Clinical - Spine Flashcards Preview

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Flashcards in Clinical - Spine Deck (37):
1

Spondylosis

Degeneration of the spinal column from any cause.

2

What is the treatment for spondylosis/OA?

Facet joint injections of steroids and anaesthetic under fluoroscopy or spinal fusion

3

In which vertebrae is intervertebral disc degeneration and acute disk prolapse most common?

L4/5 and L5/S1 (lower to bear more weight)

4

Is MRI diagnostic for intervertebral disc degeneration and acute disk prolapse, and why?

No, because many people have bulging discs on MRI with no symptoms

5

What is the typical history for an acute disc prolapse (annular tear)?

Lifting heavy object then felt a twang. Pain on coughing and settled within 3 months

6

Which nerve root is commonly compressed in disc prolapse, traversing or exiting?

Traversing root, specifically the lower root e.g. L5 for L4/L5 disc prolapse

7

Radiculopathy

Conditions where the nerve root is affected, and the pain/symptoms generally radiate to the areas which that nerve root serves ie. dermatome/myotome

8

Sciatica

Radiculopathy of the nerve roots contributing to the sciatic nerve - causing radiation of nerve pain along sensory distribution of Sciatic nerve

9

Spinal stenosis

Compression of the spinal cord or nerve roots due to narrowing of spinal canal by osteophytes and hypertrophied ligaments (eg. in OA)

10

Neurogenic claudication

Radiculopathy or burning leg pain on walking

11

Cauda Equina Syndrome

Pressure (usually prolapsed disc) on all lumbosacral nerve roots at level of lesion including sacral nerve roots for bladder and bowel control

12

Chance fracture

Flexion injuries causing fractured vertebral body with disruption posterior ligaments with or without fracture of posterior elements

13

What are the important features of a prolapsed disc?

Leg pain (sciatica) often accompanied with neurological disturbance

14

What is the purpose of surgery in prolapsed IV discs and when should it be considered?

To treat the leg pain, primarily. Disc prolapse itself will often settle on its own. Surgery should be considered if there is unresolving pain lasting more than 3 months

15

What is the most important approach to backache without sciatica: best rest and immobility, or keeping as mobile as possible with slight exercise?

Keeping as mobile as possible with exercise as tolerated (bed rest is now discredited)

16

Adjacent Segment Disease

Symptomatic deterioration of spinal levels adjacent to the site of a previous fusion

17

What are the 4 main categories of scoliosis?

Congenital, early onset idiopathic, late onset idiopathic and secondary

18

What is the common theme of congenital scoliosis?

An imbalance in the number of growth plates (e.g. unilateral hemivertebrae)

19

Hester-Volkmann's Law in Idiopathic Scoliosis

Increased pressure across an epiphyseal plate inhibits growth

20

What is the latest research on the aetiology of idiopathic scoliosis?

Genetic fault in melatonin receptors, leads to hyper excitability of motor cortex

21

What does the spine have an inherent tendency to go into kyphosis?

Centre of gravity is anterior to the spine, and there is high pre-load. Fault in the 'guy ropes' of the spine - erector spinae muscles - will result in kyphosis also

22

Spondylolysis

A defect in the pars interarticularis (ossification centres) of the vertebra

23

Spondylolisthesis

The forward slippage on one vertebra on another

24

Which grading system is used for Sponylolisthesis?

Meyerding

25

What are the 2 main surgical emergencies in back pain?

Cauda equina syndrome and nerve root deficit/fracture with deteriorating neurology

26

Which grading system is used for spinal cord involvement?

Frank/ASIA gradig

27

Spinal cord involvement can be divided into complete and incomplete, what are the 2 divisions of incomplete?

Central cord, Brown - Sequard and anterior cord

28

What is the typical situation in a Central, Brown and anterior cord injuries?

Central - hyperextension injury; Brown-Sequard - Trauma associated with fracture; Anterior - vascular insult

29

What might you see on an MRI of a patient with Lower Back Pain? (Clue: LOSS)

Loss of joint space, Osteophytes, Sclerosis, Subarticular cysts

30

What is the typical presentation for spinal claudication?

Age 50+, male, possible manual worker and/or obese, sit/lean forward to relieve symptoms and have 'heavy/tired' legs

31

What are the characteristics of discogenic pain?

Worse as day goes on, with flexion or with activity.
Deep seated central low back pain

32

What are the characteristics of the pain with facet arthropathy?

Difficulty sitting, driving, standing; Worse with extension; Better with activity. Often radiates to buttocks and legs

33

Neurogenic claudication

Painful cramping and weakness in the legs associated with a neural problem, e.g. in lumbar stenosis or inflammation in the nerve roots

34

What is the difference between spinal and vascular claudication in terms of when it is relieved?

Spinal is relieved on flexing, while vascular is relieved by standing

35

Discogenic pain

Pain originating from a damaged vertebral disc, particularly due to degenerative disc disease.

36

Segmental instability

A pattern of pain, typically a background ache, with exacerbations and remissions superimposed, often for no apparent reason.

37

Facet Arthropathy

Pain and discomfort that caused by degeneration and arthritis of the facet joints of the spine.