape and kyphosis.

Question 8

List 2 distinct symptoms of Adolescent kyphosis (Sheuermann’s disease)

Answer 8

Pain

Difficulty breathing

Question 9

Name one key radiological finding associated with Adolescent kyphosis (Sheuermann’s disease). What causes this finding?

Answer 9

Smorl’s nodes

Some of the IV disc (nucleus pulposus) pushes into the end plate of vertebral body

Question 10

What is lordosis?

Answer 10

When the anterior rotation of pelvis produces increased lumbar curvature.

Question 11

Name two main causes of lordosis

Answer 11

weakened trunk muscles

weakened hip flexors

Question 12

what is psoas dysfunction and how does it cause lordosis and back pain - describe 6 components

Answer 12

– Chronic psoas shortening and weakness
– Increased lumbar lordosis
– Shortening of the thoraco-lumbar fascia and erector spinae muscles
– Stretching and weakness of abdominal muscles
– Hamstring and gluteal muscles tightened and often hypertonic
– This increases the shearing forces on the intervertebral discs
- intervertebral discs degenerate and arthritic changes develop in the facet joints

Question 13

What is flat back syndrome?

Answer 13

When the pelvis tils backwards and pulls the lumber spine flat

Question 14

List 5 key features of flat back syndrome including potential causes

Answer 14

Tight musculature between ribs makes breathing shallow
Hamstrings tight – knees flexed
Hip flexors weak – hip flexed (gravity)
Pelvis tilts backwards pulls vertebral column flat
Ankylosing spondylitis, degenerative disc, spinal fusion

Question 15

What is scoliosis?

Answer 15

abnormal lateral curvature

Usually accompanied with rotation of the vertebrae

Question 16

What causes scoliosis? - list 4

Answer 16

developmental defects, asymmetric muscle strength, poor posture, or idiopathic

Question 17

Which demophragic is most likely to have scoliosis?

Answer 17

Females around puberty

Question 18

How is scoliosis treated?

Answer 18

Brace is curve is 20-40o

If cure is greater than 50-

Vertebral fusion
Harrington rods
Newer flexible rods attached to each vertebrae

Question 19

List 5 signs of degenerative spine disorders

Answer 19

Osteophytes (syndesmophytes)
Loss of disc height
Loss or increase in curves
Spinal Stenosis
Ossification of vertebral ligaments

Question 20

What kind of joint is the intervertebral disc?

Answer 20

cartilaginous joint (symphysis)

Question 21

List 4 main features of the nucleus pulposus

Answer 21

70-90% water
Proteoglycans
Avascular
No innervation

Question 22

List 4 main features of the annulus fibrosis

Answer 22

Alternating layers of collagen
Type I
Outer 1/3rd is innervated
Firmly attached to outer margin of vertebral body

Question 23

At what age will the IV disc begin to dry out? Which part of the disc dries out?

Answer 23

After the age of 30 IV discs dry out – nucleus pulposus

Question 24

Where along the spine is the herniated/ prolapsed disc most likely to occur?

Answer 24

commonly IV disc between L4/5 or L5/S1

Question 25

What is the cause of pain when someone is suffering from a herniated/ prolapsed disc?

Answer 25

Nucleus pulposus irritates and/or compresses the spinal nerve root Pain felt along distribution of the compressed/irritated nerve root

Question 26

List 6 symptoms associated with cauda equina syndrome

Answer 26

Low back pain Unilateral or bilateral sciatica Saddle and perineal hypothesia or anaesthesia Bowel and bladder disturbances Lower extremity motor weakness and sensory deficits Reduced or absent lower extremity reflexes

Question 27

Name the 2 surgical treatments use to treat cauda equina syndrome

Answer 27

Discetomy | laminectomy

Question 28

List 2 immediate complications of a burst fracture

Answer 28

Compression of the spinal cord or nerve roots instability

Question 29

List a late complication of a burst fracture

Answer 29

Hematoma- in center of the injured disc Necrosis-

Question 30

Where do osteophytes commonly develop?

Answer 30

around margins of vertebral body and zygapophysial joints

Question 31

Name 3 conditions which can cause osteophytes

Answer 31

Spondylosis and osteoarthritis

Question 32

What causes Vertebral-basilar artery insufficiency?

Answer 32

OA or degenerative disc disease

Question 33

What is Diffuse idiopathic skeletal hyperostosis?

Answer 33

Ossification of ligaments | e.g. anterior longitudinal ligament

Question 34

Which age does Diffuse idiopathic skeletal hyperostosis affect most often?

Answer 34

50-75 years

Question 35

In an X-ray what is the main radiological sign for Diffuse idiopathic skeletal hyperostosis (DISH)?

Answer 35

osteophytes bone spurs Disc height maintained

Question 36

Which joint does Diffuse idiopathic skeletal hyperostosis (DISH) not effect?

Answer 36

sacroiliac joint

Question 37

At what age is Ankylosing spondylitis most likely to occur?

Answer 37

19-25 year olds

Question 38

Which part of the boy does Ankylosing spondylitis mostly affect?

Answer 38

Axial skeleton

Question 39

List for X-ray features for Ankylosing spondylitis

Answer 39

AP and lateral X-rays show “Bamboo-spine” Narrowing and sclerosis of both sacroiliac joints Sclerosis and ankylosis of vertebral bodies with no loss of disc space Bone formation extends across anterior and lateral margins of IV discs

Question 40

Which gene is associated with Ankylosing spondylitis and how?

Answer 40

HLA-B27 >95% of patients positive 5% chance of developing AS

Question 41

Which sex is most affected by Ankylosing spondylitis and by how much?

Answer 41

Males, 3 times more affected

Question 42

What is Enthesopathy?

Answer 42

inflammation of entheses where tendon or ligament attach to the bone

Question 43

How does the HLA B27 gene affect the gut?

Answer 43

It influences the composition of the endogenous gut flora causing a leaky gut Leaky gut allows substances trigger cascades of inflammatory reactions

Question 44

What type of joint connects C1 and C2?

Answer 44

pivot synovial joint

Question 45

Which type of subluxation is most common in Rheumatoid arthritis?

Answer 45

Atlantoaxial subluxation

Question 46

Which arteries can be compressed in Rheumatoid arthritis?

Answer 46

Vertebral arteries