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anatomy of the spine > General Pathology > Flashcards

General Pathology Flashcards

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1
Q

Position of spine in normal balance

A

Balanced over the pelvis in frontal plane/balanced over the femoral heads in the sagittal plane

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2
Q

Position of spine in imbalance

A

Affected in the sagittal balance and moves towards the front of the body, head posture is anterior to instead of balanced over the hips

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3
Q

Which planes are affected by adolescent idiopathic scoliosis?

A

Thoracic, left or right and sagittal plane

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4
Q

List the four broad categories of etiologies of scoliosis

A

1) neuromuscular curves
2) congenital curves
3) Curves resulting from a specific disorder i.e. disease, tumor, trauma
4) Idiopathic curves

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5
Q

Neuropathic disorders

A

Polio, cerebral palsy, spinocerebellar Dysfunction

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6
Q

Myopathic disorders

A

Arthorgryposis and Muscular dystrophy

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7
Q

What are the three main categories of idiopathic scoliosis in children?

A

Infantile – birth to three years
Juvenile – 3 to 10 years
Adolescent- 10 to 17 years

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8
Q

What are the steps in the evaluation process of scoliosis?

A 
Family and general health history
Physical examination
Radiographic evaluation
Classification of curve
Cobb angle measurement
Risk of progression
Determination of skeletal maturity
Treatment by observation
Non-operative treatment
Operative treatment
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9
Q

Describe a structural curve/major curve

A

Will not bend out on forced bending x-rays, generally at least 10° greater than a minor curve

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10
Q

Describe a non-structural curve/minor curve/compensatory curve

A

Generally do bend out on x-rays, appear to develop an attempt to keep balance in coronal plane. Often resolved once the major curve has been corrected

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11
Q

Describe how a bending film is taken and what it shows

A

Left and right side bending x-rays taken in the supine position to show maximum amount of spinal column flexibility

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12
Q

How do you identify the end vertebrae for a Cobb angle measurement

A

End vertebrae are the last vertebrae on each end of the curve that are tilted into the concavity of the curve

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13
Q

What planes does the king classification relate to and what region of the spine does it describe

A

Thoracic scoliosis, type one to type five, type one deformity is often a true double major curve

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14
Q

Which planes do the Lenke classification system relate to and what region of the spine does it describe

A

Sagittal planes and lumbar curves, made from long P-A lateral and dual side bending x-rays. There are three components: Lumbar spine modifier, curve type and thoracic sagittal plane modifier

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15
Q

What are the five main indicators to help determine the risk of curve progression

A 
Gender of the patient
Magnitude of the curve
Curve pattern
Age at onset of the curve
Skeletal maturity of the patient
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16
Q

How is the Risser sign used?

A

Sections which have been fused, score of five would mean sections 1 through 4 have fused and the patient is scheduled to leave mature. Based upon sacrum joint.

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17
Q

List and describe the three basic treatment options for adolescent idiopathic scoliosis

A

Observation
Non-operative treatment with observation
Surgical intervention

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18
Q

Differentiate between casting and orthotics

A

Casting not performed as frequently today. Requires patient interaction on special frame prior to application of the cast mainly reduce his scoliosis as much as possible but has had limited success

Orthotics/braces, numerous ones, and have two functions. One should improve the deformity initially and two it should prevent curve progression

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19
Q

Difference between patients who have adult idiopathic scoliosis under 40 versus over 40

A

Under 40 is a continued progression or cosmetic appearance of their curve.

Over 40 is present because of back pain, significant degenerative disease process and a pre-existing curve otherwise known as adult scoliosis

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20
Q

For indications for treatment of adult scoliosis

A

Progression of the deformity
Unrelieved pain
Decreased pulmonary function
Cosmesis

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21
Q

What is DeNovo scoliosis

A

Degenerative scoliosis is the onset of a scoliotic curve in a previously straight spine

Spinal stenosis, foraminal stenosis of a concave side, disc degeneration, Motion segment instability, rotatory subluxation of lateral listhesis, and osteoporosis w compression fractures

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22
Q

What is the difference between a postural and structural kyphosis?

A

Postural-When bended forward spine forms a smooth curve. Generally can correct with consciousness

Structural-When bent forward the angular gibbus can be seen as a sharp angular pattern

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23
Q

What are the normal degrees of sagittal curvature in the cervical, thoracic and lumbar curves of the spine?

A

20 to 40°, 20 to 40°, 30 to 50°

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24
Q

What is Scheuermann’s disease?

A

Kyphotic deformities most common form of primary hyperkyphosis

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25
Describe the difference between a curve with a smooth radius and a curve with an angular radius
The greater the radius, the smoother the curve. Curves that are more angular have a greater risk of progression
26
Spondylosis
Degenerative changes in the vertebrae and articulation points i.e. disc and facet
27
Soondylolysis
Refers to a defect in the vertebrae, usually in the area of the pars
28
Spondyloptosis
Spondy, where L5 vertebral body has fallen below the horizontal line across the top of the sacrum
29
Most vertebral slips are the result of a defect in the?
Pars area of the lamina
30
Wiltse’s Classification system
Types of spondylolistheis (type I to type VI)
31
What is low dysplastic spondylolisthesis?
Translational shift of one vertebrae
32
What is high dysplastic spondylolisthesis?
Significant segmental kyphosis associated with the translational shift
33
What is Marchetti & Bartolozzi’s Classification system for spondylolisthesis?
Classifies them as developmental or acquired categories i.e. high and low dysplastic forms
34
What type of x-ray will you see Napoleon’s hat?
AP x-ray
35
What type of x-ray will you see the Scottie dog sign?
Oblique view
36
Meyerding’s grading system
``` Grade I -less than 25% Grade 2–25 to 49 percent Grade 3–50to74 percent Grade 4–75 to 99 percent Grade 5 – spondyloptosis ```
37
Describe tilt
Measured from the anterior inferior corner of the vertebrae, perpendicular to the line of the anterior surface of the sacrum
38
Describe slip
Measured from the posterior inferior angle of the body perpendicular to the sacral end plate line
39
Osteoarthritis
Inflammation of the bones and cartilage of a joint due to a degenerative process
40
What is the motion segment?
Human spine Dash each motion segment has three joints, two facet joints and the intravertebral disc
41
What makes up the three joint complex?
To facet joints and intervertebral disc
42
The intravertebral disc acts as...
Shock absorber and pivot point
43
The nucleus pulposus Is the central telogen a substance that accounts for about _____ of the IVD?
40
44
Which has more water and proteoglycan content, The nucleus or the anulus?
Nucleus – 90 percent at birth, 70 percent after 50
45
Which carries the smallest portion of the compress upload – the cortical shell or the spongy trabecular bone?
Cortical
46
The end plate is composed of how many layers?
Two layers – an inner bony layer and an outer cartilaginous layer
47
The cartilaginous layer is highly porous and nutrition diffuses across this service from the _____ layer.
Bony
48
The facet joins are important in stabilizing the spine. Their ______ _______ and _________ affect the mobility of each spinal region.
Anatomic position and orientation
49
The facet joints in the lumbar region are oriented in the _____ plane and limit the ________ ___ _______ in rotation
Sagittal/range of motion
50
Ligaments have many functions including....
Provide stability for the spine, allow for normal spinal motion, protect the spine and neurological structures, prevent the motion segment from exceeding its physiological range of motion
51
List the seven ligaments that attach the motion segment together
Anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, facet capsular ligament, intertransverse ligament, interspinous ligament, supraspinous ligament
52
Muscles are the _____ that produce _________ through __________ and ________ across a ____ or _______. Muscles also provide significant ________ and _______ to the spinal column. They resist ______ placed on the body through _________.
Active structures/spinal movements/bending movements/torque/joint/motion segment/dynamic stability/stiffness/external leads/isometric forces
53
What are the two most negative affects of sclerosis on the motion segment
Sclerosis of bone and formation of osteophytes
54
What is another name for attractions Spurs
Osteophytes
55
Major trauma or repetitive minor trauma may lead to ____________
A nonspecific synovitis
56
The articular processes begin to override each other as the joint capsules become stretched. This results in…
Malalignment of the joints and abnormal biomechanical function of the motion segment
57
How do spinal ligaments show the effects of aging?
Partial rupture’s, necrosis, and calcification of fibers
58
List seven changes to the motion segment that may occur due to degenerative disc disease
Complete resorption of the desk, marked sclerosis/end plates and osteophytes, encroachment into the spinal canal, Significant over writing of the articular surface is with osteophytes, development on both superior and inferior margin’s, infolding and redundancy of the ligamentum flavum and Compromising space and the intravertebral foramen.
59
What are the most frequently affected levels of degenerative disc disease?
L4-L5, L5-S1 and C5-C6
60
What does stenosis mean?
Narrow/pathological condition/Narrowing of a tube
61
What is the most common form of spinal stenosis?
Acquired degenerative type (lower cervical and lumbar areas)
62
What is neurogenic claudication and how can it be relieved?
Brought on by and intensified by walking and standing upright. Relieved when one flexes Ford and open up more of the spinal canal, which relieves pressure. Sitting or lying down can also help
63
What is the difference between neurogenic claudication and vascular claudication?
Vascular is caused by narrowing of the major arteries supplying blood to the legs
64
What kind of radiographic studies are most commonly used when evaluating lumbar spinal stenosis?
Myelography combined with a CT scan and MRI can also be done
65
What are some of the conservative treatments for mild degenerative lumber stenosis?
Stretching exercises that increase their flexion motion. Biking, water walking and swimming are excellent activities
66
What is the most common cause of spinal stenosis in the cervical region?
Degeneration of the three joint facets and intervertebral disc
67
What is radiculopathy?
Progressive deterioration of a nerve root
68
What is myelopathy?
Deterioration of the spinal cord
69
Surgical treatment for degenerative cervical stenosis is generally given to what kind of patients?
Ones with myelopathy or ones with significant deformity or instability
70
Describe surgical approaches and techniques used for decompression in the cervical region
Laminectomy and laminoplasty
71
What is a laminectomy?
Partial or complete removal of the posterior elements, allowing increase space for the neural structures
72
What is laminoplasty
Surgical reconstruction of the posterior elements that allow for increased canal space but maintains the posterior arch
73
What are the most frequent discs to herniate in the cervical and lumbar regions of the spine?
Cervical: C5 to C6, C6 to C7, C4 to C5 Lumbar: L4-L5, L5-S1 and L3-L4
74
What is sciatica?
Posterior leg pain from disc herniations, where protrusion occurs. Usually follows the distribution of the sciatic nerve
75
What are the most common symptoms with an S1 radiculopathy?
Posterior thigh and calf And lateral aspect of the bottom of the foot from heel to last two toes
76
What are the most appropriate radio graphic studies done for evaluating herniated lumbar discs?
MRI and CT scans
77
What are the most common surgical procedures for lumbar disc herniation?
Laminectomy with this ectomy, micro discectomy, endoscopic discectomy and ablation (Removal of a body part or destruction of function)
78
What are the most appropriate radiographic studies for evaluating herniated cervical discs?
MRI and plain films, CT scan and cervical myelogram may be used.
79
What are the most common surgical procedures for cervical disc herniation?
Anterior posterior surgical procedures/fusion Anterior discectomy without fusion, partial anterior discectomy, discectomy with fusion, posterior laminectomy, posterior laminotomy and posterior laminoplasty
80
What is instability?
Loss of normal relationship between anatomic structures with a resulting alteration of natural function
81
What are the primary problem is that concern surgeons and spinal trauma?
Mechanical instability of the vertebral column and actual or potential neurologic injury
82
What is a dislocation?
Misalignment of the normal structure of anatomic components a.k.a. disruption of soft tissue
83
Axial force
Pushes material fibers together in a Christian manner. Pier axial load is rare such as at diving injury and facture vertebrae in multiple pieces
84
Distraction force
Force In which the primary mechanism is pulling apart at the disc or bony soft tissue elements
85
Extension force
Axial severe backward bending of neck or trunk. Fractures of spinous processes or lamina
86
Flexion force
Distraction- a severe forward bend of neck or trunk. Most frequently force associated with neurological damage wedge or teardrop fracture to the vertebral body
87
Shear force
Force parallel results in translation or subluxation movement of the shared component. Usually anterior or lateral
88
Rotational force
Rotational tension on the tissue fibers. Associated with axial loading force
89
What is a major fracture?
Involving the vertebral body, pedicles or lamina and are more serious injuries
90
What is a minor fracture?
Involve the transverse, spinous and articular processes not as serious but may be painful
91
What is a stable fracture?
No significant displacement of or deformity to the bony or soft tissue. Spine can withstand but patient may have pain
92
What is an instable fracture?
Spine may not be able to carry normal loads without risk of causing new or additional neurological damage/injury. Significant deformity and incapacitating pain
93
What is Cauda equine syndrome?
Neurological injury below L1 – drama to spinal nerves may result in a complete or incomplete loss of neurological function of affected levels
94
How many pairs of spinal nerves are found in the spinal column?
31
95
Describe Frankel’s classification of neurological impairment?
Complete loss of motor and sensory function, only sensory function remains, motor function present but have no practical use, motor function impaired, no neurological impairment noted
96
What is a craniovertebral junction injury?
Base of the skull (C0), the atlas (C1) and/or axis (C2)
97
Occipito-Atlantal dislocation
Rare fatal dislocation where the head is struck and the occiput is subluxed over C1
98
Jefferson’s fracture
Burst fracture of the ring of C1; caused by axial loading combined with extension and rotation May not result in neurological loss if bone fragments do not compromise the spinal canal
99
Hangman’s fracture
Posterior arch of C2, caused by hanging, sudden force of hyperextension of head and neck; results in complete neurological loss
100
Odontoid process fractures
Type one – generally stable Type two and three – not stable
101
Atlantoxial joint subluxation
Rotatory distractive force, causes the atlas to rotate around odontoid. Results in partial dislocation of lateral articular mass of C1 on C2. May not be any neurological symptoms
102
Subaxial injury
Traumas of the cervical spine below C2.
103
Compression fracture
Cost by pure Flexion, generally stable, looks like a teardrop or wedge shaped fracture
104
Flexion/axial load injury
Fracture/dislocation at C-5 C from diving. Very unstable with three column involvement and significant neurological damage/deficit
105
Extension/axial load injury
Multiple level laminae fractures, much lower incidence of neurological involvement. Any middle column involvements results in unstability
106
Facet dislocation
Occurs with or without a fracture. Potentially serious, anterior translation of the superior level
107
Three types of thoracolumbar injuries
Burst, Flexion/compressive fractures, and Flexion/distraction
108
Two types of lower lumbar injuries
Flexion/distraction and compression/torsion/translational
109
Neoplasm
Tumors, new growth
110
Primary tumors
Benign or malignant – originate within the vertebrae and aren’t coming
111
Secondary tumor’s
Originate within another organ and then metastasize to the vertebrate
112
Metastasis
Spread of a neoplasm from one part of the body to another
113
Most patients with spine tumors present to the position with _______
Back pain
114
Five types of primary benign tumors
Aneurysmal bone cyst or ABC, giant cell tumor or GCT, Hemangioma, Osteoid osteoma and osteoblastoma
115
Three types of primary malignant tumors
Chardoma, Osteosarcoma, Chondrosarcoma
116
Four types of round cell tumor’s
Plasmacytoma, multiple myeloma, lymphoma and Ewing’s sarcoma
117
Where is the most common site for metastasis in the skeleton
Vertebral column
118
What is the five-year survival rate for all forms of lung cancer
Less than 10 percent
119
What is the five-year survival rate for breast cancer
Exceed 75 percent
120
What is the five-year survival rate for patients with global metastasis of prostate cancer
20 percent
121
What is osteoporosis
Decrease in skeletal bone mass
122
What factors may influence osteoporotic bone loss?
Racial and genetic, menopause, decrease of estrogen, park calcium intake, cigarettes, excessive drinking and inactive lifestyle
123
Describe the conservative treatment for compression fractures
Bed rest, pain medication and bracing
124
Describe the treatment for secondary osteoporosis
Treating the underlying Malady or discontinuing the offending agent/drug treatment
125
What is Paget’s disease
Chronic, usually localized, skeletal disorder resulting from the rapid metabolism of new bone
126
What is osteomalacia
Decrease in mass of chemically normal bone; similar to osteoporosis
127
What are the most common causes of osteomalacia
Vitamin D deficiency (nutritional intake or inadequate sunlight exposure) or acquired disorders of vitamin D metabolism (kidney failure)
128
What is the clinical presentation of tuberculosis infections of the spine
Weight lost, general malaise, night sweats, and intermittent fever. Back pain with spine patients, kyphotic deformity and neurological deficit in long-standing cases. Thoracic spine as most common
129
What is the treatment of choice for spinal TB
Multiple drug treatment – surgical intervention one bone collapse is significant and deformity when spinal cord is compressed is evident or when there is a para spinal abscess formation
130
What is osteomyelitis of the spine
Inflammation of the bone marrow of the vertebral body and the adjacent cortical bone due to an infection
131
About half of all the osteomyelitis infections in the spine occur in which region of the spine?
Lumbar region
132
What is discitis?
Infection in the disc
133
What is the most frequent treatment of spinal osteomyelitis
IV drug therapy with broad-spectrum antibiotics – oral antibiotics. Evidence of spinal instability or potential or actual neurological compromise, surgical intervention may be had/done. Anterior approach is option performed

anatomy of the spine (2 decks)

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