Back Problems

Question 1

What are abnormal curves?

Answer 1

• increase or decrease in one of normal curves

- due to developmental anomalies or pathological conditions

Question 2

What is extreme kyphosis?

Answer 2

• convex/outwards
• humpback/hunchback
• thoracic region as sacrum is fused so cannot change
• erosion of anterior part of 1 or more vertebrae so move posteriorly

Question 3

What can cause extreme kyphosis?

Answer 3

• osteoporosis kyphosis (due to crush/compression fracture)

- adolescent kyphosis/Sheuermann’s disease

Question 4

What is Sheurermann’s disease?

Answer 4

• EGP of vertebral bodies affected in 1 or more thoracic vertebrae = wedging of bone
• severe kyphosis
• only very prominent when lean forward
• pain, difficulty breathing

Question 5

What is the treatment for extreme kyphosis?

Answer 5

• kyphoplasty (vertebroplasty)
• safe, highly effective at providing pain relief/preventing collapse
• percutaneously place balloon into vertebral body and inflate it
• in space created inject cement to support vertebra

Question 6

What is extreme lordosis?

Answer 6

• concave
• inwards
• hollow back, sway back
• lumbar region
• anterior rotation of pelvis increases lumbar curvature
• weakened hip flexors
• develop in late pregnancy or obesity
• weight of vertebral bodies shifted onto posterior elements

Question 7

What are the muscles involved with extreme lordosis?

Answer 7

• chronic psoas shortening and weakness
• shortening of thoracic-lumbar fascia and erector spinae muscles
• stretching and weakness of abdominal muscles
• hamstring and gluteal muscles tightened

Question 8

What are the symptoms of extreme lordosis?

Answer 8

• back ache

- sciatica (small shift in lumbar nerves can impinge them as so large)

Question 9

What is flat back syndrome?

Answer 9

Pelvic Tilt

• tight musculature between ribs makes breathing shallow
• also mankes hamstrings tight
• hip flexors weak
• pelvis tilts backwards pulling vertebral column flat

Question 10

What are the types of pelvic tilt?

Answer 10

• anterior = lordotic back
• posterior = flat back
• neutral pelvis = neutral back

Question 11

What is scoliosis?

Answer 11

• curved back
• usually accompanied with rotation of vertebrae
• mainly affects girls around puberty (hormone related)
• result of development defects, asymmetric muscle strength, poor posture
• idiopathic mostly
• often goes right at an angle then left at the same angle

Question 12

What is the treatment of scoliosis?

Answer 12

• goal is stabilisation
• brace (20-40 degrees)
• curves greater than 50 degrees
• vertebral fusion
• Harrington rods
• newer flexible rods (attached to each vertebrae)

Question 13

How do degenerative spine disorders present?

Answer 13

• both vertebrae and disc affected
• osteophytes
• loss of disc height
• loss or increase in curves
• spinal stenosis
• ossification of vertebral ligaments

Question 14

What is the anatomy of the intervertebral disc?

Answer 14

• IV disc is cartilaginous joint (symphysis)
• nucleus pulposus
• annulus fibrosus

Question 15

What is the nucleus pulposus?

Answer 15

• mostly water
• proteoglycans
• avascular
• no innervation
• dry out with age so lose height

Question 16

What is the annulus fibrosus?

Answer 16

• alternating collagen I layers
• outer 1/3 innervated
• firmly attached to outer margin of vertebral body

Question 17

What is a herniated disc?

Answer 17

• greater risk when nucleus pulposus dried out
• common between L4/L5 or L5/S1
• nucleus pulposus irritates and compresses spinal nerve root
• stimulates action potentials so pain felt along distribution of compressed nerve root

Question 18

What is cauda equina syndrome? What are the symptoms?

Answer 18

• herniated L3/L4
• low back pain
• uni/bilateral sciatica
• saddle and perineal hypothesia
• bowel and bladder disturbances
• lower extremity motor weakness and sensory deficits
• reduced/absent lower extremity reflexes

Question 19

What is the treatment of cauda equina syndrome?

Answer 19

• laminectomy = cut through lamina to pedicles

- discectomy = remove disk to suck it out

Question 20

What are some immediate burst fracture complications?

Answer 20

• compression of spinal cord or nerve roots

- instability

Question 21

What are some late burst fracture complications?

Answer 21

• hematoma/necrosis
• disc cannot function
• blood clot unable to be cleared out so get necrosis

Question 22

What are the significance of osteophytes?

Answer 22

• develop around margins of vertebral body and zygapophyseal joints
• in spondylosis/OA

Question 23

When may you get vertebral-basilar artery insufficiency?

Answer 23

• OA or degenerative disc disease

Question 24

What is diffuse idiopathic skeletal hyperostosis?

Answer 24

• 50-75 year olds
• ossification of anterior longitudinal ligament
• may or may not have osteophytes
• disc height maintained
• sacroiliac joint not involved

Question 25

What is ankylosing spondylitis?

Answer 25

• chronic inflammatory disorder
• mainly involves axial skeleton
• enthesopathy = attachment of tendons and ligaments into bone and get ossified on anterior longitudinal ligament
• 19-25 year olds
• more males
• only autoimmune disease affecting more men

Question 26

What are the x-ray features of ankylosing spondylitis?

Answer 26

• bamboo spine
• narrowing and sclerosis of sacroiliac joints
• sclerosis and ankylosing
• bone formation extends across anterior/lateral margins

Question 27

What is the significance of HLA-B27?

Answer 27

• most ank spon patients are positive

Question 28

What are the synovial joints of the vertebral column?

Answer 28

• zygapophysial joints (facet joints)

- C1 and C2 pivot synovial joint

Question 29

How does RA affect the spine?

Answer 29

• commonly involves cervical spine
• subluxations
• atlantoaxial subluxation most common = irreversible neurological symptoms as joint presses on brainstem
• pannus invasion in lower cervical IV discs