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Clin Med IV Exam 1 > Cervical and Lumbar Spine Injuries > Flashcards

Cervical and Lumbar Spine Injuries Flashcards

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1
Q

How many vertebrae are in the human body

A

33

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2
Q

How many cervical vertebrae/nerves?

A 
V = 7
N= 8
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3
Q

How many thoracic vertebrae/nerves?

A

V= 12

N=12

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4
Q

How many lumbar vertebrae/nerves?

A 
V= 5
N= 5
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5
Q

How many sacral vertebrae/nerves?

A 
V= 5
N= 5
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6
Q

How many coccyx vertebrae?

A

4

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7
Q

Where does the spinal cord end?

A

L2

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8
Q

What are the cervical spine x-ray views?

A 
AP
Lateral
Odontoid --> C1-C2 clear space
Obliques
Fuchs
Swimmer's --> C6-C7
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9
Q

What are the lumbar spine x-ray views?

A

AP
Lateral
Coned-down (spot)–> L4 and L5
Obliques–> scotty dog

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10
Q

Which vertebrae does the odontoid fracture impact?

A

C2

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11
Q

What is an odontoid fracture?MOI?

A
  • aka pegs or dens fx
  • fx through odontoid process of C2
  • from flexion or extension w/ or w/o compression
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12
Q

Type I Odontoid Fx

A

fx upper part of odontoid peg
potentially unstable
rare

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13
Q

Type II Odontoid Fx

A

fx base of odontoid
unstable
high risk non-union

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14
Q

Type III Odontoid Fx

A

through odontoid & into lateral masses of C2

best prognosis of healing

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15
Q

Which type of odontoid fx has best prognosis of healing?

A

Type III

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16
Q

What are some associated injuries of odontoid fx?

A

Atlas (c1) fx (jefferson fx)
Transverse ligament rupture
Pharangeal injury

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17
Q

Imaging of choice for odontoid fx?

A

CT scan

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18
Q

Tx odontoid fx

A

Conservative
-halo brace 3mo (<50yo, <5mm displacement, reduction maintained)

Operative
-posterior atlantoaxial arthrodesis w/ wire & bone graft (pt >50yo, C1 intact)

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19
Q

Which vertebrae does cervical spondylosis most commonly impact?

A

C5-C6 > C6-C7

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20
Q

What is cervical spondylosis–DDD?

A
  • combo of degenerative disc dz (DDD) & osteophyte formation
  • age 40-50yo
  • may lead to radiculopathy

basically arthritis of the neck

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21
Q

Would you get an MRI for cervical spondylosis?

A

Only if intervention is being done (ESI, surgery)

If not, plain films only

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22
Q

When would surgery be indicated for cervical spondylosis?

A
  • Intractable pain
  • Progressive neurological deficit
  • Severe deltoid or wrist extensor weakness
  • Myelopathy
  • Discectomy of affected disc
  • Fusion of vertebrae affected
  • C5-C6 disc herniation w/ anterior cervical disc fusion
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23
Q

What are some conservative mgmt that could be done for cervical spondylosis?

A
  • Pain control
  • Oral steroids
  • PT
  • Light activity
  • Epidural steroid injections
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24
Q

What is a Herniated Nucleus Pulposis (HNP)?

A

disc herniation

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25
HNP presentation
- neck pain w/ RADIATING pain and/or numbness to arm - radicular pain w/ compression of neural structures - extremity numbness & weakness - appear stiff - pain worse w/ FLEX/EXTENSION of spine - myelopathy
26
What special test is positive for HNP?
Spurlings -turn pt head to affected side while extending and applying downward pressure to top of pt's head (axial load to head)
27
What sort of imaging would you get for HNP?
MRI | CT myogram
28
What vertebrae does hangman's fx impact?
C2 (pars interarticularis)
29
MOI of hangman's fx
- post traumatic neck pain after high-velocity hyperextension injury - high speed MVC - invovles pars interarticularis of C2
30
What x-ray features indicate a hangman's fx?
- bilateral lamina & pedicle fx at C2 | - assoc w/ anterolithesis of C2 on C3
31
What spinal vertebrae does a jefferson fx impact?
C1
32
MOI of Jefferson Fx
- burst fx of C1 - 3 part fracture w/ 2 part fx through anterior and posterior arches - axial loading along axis of c-spine w/ occipital condyles being driven into lateral masses of C1 - ex. diving head 1st in to shallow water - vertebral artery injury - extra-cranial nerve injury
33
What kind of view on x-ray would you want for jefferson fx? A. AP B. Oblique C. Lateral D. Odontoid
Odontoid! --gives clear visualization of C1-C2 - will see displacement of lateral masses away from dens - distance >6mm --> suspect ligamentous injury
34
What vertebrae are most commonly impacted for low back pain?
L4-L5
35
If low back pain radiates past knee, what other injury might there be?
Disc problem; radicular sx
36
What are Waddell's Signs?
Exam findings that correlate w/ non-organic low back pain 1. Tenderness--pain w/ light touch, nonanatomic, widespread deep pain 2. Simulation--pain w/ light compression of skull or light twisting of pelvis 3. Distraction--no pain w/ distracted straight leg raise test 4. Regional--nonanatomic or inconsistent 5. Overreaction
37
Where would a HNP most commonly be seen in the lumbar spine?
L4-L5 | L5-S1
38
HNP L-spine presentation
-low back pain w/ or w/o radiation of pain and/or numbness -pain w/ flexion or prolonged sitting; WANT TO STAND -radicular pain -varying lvl of pain -pain worse w/ flex/extension of spine +SLR on affected side
39
What sx might be indicative of cauda equina syndrome?
Perianal numbness or bowel or bladder incontinence
40
What sx might be indicative of Sciatica?
electric shock-like pain radiating down posterior aspect of leg; often below knee
41
Which vertebrae is spondylolysis commonly located in the lumbar region?
L5
42
Presentation of spondylolysis
- can be asymptomatic - pain w/ extension and/or rotation of lumbar spine - common cause of low back pain in ADOLESCENTS
43
MOI of spondylolysis
-defect in pars interarticularis portion of neural arch that connects superior & inferior articular facets -caused by repeated microtrauma, resulting in stress fx -high energy trauma w/ hyperextension of lumbar spine (football tackling, sled, swimmers)
44
What x-ray view do you want for spondylolysis and what will you see?
Oblique view Want to look at scotty dog Scotty dog has a collar (fracture)
45
Spondylolysis Tx
Conservative --> activity limitation (6-8mo) Bracing --> if sx persist in spite of activity modification Surgery --> painful and not responding to orthosis after 6-8mo, if L5 pars defect, decompression required only for focal neuro deficit
46
What vertebrae are most commonly impacted by Spondylolisthesis?
L5-S1
47
MOI of spondylolisthesis
- Displacement of vertebral body in relation to inferior vertebrae - anterolisthesis (anterior displacement) - retrolisthesis (posterior displacement) - Synonymous w/ anterolisthesis D/t spondylolysis (pars interarticularis defect)
48
Grading of Spondylolisthesis
``` I <25% displacement II 25-50% III 50-75% IV 75-100% V Spondyloptosis ```
49
Spinal stenosis presentation
-pain worsens w/ extension -reproducible single or bilateral leg sx worse after walking several mins; relieved by sitting -pain worse w/ back extension & relieved by leaning forward -present w/ neurogenic claudication sx w/ walking +SLR on affected side
50
What pt population in spinal stenosis commonly seen in?
Elderly >50yo Hx of osteoarthritis
51
What is the study of choice for spinal stenosis?
MRI | but get plain films 1st!
52
Tx Spinal Stenosis?
``` Pain control Oral steroids PT Light activity Facet or epidural injections Surgery ``` Surgery > Conservative Tx (Spinal decompression, nerve root decompression, spinal fusion, multi-lvl spinal fusion)
53
Which vertebrae is a wedge fracture commonly seen in?
T12-L1
54
MOI of wedge fx
- Hyperflexion injuries to vertebral body resulting from axial loading - YOUNG PT - d/t insufficiency fx secondary to osteoperosis
55
What is seen on imaging for wedge fx?
CT/MRI --> cortical disruption w/ impacting of antero-superior endplate; "wedge appearance" Antero-inferior endplate & posterior vertebral body remain unaffected
56
Tx wedge fx
TSLO brace
57
Which vertebrae is a compression fx commonly seen in?
T7-8 | T12-L1
58
MOI of compression fx
- Osteoperotic fx occurring after fall from standing height or less - OLDER PT - vertebral compression fx most common type
59
Radiographic features of compression fx
loss of height in anterior, middle or posterior dimension of vertebral body >20%
60
How can you tell if the compression fx is acute or chronic?
If acute, x-ray will show cortical breaking or impaction of trabeculae Chronic fx will not see this
61
Tx Compression Fx
Require tx is symptomatic Non-surgical: - observation/TSLO brace - bisphosphonate Surgical -vertebroplasty
62
17yo pt presents with lumbar pain w/ extension. The pt noticed the pain getting progressively worse after each football practice. On an oblique x-ray, a defect is seen in the pars interarticularis. What injury may this be? A. Spondylosis B. Spondylolysis C. Spondylolithesis D. Spinal Stenosis
B. Spondylolysis! Key words; - Defect in parts interarticularis - 17yo (young pt) - pain w/ extension (hyperextension) - common in football players, sled, swimmers
63
65yo pt is presenting with back pain that worsens w/ extension and when walking. Pain is relieved w/ sitting and leaning forward. Pt finds that when grocery shopping, they need to lean on the shopping cart to relieve the pain. +SLR on exam. What injury may this be? A. Spondylolysis B. Spondylolithesis C. Spinal Stenosis D. Compression Fx
Spinal Stenosis! Key words: - older pt - pain w/ extension - pain relieved w/ sitting and learning forward
64
70yo pt presents with low back pain. On x-ray, loss of height in anterior and posterior dimension of T7-T8 is noted along with cortical breaking of the trabeculae. What injury may this be? A. Herniated Nucleus Pulposis B. Wedge Fracture C. Spondylolisthesis D. Compression Fx
Compression Fx! ``` Key words: -loss of height of anterior, middle or posterior dimensions -T7-T8 common -cortical breaking of trabeculae -seen in elderly!! Wedge fx --> young pt ```

Clin Med IV Exam 1 (9 decks)

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