Lumbar and Cervical Spine

Question 1

Function of the posterior spine

Answer 1

Restricts movement of the spine to protect the spinal cord, and acts as a tension band during movement

Question 2

Spinal stenosis

Answer 2

Cord foramen diameter

Question 3

Primary movement of the C1/Occipital joint

Answer 3

Flexion and extension

Question 4

Primary movement of the C1/C2 joint

Answer 4

Rotation

Some flexion/extension

Question 5

Primary movement of the lower cervical spine

Answer 5

Flexion/ Extension

Question 6

Primary movement of the thoracic spine

Answer 6

Lateral bending and rotation

Ribs limit flexion

Question 7

Primary movement of the lumbar spine

Answer 7

Lateral bending and flexion/extension

Pelvis limits rotation

Question 8

Type of collagen in vertebral discs

Answer 8

Type II

Question 9

Vertebral endplates

Answer 9

thin edges of cortical bone at vertebral articulations with discs. Diffusion across the endplates keeps cartilage healthy

Question 10

Normal MRI changes seen in vertebral discs with aging

Answer 10

Loss of hydration (and thus T2 signal)
Loss of disc height
Endplate edema

these findings are found in pathological and nonpathological persons

Question 11

Activities that increase risk for vertebral disc problems

Answer 11

Vibrational equipment
Repeated heavy loading
SMOKING
Genetic colalgen diseases

Question 12

Ways to prevent IVD disease

Answer 12

Little can be done

Regular exercise
Ergonomics/ proper lifts
Good core strength

Question 13

Referral of axial neck pain

Answer 13

Referred to the posterior neck in the correct dermatome

Question 14

Structures that may be damaged in whiplash syndrome

Answer 14

Anterior neck muscles (hyperextension)
Disc herniation
Cervical radiculopathy
Facet joint impaction
SYMPATHETIC PLEXUS (horner's)

Question 15

Imagining that should be ordered with any patient presenting immediately after acute spinal trauma

Answer 15

CT
Can visualize posterior spine better than MRI

If patient is presenting weeks later, can get XR instead

Question 16

Predictor of spinal trauma prognosis after trauma

Answer 16

Severity of symptoms, NOT speed of impact

Question 17

Factors that increase risk of disabling pain in patients with spinal trauma

Answer 17

High pain with initial contact
Social isolation
Poor coping skills
History of chronic pain or drug abuse

Question 18

Motor, sensory and reflex abnormalities seen with a C5 impingement

Answer 18

WEAKNESS: Deltoid, bicep
SENSORY: Lateral arm, shoulder
REFLEX LOSS: Bicep

Question 19

Motor, sensory and reflex abnormalities seen with a C6 impingement

Answer 19

WEAKNESS: Bicep, wrist extension, pronation
SENSORY: Arm, thumb, index finger (6 shooter)
REFLEX LOSS: Bicep

Question 20

Motor, sensory and reflex abnormalities seen with a C7 impingement

Answer 20

WEAKNESS: Triceps
SENSORY: Index and long fingers (mostly long)
REFLEX LOSS: Triceps

Question 21

Motor, sensory and reflex abnormalities seen with a C8 impingement

Answer 21

WEAKNESS: Intrinsic muscles of the hand
SENSORY: Ulnar digits
REFLEX LOSS: None

Question 22

Spurlings test

Answer 22

Flexion and compression of the cervical spine to elicit pain on the flexed side with the compressed disc

(like giving them spurs in their neck)

Question 23

Imaging studies used on a suspected disc herniation

Answer 23

None, unless pain persists for >6 weeks or gets worse

Question 24

Typical treatments for an acute radiculopathy

Answer 24

Pain management >75% recover without need for surgery

Question 25

Indications for surgery in radiculopathies

Answer 25

Persistent, disabling pain Involvement of bowel or bladder Pain that worsens while being treated

Question 26

Treatment for cervical myelopathy

Answer 26

SURGERY, spinal ischemia can occur due to compression of the spinal cord

Question 27

Hoffman sign

Answer 27

Flexion of the fingers when flicking the nail bed Flexion is a positive (normal test) If Flexion is absent, suspect a cervical myelopathy (UMN problem)

Question 28

Spinal diseases that elicit pain with forward flexion

Answer 28

Lumbar disc herniation

Question 29

Spinal diseases that elicit pain with extension

Answer 29

Spondylolisthesis (pushes vertebral body further anterior)

Question 30

Motor, sensory and reflex abnormalities seen with a L4 impingement

Answer 30

Quadriceps weakness Absent patellar reflex Absent sensation to anterior thigh

Question 31

Motor, sensory and reflex abnormalities seen with a L5 impingement

Answer 31

Foot dorsiflexion and hallux extension weakness Loss of sensation to lateral thigh and calf Loss of sensation to dorsum of foot No reflex losses

Question 32

Motor, sensory and reflex abnormalities seen with a S1 impingement

Answer 32

Foot plantarflexion weakness Loss of sensation to Most lateral aspect of foot and small toe Loss of achilles reflex

Question 33

Imaging ordered for lumbar nerve impingement

Answer 33

MRI ONLY if pain persists for 2-3 months

Question 34

Typical treatment options for lumbar herniated disc

Answer 34

Same as cervical: Pain treatment Surgery only if pain is debilitating, chronic, progressive, or involves bowel/bladder McKenzie's extension exercises have proven effective

Question 35

Risk factors for developing spinal stenosis

Answer 35

Woman | Obese

Question 36

Spinal diseases in which pain is relieved by forward flexion

Answer 36

``` Spinal stenosis (also helped with sitting) Spondylolisthesis ```

Question 37

Most common causes of spinal stenosis

Answer 37

``` Degeneration of the facet joints --> bone spurs and ligamentum thickening Disc herniation Compression fracture Spondylolisthesis Vertebral cysts ```

Question 38

Clinical presentation of Spinal Stenosis

Answer 38

Back, buttock, or leg pain Heaviness with standing or walking Pain relieved by sitting or flexing trunk (pulls on SC)

Question 39

Treatment options for patients with spinal stenosis

Answer 39

Similar to spondylolisthesis Pain management Surgery only if pain worsens, becomes chronic, or if slip becomes worse

Question 40

Spondylolysis

Answer 40

Stress fracture occurring in the pars interarticularis of the spine (most often L5) a principal factor in developing spondylolisthesis

Question 41

spondylolisthesis

Answer 41

Anterior shifting of the vertebral body after spondylolysis-, leading to a myelopathy

Question 42

Physical exam findings for patients with spondylolithesis

Answer 42

``` Forward stooping (flexion relieves pain) Negative straight leg raise (not a radiculopathy) Palpable "step off" in lumbar spine ```

Question 43

Treatment of spondylolisthesis

Answer 43

Similar to spinal stenosis Pain management Surgery only if pain worsens, becomes chronic, or if slip becomes worse Rest and core strengthening are also essential to healing the stress fracture

Question 44

Surgical approach to spondylolisthesis

Answer 44

Typically a fusion of L5 to the sacrum

Question 45

Clinical presentation of actue back pain

Answer 45

Sudden onset pain Non-radiating (not radiculopathy) Lack of numbness or weakness Subsides in 3-5 days with RICE

Question 46

Clinical presentation of Chronic Back pain

Answer 46

Often patients are obese, or have poor lifting ergonomics or posture Only effective treatment is exercise, and core strengthening Weight loss is essential