Flashcards in Clinical - Spine Deck (37):
Degeneration of the spinal column from any cause.
What is the treatment for spondylosis/OA?
Facet joint injections of steroids and anaesthetic under fluoroscopy or spinal fusion
In which vertebrae is intervertebral disc degeneration and acute disk prolapse most common?
L4/5 and L5/S1 (lower to bear more weight)
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
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
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
Conditions where the nerve root is affected, and the pain/symptoms generally radiate to the areas which that nerve root serves ie. dermatome/myotome
Radiculopathy of the nerve roots contributing to the sciatic nerve - causing radiation of nerve pain along sensory distribution of Sciatic nerve
Compression of the spinal cord or nerve roots due to narrowing of spinal canal by osteophytes and hypertrophied ligaments (eg. in OA)
Radiculopathy or burning leg pain on walking
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
Flexion injuries causing fractured vertebral body with disruption posterior ligaments with or without fracture of posterior elements
What are the important features of a prolapsed disc?
Leg pain (sciatica) often accompanied with neurological disturbance
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
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)
Adjacent Segment Disease
Symptomatic deterioration of spinal levels adjacent to the site of a previous fusion
What are the 4 main categories of scoliosis?
Congenital, early onset idiopathic, late onset idiopathic and secondary
What is the common theme of congenital scoliosis?
An imbalance in the number of growth plates (e.g. unilateral hemivertebrae)
Hester-Volkmann's Law in Idiopathic Scoliosis
Increased pressure across an epiphyseal plate inhibits growth
What is the latest research on the aetiology of idiopathic scoliosis?
Genetic fault in melatonin receptors, leads to hyper excitability of motor cortex
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
A defect in the pars interarticularis (ossification centres) of the vertebra
The forward slippage on one vertebra on another
Which grading system is used for Sponylolisthesis?
What are the 2 main surgical emergencies in back pain?
Cauda equina syndrome and nerve root deficit/fracture with deteriorating neurology
Which grading system is used for spinal cord involvement?
Spinal cord involvement can be divided into complete and incomplete, what are the 2 divisions of incomplete?
Central cord, Brown - Sequard and anterior cord
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
What might you see on an MRI of a patient with Lower Back Pain? (Clue: LOSS)
Loss of joint space, Osteophytes, Sclerosis, Subarticular cysts
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
What are the characteristics of discogenic pain?
Worse as day goes on, with flexion or with activity.
Deep seated central low back pain
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
Painful cramping and weakness in the legs associated with a neural problem, e.g. in lumbar stenosis or inflammation in the nerve roots
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
Pain originating from a damaged vertebral disc, particularly due to degenerative disc disease.
A pattern of pain, typically a background ache, with exacerbations and remissions superimposed, often for no apparent reason.