Muscle relaxants, back pain, and clinical applications of the spine Flashcards Preview

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Flashcards in Muscle relaxants, back pain, and clinical applications of the spine Deck (13):
1

Muscle paralysis

-Achieved by non-depolarizing or depolarizing (succinylcholine) neuromuscular blockers
-Activity of these drugs monitored by nerve stimulation/muscle twitch
-Reversal of non-depolarizing drugs: CEIs (edrophonium, neostigmine)
-Reversal of succinylcholine: none
-Succinylcholine will be metabolized by pseudocholinesterase (in plasma), only lasts 5 min
-Succinylcholine causes hyperkalemia (contraindicated w/ burn victims)

2

Evolutionary perspective of back pain

-Today our lifestyles are more sedentary, as compared to our active ancestors
-Many humans now have poor posture and sit excessively
-Our unique S-shaped back (to walk upright) puts a lot of stress on the lower back area
-Other social factors that lead to back pain: obesity, depression, the way we carry, lift, walk and run

3

Etiologies of back pain (not serious)

-Muscle or ligament strain
-Disk degeneration/rupture
-Osteoarthritis
-Vertebral fracture/collapse
-Psychosocial factors
-Spinal stenosis (narrowing of intervetebral foramen)

4

Etiologies of back pain (serious) and red flags

-Neoplasm: Hx of cancer, recent fever/chills/weight loss, night pain, worse in supine position
-Infection: Hx of infection, IV drugs, immune suppression, recent fever/chills, night pain, worse in supine position
-Metabolic problems (osteoporosis)
-Neurologic damage: trauma, cauda equina syndrome (saddle anesthesia, bladder/bowel dysfunction, neuro deficits in LE)

5

Most common area of back pain

-In lower back, around the L5-S1 area
-When there is lumbar disc protrusion (or in cervical region), the disc does not affect the nerve exiting above it or the remaining cord
-Instead, the protrusion of a lumbar disc affects the nerve directly below it
-Therefore the disc btwn L4/L5 affects the L5 nerve, and disc btwn L5/S1 affects S1 nerve
-Most pressure on L5 in the slumped sitting position

6

Sx of L/S level nerve compression

-Sciatica: pain in dermatome of sciatic nerve (L4-S3)
-Compression of L4 by L3/L4 disc: extension of quads weak, knee reflex diminished
-Compression of L5 by L4/L5 disc: dorsiflexion of big toe and foot weak, heel walking
-Compression of S1 by L5/S1 disc: plantar flexion of big toe and foot weak, walking on toes, ankle reflex diminished

7

Psychological issues associated w/ back pain

-Depression: less active
-Anxiety
-Hypochondriasis
-Acute remunerative back pain: a person who doesn't have much motivation to fully recover (receiving disability, ect)

8

Back pain vs leg pain

-Back pain usually due to problems in the spinal structures
-Leg pain usually due to neural compression

9

Complete vs incomplete spinal damage

-Complete means there is no sensation or motor function at and below the level of a SC injury (not salvageable)
-Incomplete: there is some functionality in some part of the body below the level of a SC injury (potentially salvageable)
-Must Rx more aggressively for incomplete to save/improve the remaining functions

10

Types of incomplete SCI

-Central cord syndrome: motor deficit worse in UE than LE (some preserved motor function), and hands have more pronounced motor deficit than arms (good prognosis)
-Brown-sequard syndrome: loss of contralateral STT and ipsilateral motor/light touch/proprioception (one half of SC is transected, good prognosis)
-Anterior cord syndrome: loss of motor/STT on both side, preservation of light touch/proprioception on both sides (poor prognosis)
-Posterior cord syndrome (rare): loss of proprioception and light touch on both sides, motor/STT intact bilaterally, foot slapping gait

11

Cauda equina syndrome

-Due to compression of central canal space (below L1/L2)
-Results in saddle anesthesia, sensorimotor deficits, bladder/bowel retention/incontinence
-Surgical emergency

12

Spinal surgery

-Surgeries will be done for spinal emergencies (cancer, infection, cauda equine syndrome) and the pts that have the correct pathology/medical Hx/social Hx
-Conservative care will solve 99% of spinal problems
-Contraindications to surgery: wrong pathology, social issues (remunerative back problems), psych issues, obesity, metabolic diseases, drug use, prior surgery did not result favorably

13

Reflexes and spinal segments

-C5/6: biceps
-C6: brachioradialis
-C7/8: triceps
-L3/4: patellar
-S1/2: achilles