Disorders of the neck and back Flashcards

Question

Treatment for Cervical Disc Herniation?

Answer 1

Non Surgical-PT, Medications, Injections Surgical-1st line with central spinal cord compression from acute injury Direct decompression of spinal cord

Answer 2

upper cervical levels C1-C2

Answer 3

C2 or C6/C7

Answer 4

involve disruption of both the anterior & posterior arches that may allow progressive displacement of the lateral masses of the atlas leading to vascular & neurologic compromise

Answer 5

1. Posterior Arch Fractures – more common & typically heal well with bracing 2. Burst Fractures Patients with Jefferson fx’s have neck pain & restricted ROM, but usually normal neurological exam Open mouth odontoid view xray establishes dx Fx is suggested by an increased periodontoid space & bilateral symmetric overhang of the lateral masses in relation to the axis (C2)

Answer 6

direct head impact can fx the odontoid (dens) & may occur at the tip or the base - avulsion fx at the tip are less common but more stable - fx at the base has higher rate of non-union w/o surgery

Answer 7

fx of the pedicle of the axis resulting from a hyperextension injury (MVA, diving injuries, headlong Falls) - marked displacement of C2 on C3 can be lethal - if they survive the injury minimal or no spinal cord injury may result - present with neck pain & no neuro sx or signs - treated with immobilization & halo vest - surgical fusion is indicated if there is non-union or disruption of the C2-3 disc

Answer 8

Hangmans | Odontoid

Answer 9

Caused by axial loading with or without cervical flexion or extension May present only with neck pain & spasm in mild Type I & II fractures In severe fractures Types III – V may present with respiratory arrest & quadriplegia Most are identified by plain xray & classified by CT

Answer 10

simple wedge compression fx Stable fractures that heal well with conservative management of 8-10 weeks in a semi-rigid cervical collar (Philadelphia Collar)

Answer 11

“teardrop” or isolated anterior-inferior vertebral body compression fractures with intact posterior elements Occurs when abrupt neck extension causes the anterior longitudinal ligament to pull the anterior-inferior corner away from the remainder of the vertebral body Conservative Treatment like type 1

Answer 12

comminuted burst vertebral body fractures. The posterior element remains intact, but bony fragments may be displaced in the into the spinal medullary canal resulting in serious neurological injury Should be evaluated by CT Surgical stabilization is needed to prevent late movement of the fragments

Answer 13

complex vertebral fractures involving the posterior elements | Unstable fractures with poor prognosis & often result in quadriplegia

Answer 14

``` Curvature of the spine in which the convexity is directed posteriorly Otherwise known as “hunchback” Caused by disorders of the discs & vertebral bodies Different Types Senile Kyphosis Postural Kyphosis Scheuermann’s Kyphosis Congenital kyphosis ```

Answer 15

Multiple areas of disc degeneration at the thoracic level Xray shows thinning of discs and osteoporosis with mild wedging deformities Common in elderly May be symptomatic Treatment Maintain good posture Exercises to strengthen back and abdominal muscles Light spinal brace may be helpful

Answer 16

Most common Girls > Boys Typically first noticed during adolescence Caused by poor posture & weakening of the back muscles & ligaments Slow to develop, but does not continue to become progressively worse Have symptoms of upper back pain & muscle fatigue Does not lead to severe kyphosis with a risk of neurologic, cardiac or pulmonary problems Treatment is stretching & strengthening of muscles

Answer 17

First noticed during adolescence Results from structural deformity of the vertebrae Requires xray to show wedge of at least 5 degrees at the front of at least three neighboring vertebral bodies Reason for this is not well understood

Answer 18

Bracing for one to two years for those who have not reached full height, along with muscle strengthening & hamstring stretching to relieve the pain Surgery is rare & only indicated for patients with a curve of 70 degrees or greater, severe pain, or neurological compromise The discs are removed & a fusion is performed with an anterior approach & then a posterior approach is done to place rods along the spine to hold the fusion in place

Answer 19

Least common Caused by an abnormal development of the vertebrae prior to birth Can lead to several of the vertebrae fusing due to failure of formation or failure of segmentation on the anterior portion of the vertebral bodies or discs

Answer 20

Failure of Formation - failure of formation of a portion of one or more vertebral bodies - usually visible at birth as a lump or bump in the infants spine - worsens with growth

Answer 21

Failure of Segmentation - two or more vertebrae fail to separate & form normal discs & rectangular bones - more often likely to be diagnosed later after the child is walking

Answer 22

Non-surgical treatment is mostly observation with periodic xray to measure the progression of the curve Bracing is not indicated as it has been proven to be of no benefit Curves > 45 degrees or those associated with neurological weakness are treated surgically Early surgical intervention usually has the best results

Answer 23

Lateral curvature of the spine in an upright position | There is also a rotational deformity which may increase the normal kyphosis and lordosis of the spine

Answer 24

Structural-Fixed and non flexible and do not correct with side bending May be congenital cause Non Structural-Flexible and corrects with side bending Seen as a compensatory mechanism due to irregular leg length, local irritation or inflammation Tends to disappear when the offending disorder is treated

Answer 25

Represents 90% of all scoliosis Appears to be hereditary but true cause is unknown Appears clinically between 10-13yo More common in females Curve must be greater than 10 degrees Usually asymptomatic (c/o pain think tumor) Diagnosed on routine physical exam

Answer 26

Most important aspect is early detection Failure to dx & treat problem early may result in progressive deformity, cardiopulmonary compromise, & disability Frequent observation & measurement of the curve in younger patients usually every 4-6 months Curves > 20-25 degrees may need bracing & exercise Curves > 45 degrees cannot be effectively braced Curves 45-50 degrees or greater may need surgery to correct the curve & fuse the spine

Answer 27

Dull, diffuse, deep seated pain in LS region May or may not radiate to buttocks and hips Pain worsened by bending and relieved by inactivity Palpation may reveal paraspinous tenderness or knots Muscle spasm Normal neuro exam and normal straight leg raise

Answer 28

May be normal or may show degenerative changes 50yo+ pt image to r/o cancer mets <20yo image to r/o congenital anomalies

Answer 29

Rest and pain meds Exercise/PT Educate on proper body mechanics Relapse is common

Answer 30

Discomfort, tension, stiffness below the costal margin and above the inferior gluteal folds Second most common complaint to PCP Lifetime prevalence of 60-90% Leading cause of disability in the US for adults<45yo 85% of back pain has no identifiable cause and 1/3 will develop chronic back pain

Answer 31

Acute muscular or ligament injury Incomplete muscle tears or ligament sprains occur and lead to pain over the affected area Simple acute injury Responds well to brief rest and tx of symptoms “Waste Basket” Diagnosis Exact dx of low back pain can be difficult Symptom overlap with muscle strain, ligament strain, mild early disk herniation/degeneration Relevance of imaging difficult to establish

Answer 32

Obesity Smoking Ergonomics High Heeled Shoes

Answer 33

Localized pain Decreased ROM Negative Straight Leg Raise No neuro deficits

Answer 34

``` Short period of rest (1-2days) Early return to normal activities is important Pain meds Exercise Proper ergonomics Weight Loss and Smoking Cessation ```

Answer 35

Narrowing of any part of the lumbar spine Spinal canal, nerve root canal, and intervertebral formina Can occur at single or multiple spinal levels Compression of nerve roots is common Causes Acquired (most common) or congenital Acquired causes include degenerative dz, trauma, and spine surgery

Answer 36

May be asymptomatic Neurogenic claudication is the classic symptom Back/Buttock/Leg pain induced with walking or standing and relieved by sitting Symptoms in legs usually bilateral Can walk farther leaning over a shopping cart Flexed position=Pain relief

Answer 37

**MRI is gold standard for dx NSAIDS Exercise Tx acute episodes of pain Surgery when medical tx fails May need second surgery a few years later Insufficient evidence to support steroid injections

Answer 38

Tears in the annulus fibrosis cause a portion of the nucleus pulposus to extrude through the defect The resulting mechanical pressure exerted on the nerve roots as well as irritation from direct contact from the NP and the nerves leads to lumbar radiculopathy

Answer 39

Caused by trauma or degenerative changes or both | L4-5 and L5-S1 are the most commonly herniated disks of the lumbar spine

Answer 40

Most common presentation is stabbing low back pain with radiating pain, numbness, and tingling into the buttock and down one leg Pt visibly uncomfortable, prefers to stand with affected knee stretched

Answer 41

MRI is study of choice | CT can be used if MRI contraindicated

Answer 42

Non Surgical-PT, meds, injections Most pts will respond to a non surgical approach 6-12 weeks before considering surgery Surgical-Laminectomy or discectomy

Answer 43

Chronic inflammatory condition of the joints of the axial skeleton, considered an autoimmune arthritis Manifests as morning stiffness in the low back with progressive loss of spinal movement 10 times more common in men and can be familial Avg age of onset 15-30yo

Answer 44

Bilateral sacroiliac tenderness Limited motion of lumbar spine Loss of chest expanasion to <2.5cm due to costosternal involvement Pain usually located low in the buttocks and thigh region

Answer 45

Xray or MRI(detecting early AS) Early findings usually bilateral sacroiliitis Squaring of the anterior vertebral bodies May be complete fusion of the SI and hip joints Bamboo Spine Appearance

Answer 46

Psoriatic Arthritis Later involvement of SI joints, +skin lesions, no pulmonary dz Reiter’s Syndrome Later involvement of SI joints, +urethritis, no pulmonary dz Rheumatoid Arthritis

Answer 47

``` Medications-NSAIDS, DMARDs, TNF Blockers Exercise Postural Training Surgery (Severe AS) Refer to Rheumatology and PT ```

Answer 48

Injury of multiple lumbosacral nerve roots within the spinal canal distal to where the cord ends at L1-2. Does not affect the spinal cord itself

Answer 49

Low back pain Weakness and areflexia of on legs Loss of bladder/bowel function Saddle anesthesia

Answer 50

Ruptured LS intervertebral disk LS Spine fracture Hematoma in the spinal canal (s/p LP) Tumor or mass lesion

Answer 51

Diagnosis by MRI Treatment Surgical decompression Radiotherapy for tumors

Disorders of the neck and back Flashcards

(75 cards)