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Semester 3 > orthopedic pathology (spinal pathologies) > Flashcards

orthopedic pathology (spinal pathologies) Flashcards

1
Q

scoliosis

A

Abnormal lateral curvature of the spine

On x-ray, spine may look more like an “S” or a “C” than a straight line

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2
Q

left vs right scoliosis

(levoscoliosis vs dextroscoliosis)

A

Named according to convexity

Left more common in L-spine

Right more common in T-spine

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3
Q

May also involve rotational component

A

esp in thoracic spine (“RIB HUMP”)

SPs face toward concave side (thoracic)

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4
Q

terms related to classification

A

Right thoracic scoiosis

left lumbar scoliosis

right THORACO-LUMBAR scoliosis (both)

right thoracic - left lumbar scoliosis

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5
Q

classifiction via etiology

A

Idiopathic scoliosis (80%)
–> MOST COMMON

osteopathic scoliosis
–> Due to bone abnormality (STRUCTURAL SCOLIOSIS)

myopathic scoliosis
–> Due to muscle weakness (could be FUNCTIONAL SCOLIOSIS ??)

Neurologic/Neuropathic SCOLIOSIS

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6
Q

classificaiton according to age of onset

A

Congenital
Infantile
Juvenile
Adolescent
Adult

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7
Q

Structural scoliosis

A

Fixed curvature of the spine associated with vertebral rotation and asymmetry of the ligaments

Can be caused by congenital, neuromuscular, musculoskeletal, idiopathic

ALSO, vertebral deformities / malformation (???)

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8
Q

note vertebral malformation vs structural scoliosis

A

PARTIAL UNILATERAL FAILURE OF FORMATION (WEDGE)

COMPLETE UNILATERAL FAILURE OF FORMATION (HEMIVERTEBRA)

UNILATERAL FAILURE OF SEGMENTATION (CONGENITAL BAR)

BILATERAL FAILURE OF SEGMENTATION (BLOCK VERTEBRA)

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9
Q

what percentage children need intervention? (SURGICAL???)

A

2.5 %

1/10 Children diagnosed ——> 25% of those require intervention

—-> Rest sorts itself out on its own (???)

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10
Q

what conditions increase incidence of Scoliosis in children?

A

Incidence increases with cerebral palsy, spina bifida, neurofibromatosis, muscular dystrophy

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11
Q

male vs female difference?

A

Equal in males and females but females are more likely to develop severe curvatures that require intervention

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12
Q

Idiopathic adolescent scoliosis

A

Idiopathic

Seems to have a genetic component – Recurrence among relatives

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13
Q

WHY???? (Idiopathic adolescent scoliossi)

A

Common theory is that sensory information is either misinterpreted or incorrect resulting in inappropriate output regarding body orientation.

——-> SAME THEORY AS CHARCOT’S NEUROPATHY

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14
Q

WHY NOT (idiopathic adolescent scoliosis)

A

REACTION NOT A CAUSE

Muscular imbalances in activity or strength do not seem to be a cause. Evidence suggests that these imbalances are reactions to the curve rather than a cause.

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15
Q

Idiopathic adolescent Scoliosis, female vs male

A

GENETIC COMPONENT

FEMALES

Most common form is adolescent idiopathic scoliosis,

has a genetic component and is more common in females

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16
Q

Cobb Angle Test

A

The Cobb angle is the most widely used measurement to quantify the magnitude of spinal deformities, especially scoliosis, on plain radiographs.

Scoliosis is a lateral spinal curvature with a Cobb angle of >10° 4.

The Cobb angle technique can also assess the degree of kyphosis or lordosis in the sagittal plane 7.

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17
Q

Idiopathic adolescecnt scoliosis vs COBB ANGLE

A

Prevalence of AIS is approx 2-3% with less than 10% on screening evaluation requiring treatment (based on 10 degree cobb angle)

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18
Q

symptoms/presentation

A

Asymptomatic

Pain

Uneven musculature

A rib “hump” and/or a prominent shoulder blade

Uneven hip, rib cage, and shoulder levels

Asymmetric size or location of breast

Uneven distance between arm and body

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19
Q

Diagnosis

A

Presentation

Adam’s (forward bend) test

Scoliometer measurements (measures rib hump)

X-ray

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20
Q

Forward bend test

A

NOTE THAT SOME PATIENTS CANNOT CURVE THEIR BACK (BEND FORWARD WITH FLAT BACK)

—-> shortened spinal cord = prevents back curving to create shortest distance in vertebral canal for (congenitally?) shorter spinal cord

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21
Q

APEX scoliosis

A

most protruding vertebra

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22
Q

Prognosis Scoliosis

A

Depends on likelihood of progression

Generally larger curves carry a higher risk of progression than smaller curves

Thoracic curves carry a higher risk of progression than lumbar or thoracolumbar curves

Patients who have not reached skeletal maturity have a higher likelihood of progression.
—–> Risser’s Sign
—–> Onset before (first menstruation) menarche

Males with similar sized curves have less likelihood of progression

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23
Q

WHICH CURVE HAS GREATER RISK OF PROGRESSION

A

THORACIC CURVE*****

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24
Q

Risser’s sign

A

The Risser sign is an indirect measure of skeletal maturity, whereby the degree of ossification of the iliac apophysis by x-ray evaluation is used to judge overall skeletal development.

I.e.
Growth plate not closed = less mature skeleton = more likelihood of scoliosis progressing/worsening

(Starting earlier = worse)

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25
Q

which gender likelihood of progression

A

females

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26
Q

Management/treatment

A

Observation

Bracing

Surgery

Management is complex and is determined by the severity of the curvature and degree of skeletal maturity, which together help predict the likelihood of progression

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27
Q

surgery scoliosis

A

insert plates/screws

incision/open every once a in a while to tighten screws to continue manipulating direction of spine

—-> similar concept to dental braces

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28
Q

Fucntional scoliosis

A

Have no permanent rotary component

not related to structure —> more likely to be fixable/treatable

Correct themselves on positional changes

Compensation for biomechanical problems or due to a muscle spasm

E.g. pain, poor posture, leg length discrepancy, disc herniation, etc

Disappear if the cause is remedied

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29
Q

strucutral vs functional scoliosis

A

Positional change (adams test, bend towards convexity)

Pain (especially with forward bending)

Idiopathic Adolescent Scoliosis is usually asymptomatic until later in life

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30
Q

BENDING TOWARD CONVEXITY

A

If bending toward convexity, curve persist ==> STRUCTURAL SCOLIOSIS

IF BENDING TOWARD convexity, curve temporarily disappears or is reduced, could be FUNCTIONAL SCOLIOSIS
—> Not as result of malformation of vertebral structures

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31
Q

Cervical spine

A

**

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32
Q

Whiplash

A

Acceleration-deceleration injury to head and neck relative to body

Cervical flexion-extension sprain/strain injury

Trauma esp. MVA esp. rear-impact collisions

Contributing factors – active TrPs in SCMs; other concurrent health conditions

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33
Q

MOI (FYI)

A

Vehicle is struck from behind
Seat pushes torso as vehicle moves forward
Head is fixed
Torso moves upward

Vehicle and torso reach peak forward acceleration
Seat recoils to original position
Head and neck stay in place
Anterior neck mm and ligaments overstretched

Head and neck at peak forward acceleration
Vehicle and torso slowing down

Head and torso at full deceleration
Shoulder harness restrains torso
Head and neck continue to flex forward
Head moves into hyperflexion
Most stress places on lower C-spine and upper T-spine

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34
Q

Other factors to consider (whiplash) —-> (TO ASK PATIENTS)

–> gives more context/info to potential questions like which structures affected

A

Head position

Seatbelts

Headrest position

Seat position

Stature

Airbags

Front or side impact

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35
Q

tissues involved

A

Cervical-spine, Thoracic-spine, head

Vertebrae

DISKS

Facet joints

Joint capsules/ligaments

TMJ

ALL, PLL (ANTEIROR/posterior longitudinal lig)

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36
Q

other tissue involved

A

Lymphatics

Fascia

Blood vessels

Nerve roots

Cranial nerves

ANS

Spinal cord

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37
Q

muscles involved

A

suboccipitals

rotatores, multifidi, semispinalis cervicis, longissimus cervicis

upper trapezius, levator scapulae

rectus capitis anterior, longus capitis, longus colli

SCM, platysma

mylohyoid, omohyoid, suprahyoid, infrahyoid

rectus capitis lateralis

anterior, middle, posterior scalene

Muscles of mastication
CAN BE AFFECTED

THORAX –> intercostals, posterior spinal muscles, diaphragm

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38
Q

which two groups of muscles also can be affected (whiplash) ??

A

Muscles of mastication
CAN BE AFFECTED

THORAX –> intercostals, posterior spinal muscles, diaphragm

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39
Q

FOUR GRADES OF WHIPLASH DECRI)BED BY

A

Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated disorders (WADs):

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40
Q

FOUR GRADES

A

Grade 0: no neck pain, stiffness, or any physical signs are noticed

Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
—> E.g.
no loss of ROM, or tenderness upon palpation

Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.

Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
—> NEUROLOGICAL Sx

Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.
—> Fx, dislocation, spinal cord injury

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41
Q

Clinical manifestiation (acute)

A

Spasm

Strain

Contracture

Facet joint irritation

Fracture

Nerve tractioning

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42
Q

other acute clinical manifestation

A

Loss of consciousness

Headache

Edema

Tenderness

Deafness, dizziness, dysphagia, memory loss, nausea, TMJ pain, TOS, tinnitus,

Decreased strength

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43
Q

IMPORTANT FEATURES TO NOTE

A

ear-related symptoms:

tinniitus
deafness
dizziness
(ear proprioceptors)

ALSO:
Nausea
(Vestibular system = ear)

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44
Q

Chronic clinical manifestations

A

Pain

Headache

Contracture

Spasms

TMJ dysfunction

Trigger points

**

Reduced ROM

Adhesions

Hypermobility

Decreased strength

Atrophy

DDD or DJD

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45
Q

Treatment

A

Chiropractic, physiotherapy, massage

Stretching/strengthening

Hydrotherapy

Mobilization

Traction

Meds

Surgery

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46
Q

Torticollis

A

twisted
neck

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47
Q

what is “

A

Abnormal positioning of head and neck relative to body (wry neck)

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48
Q

typical presentaiton

A

Lateral flexion towards the affected side

Rotation away from affect side

Shoulder on affected side is raised

Neck may be in flexion or extension

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49
Q

Lateral flexion towards the affected side

Rotation away from affect side

A

SCM

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50
Q

Acute acquired torticollis

A

Painful unilateral shortening or spasm of neck muscles resulting in an abnormal head position

Any age

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51
Q

Causes “

A

Activation of latent trigger points

Ispilateral SCMs, scalenes, levator scapula

Subluxation of C1-C2 due to trauma

Facet joint irritation

Infection or inflammation

Disc pain due to DJD

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52
Q

Clinical manifestations

A

Usually sudden onset

Typical position

Affected muscles are shortened and in spasm

Pain especially with movement

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53
Q

Clinical manifestations

A

Tinnitus
Nausea
(ear-related symptoms)

Lacrimation (pressure on Lacrimal glands

Referred pain

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54
Q

Torticollis treatment

A

Medication (analgesics, m. relaxants)

Chiropractic, physiotherapy, massage

Hydrotherapy

Breathing exercises

Stretching, strengthening (PT)

Time (self-limiting condition)

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55
Q

SPASMODIC TORTICOLLIS (aka CERVICAL DYSTONIA)

A

Localized dystonia resulting in an involuntary spasm of cervical muscles and abnormal head position

Worse under stress

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56
Q

dystonia

A

a state of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy.

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57
Q

Etiology (Cervical dystonia)

A

Idiopathic

CNS lesions (SPASMS??)

Malformation at C0-C1

Postural dysfunction

Trauma

Iatrogenic (anti-psychotic/anti-nausea tx/med ??)

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58
Q

Contributing factors

A

Depression

Stress

Social/personal upheavals

Occupational positioning of head

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59
Q

Clinical manifestations

A

Adult onset

Typical torticollis position

Affected muscles in neck twitch and jerk

Affected shoulder shrugs

Twitching may spread to facial and arm muscles (CNS LESIONS?????)

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60
Q

other clinical manifestation

A

Intermittent or permanent or spontaneous remittance or increasing severity

Intensity varies according to head position

Exacerbated by social stress/head position

Improved by certain positions

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61
Q

Tx (Spasmodic torticollis, Cervical dystonia)

A

Antispasmodic meds

Botox

Biofeedback

Agonist contraction, relaxation

Postural retraining

Passive stretching

Relaxation courses

Breathing exercise

AROM exercises

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62
Q

Congenital torticollis

A

A contracturing of one SCM muscle resulting in an abnormal head position

Present from infancy

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63
Q

etiology (congenital torticollis)

A

Idiopathic

Theories
Trauma in birth process causing inflammation and fibrosing of SCM

Malposition of fetus in utero

Torsion of fetal cranial bones

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64
Q

Clinical manifestation (congenital torticollis)

A

Present from infancy

Typical torticollis positioning

Contracture, thickening and shortening of one SCM muscle, scalenes, associated fascia

Palpable mass in muscle

Postural dysfunction

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65
Q

late clinical manifestations

A

Compression on cranial nerves and vasculature

TMJ dysfunction on affected side

DDD (C-spine)

OA (C-spine)

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66
Q

TMJ?

A

TMJ and related disorders of the jaw system can put pressure on nerves in the jaw, and it can lead to the inefficient working of the jaw muscles or overexertion, both of which increase demands on the neck muscles. As a result, TMJ might have a role in causing torticollis.

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67
Q

Tx (congenital torticollis)

A

Massage (neuromuscular therapy)

Physiotherapy

Stretching/strengthening

ROM exercises

Craniosacral

Surgery

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68
Q

Cervical rib

A

Separate piece of bone that articulates with the transverse process of one or more cervical vertebrae

Most common at C7, C6, C5

0.5% - prevalence

Females>males (2:1)

Bilateral (66%)

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69
Q

cervical rib …

A

Often asymptomatic until middle age when shoulders begins to droop

May result in neurovascular compression (TOS)

—> Subclavian vessels (artery/vein)

—> Brachial plexus

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70
Q

TMJ dysfunction

A

Disorder of the muscles of mastication, the temporomandibular joints, and associated structures

Most common age of onset 20 - 50

Women>men (5:1)

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71
Q

Causes TMJD

A

Imbalances in muscles of mastication

Muscle overuse

Cranial bone/C-spine misalignment

Postural dysfunction

Stress/trauma

Joint pathology

Sinus blockage/infection

72
Q

muscles of throat/nasal cavity TMJD

A

TMJ disorder can cause nasal discharge. The muscles responsible for chewing and jaw movement are connected to the muscles in the throat and nasal cavities.

When these muscles become tight or inflamed due to TMJ disorder, they can cause a sensation of congestion.

73
Q

contributing/risk factors (TMJD)

A

Genetic predisposition

Trauma to neck, face, jaw

Tissue alteration

Stress/grinding/clenching

Teeth crowding/misalignment

Missing teeth

Playing musical instruments

chewing/smoking

74
Q

clinical presentation (TMJD)

A

Unilateral or bilateral
Pain

Clicking, popping with jaw movement

Headache

Spasm/hypertonicity/trigger points – temporalis, masseter, medial pterygoid, lateral pterygoid, digastric, mylohyloid, genoihyoid, infrahyoid, C-spine

75
Q

clinical presentation (TMJD) 2

A

Decreased ROM

Catching/locking

Ear dysfunction

Inflammation, edema, swelling

Tinnitus

Lacrimation

Paresthesia

Contracture/DJD (late)

76
Q

ear related sx (TMJD)

A

Ear dysfunction

Tinnitus

77
Q

TMJD lacrimation

A

When TMJ syndrome causes tension in the muscles and surrounding tissues, it can sometimes effect this nerve resulting in blurred vision, watery eyes and light sensitivity.

78
Q

Management TMJD

A

Diagnosis
Dentist, chiropractor, MD
History, Physical exam, imaging

79
Q

tx TMJD

A

Massage, chiropractic, physiotherapy, exercises, mobilization, dental splints, meds, surgery, stress management, modification of ADLs

80
Q

Scheuermann’s Disease

A

Most common cause of structural kyphosis in adolescents

81
Q

Scheuermann’s etiology

A

Etiology is idiopathic, but probably multifactorial

82
Q

Scheuermann’s when

A

Usually begins in puberty (age 13 – 16)

83
Q

Scheuermann’s gender

A

mostly males

84
Q

Scheuermann’s how common?

A

Uncommon (less than 1%)

85
Q

osteochondrosis

A

Osteochondrosis is a self-limiting developmental derangement of normal bone growth, primarily involving the centers of ossification in the epiphysis.

It usually begins in childhood as a degenerative or necrotic condition.

By definition, osteochondrosis is an aseptic ischemic necrosis.

86
Q

osteochondrosis define 2

A

Osteochondrosis is the descriptive term given to a group of disorders affecting an ossification centre in a child or adolescent resulting in alteration of endochondral ossification.

a disease especially of children and young animals in which an ossification center especially in the epiphyses of long bones undergoes degeneration followed by calcification

87
Q

what were examples of osteochondrosis we saw?

A

Legg-Calvé-Perthes disease

Sever disease

88
Q

Scheuermann’s & osteochondrosis

A

Considered part of a larger group of diseases called osteochondrosis

89
Q

Scheuermann’s pathogenesis

A

Growth ossification centres stop receiving adequate blood supply, leading to degeneration and necrosis

Blood supply is regrown and bone continues to grow, but not without structural deformity

90
Q

Scheuermann’s often seen @

A

Lower thoracic or upper lumbar vertebrae affected first

91
Q

Scheuermann’s – what type of structural deformity?

How is the structural deformity quantified?

A

Structural deformity characterized by anterior wedging of five degrees or more of three adjacent thoracic bodies

92
Q

Scheuermann’s features

A

Affected children are tall with advanced skeletal maturity and poor posture

thoracic Hyperkyphosis

93
Q

note gender of 3 osteochondroses we learned

A

Legg-Calve Perthes
Sever’s
Scheuermann’s

boys > girls

94
Q

Scheuermann’s – how about lateral deformity?

A

Possible scoliosis

95
Q

Scheuermann’s – pain or no?

A

May be painful or asymptomatic

Course is mild but long (years)

96
Q

Scheuermann’s treatment

A

Treatment – rest, bracing, surgery (plates/screws), physical therapy, meds

97
Q

Sprengel’s deformity

A

Congenital malposition of the scapula

Scapula begin near the c-spine and descend during development

With Sprengel’s deformity, the scapula fails to descend

98
Q

What diseases associated with Sprengel’s deformity

A

Spina bifida

Klippel-Feil syndrome

Hemivertibrae (scoliosis)

99
Q

Omovertebral bone

A

The omovertebral bone (os omovertebrale) is present in ~35% (range 19-47%) of cases of Sprengel deformity.

Bone extending off of one side of bifid SP of a cervical vertebra

connect to scapula (??)

“Omo” = shoulder/scapula

100
Q

Sprengel’s deformity most common in which gender

A

Girls > boys (3:1)

101
Q

Sprengel’s deformity treatment

A

Treated with physical therapy and possibly surgery

102
Q

Pectus excavatum

A

Most common deformity of chest wall

Aka funnel chest

Midline depression of sternum

103
Q

Pectus carinatum

A

Anterior protrusion of sternum

Prominent sternum

Aka pigeon breast

104
Q

carinatum

A

From the Latin carina, meaning keel

105
Q

Barrel chest

A

Barrel chest – increase in the antero-posterior dimensions of the chest wall; most commonly associated with emphysema

106
Q

emphysema define

A

Emphysema is a lung condition that causes shortness of breath.

In people with emphysema, the air sacs in the lungs (alveoli) are damaged.

Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones.

107
Q

Central Stenosis

A

Note “Mass effect”

Narrowing of the spinal canal

108
Q

Central stenosis primary vs secondary

A

Can be primary (congenital)

Can be secondary due to DJD (m/c),
subluxation,
edema,
disc herniation/DDD,
tumour,
osteoporosis, etc.

109
Q

osteoporosis and central stenosis

A

compression fractures (?)

“Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis”

110
Q

where is central stenosis most common

A

May affect any portion of the spine, but is most common in the lumbar spine

111
Q

Stenosis and neurological signs/symptoms

A

Stenosis can lead to neurological symptoms including:

Numbness, tingling and weakness to the lower extremities

Bowel and bladder changes, such as incontinence

112
Q

central stenosis and paralysis

A

in severe cases, paralysis can occur due to spinal cord damage

113
Q

Spondylosis, Spondylitis, Spondylolysis, Spondylolisthesis

A

Spondulos = vertebra

osis = condition/pathological state

itis = inflammation

lysis = degeneration/disintegration

listhesis = slipping/sliding

114
Q

Pars interarticularis

A

“The pars interarticularis, or pars for short, is the part of a vertebra located between the inferior and superior articular processes of the facet joint.”

115
Q

Pars interarticularis etymology

A

“The pars interarticularis means the ‘part between the articulations’ in Latin and is the bony bridge that joins these two upper and lower facets.”

116
Q

Spondylitis define

A

Note “Ankylosing Spondylitis”

“inflammation of the joints of the backbone.”

117
Q

Ankylosis/Ankylose etymology

A

“(of bones or a joint) be or become stiffened or united by ankylosis.”

“From Ancient Greek ἀγκύλωσις (ankúlōsis, “a stiffening of the joints”), from ἀγκυλόειν (ankulóein, “to crook, bend”), from ἀγκύλος (ankúlos, “bent, crooked”).”

118
Q

Spondylosis define

A

“a painful condition of the spine resulting from the degeneration of the intervertebral disks.”

“Most often, the term spondylosis is used to describe osteoarthritis of the spine, but it is also commonly used to describe any manner of spinal degeneration.”

“Neck or back pain that develops as we age may be a sign of spondylosis, a degenerative condition that affects the spine. Spondylosis is a normal, age-related condition.”

119
Q

Spondylolysis define

A

1
“Spondylolysis is a fracture (crack or break) in a vertebra (bone in the spine). It can happen from repetitive stress or injuries to the spine.”

2
“Spondylolysis is a stress fracture through the pars interarticularis of the lumbar vertebrae.”

3
““Spondylolysis” is the medical term for a small crack (fracture) between two vertebrae in your spine.”

120
Q

spondylolisthesis define

A

Spondylolisthesis is a displacement of a vertebra in which the bone slides out of its proper position onto the bone below it.

Most often, this displacement occurs following a break or fracture.

Surgery may be necessary to correct the condition if too much movement occurs and the bones begin to press on nerves.

In severe cases that are not treated, paralysis can occur

121
Q

note description of spondylosis on class notes

A

Broad term describing vertebral column degeneration

Most commonly used to refer to vertebral osteoarthritis

122
Q

Spondylolysis (class notes)

A

“Pars defect”

Interruption/malformation of the pars interarticularis

Can be unilateral or bilateral

Can be asymptomatic

May lead to spondylolisthesis

123
Q

Where is Spondylolysis most common?

A

Most often occurs at L5-S1

124
Q

Spondylolisthesis class notes

A

The gap at the pars defect widens

May be asymptomatic

May cause back pain

125
Q

which postural defect can occur in Spondylolisthesis

A

May cause hyperlordosis

126
Q

where is spondylolisthesis MOST COMMON

A

Can occur at any spinal level, but most commonly at L5-S1

127
Q

which shift direction is most common in spondylolisthesis

A

The shift can occur in any direction, but most commonly anterior/posterior shift

–> Anterolisthesis
–> Posterolisthesis

128
Q

spondylolisthesis, neurological symptoms and treatment

A

May cause neurological symptoms

—> severe untreated cases can lead to paralysis

“Treatment depends on clinical presentation and degree of instability”

129
Q

Schmorl’s nodes

A

Projection of the intervertebral disc into the vertebral body end plate (“Physeal plate” ??)

digs into bone (??)

Associated with conditions such as Scheuermann’s disease

Heritable link (etiology)

130
Q

Physis

A

ancient Greek term for “nature”, from the verbal noun φύσις, “phusis”, meaning “growing”, “becoming”, itself from φύω, “to grow”, “to appear”.

EPI-physis
META-physis

Meta =
meta- 6. a prefix appearing in loanwords from Greek, with the meanings “after,” “along with,” “beyond,” “among,” “behind,”

131
Q

Scheuermann’s disease – Schmorl’s nodes

A

With Scheuermann’s disease, there are sometimes additional abnormalities of the affected vertebrae. These abnormalities are called “Schmorl’s nodes”.

These nodes are areas where the disc (cushion) between each vertebra pushes through the bone at the bottom and the top of the vertebra.

132
Q

Schmorl’s nodes – why?

and why with Scheuermann’s?

A

Researchers believe that the weakening of the vertebral endplates causes Schmorl’s nodes.

However, these nodes may also have links to other conditions, such as: Scheuermann’s disease, which causes the vertebra to grow unevenly during childhood. metabolic diseases.

133
Q

Butterfly vertebrae

A

Non-union of the two halves of the vertebral body

Extremely rare

Associated with some congenital diseases not seen in this course

134
Q

Degenerative Disc Disease (DDD)

A

Degenerative joint changes at the intervertebral disc

Common musculoskeletal condition

135
Q

intervertebral disc

A

Functions as a shock absorber and to allow movement between vertebrae

136
Q

what does ddd do to discs – how does it affect discs

A

Degeneration causes alterations in volume, shape, structure and composition

These will decrease motion and alter mechanical properties of the spine

137
Q

two components of discs

A

Annulus fibrosus
annulus = ring

Concentric layers of collagen

Posterior side is thinner and less firmly attached to endplates

138
Q

which side is thinner and elss firmly attached to vertebral body (endplate)

(more mobile?)

A

Posterior side is thinner and less firmly attached to endplates (MORE MOBILE)

RECALL medial meniscus –> posteiror side is LESS mobile (MOST COMMONLY INJURED)

139
Q

two components of discs

A

Nucleus pulposus

Jelly-like material in the center of the disc

Has a high-water content and is quite viscous

Moves slightly with movement of spine

140
Q

2

A

Annulus fibrosus

Nucleus pulposus

141
Q

how is separation of vertebrae determined

A

Internal pressure of disc maintains:

Separation of vertebrae

142
Q

discs, innervation

A

Only posterior peripheral aspect of annulus fibrosus is innervated

143
Q

discs, blood supply

A

Discs are hypovascular

Slow repair process

Only periphery is vascularized

144
Q

how does rest of disc received O2/nutrients

A

Rest of disc receives nutrition by diffusion through vertebral endplates

145
Q

disc changes with age

A

Considered a “normal” degenerative process (wear and tear)

1) Fibrous changes within nucleus

2) Changes in organization of annulus fibrosus

3) Disappearance of the cartilaginous endplates

146
Q

what happens to nucleus pulposus

AT WHAT AGE?

A

Number of cells and the concentration of proteoglycans and water decreases

Gradually nucleus changes to a fibrous material similar to the annular fibers

Typically occurs around 40-50 years of age

147
Q

proteoglycan

A

a compound consisting of a protein bonded to glycosaminoglycan groups, present especially in connective tissue.

148
Q

what is the result of fibrosis of nucleus pulposus

A

Results in decreased disc height and reduced range of motion

149
Q

what happens to annular fibers with age?

A

Annular fibers become weaker and less elastic

Fibers compress and bulge

Creates tension in outer layers

150
Q

what can weakened fibrous layers (annulus fibrosus) lead to

A

Clefts appear between annular layers and progress to gaps and larger tears

This can allow nucleus to protrude (DISC HERNIATION)

151
Q

which side of disc weaker?

A

Posterolateral portion of disc weakens first

affecting which movements?
—> Flexion and rotational movements

152
Q

what happens at edges of vertebral bodies?

A

Altered disc mechanics encourages bone formation at edges of vertebrae

Osteophytes (exostosis)

153
Q

what can compression of vertebral discs do to nerve roots?

A

compression = pain, numbness/tingling, and other neurological symptoms

154
Q

DDD risk factors

A

Genetics
Age
Weight

Atherosclerosis

Repetitive mechanical loading

Trauma

Muscle imbalances

155
Q

atherosclerosis and DDD (?)

A

poor blood supply = poor regeneration/nutrition of discs, which already have limited blood supply

156
Q

which ages is herniation most common?

A

Most common at 30 – 45 years of age

Annular fibers are weakened and disc is still hydrated

157
Q

which ages is herniation less common?

A

Rupture is less likely after age 50

Disc is usually fibrosed

158
Q

where do majority of disc herniations occur

A

98% of lumbar herniations occur at L4-L5 and L5-S1 levels.

159
Q

what is herniation?

which direction most common?

which movement most common MOI?

A

Herniation is commonly used to describe a disc injury that results from a rupture of annular fibers

Disc most commonly bulges posterolaterally and may compress nerve roots and ligaments that are pain sensitive

Suggested mechanism of injury is flexion and rotational/torsional forces

160
Q

disc herniation and mass effect

A

may compress nerve roots and ligaments that are pain sensitive

161
Q

Disc herniation, single event, or repetitive use (?)

A

May be a single traumatic event, repeated minor strains or sustained flexion

162
Q

4 stages of disc herniation

A

1) degeneration
—> annulus fibrosus is degerating; minor displacement may be seen (?)

2) prolapse
—> annulus fibrosus is displaced; no break/protrusion of nucleus pulposus

3) extrusion
—> nucleus pulposus protruding from annulus fibrosus (displacement & break)

4) sequestration
—> protruding as well as fragmenting / “dripping”

163
Q

DDD SSx 1

A

Many cases are asymptomatic

Imaging does not always correlate with symptoms

Pain across the lower back and hips

Occasionally pain into the leg

Worse with prolonged activity

Typically a history of back injuries

164
Q

pain vs damage (?)

A

like OA, can be much pain with little damage, vs little pain with much damage

(???)
“Imaging does not always correlate with symptoms”

165
Q

DDD SSx 2

A

Pain

From compression of structures

Nerve roots, ligaments, dura mater (meninges), blood vessels

Starts centrally where disc is affected and may spread laterally and increase in intensity

Gluteal area, thigh, leg, foot

Usually worse in the morning

Usually deep and poorly localized

166
Q

Scoliosis and DDD (?)

A

Scoliosis

FUNCTIONAL SCOLIOSIS

90% have a lateral shift away from pain (reduce compression)

167
Q

Functional scoliosis and Disc herniation

A

Transient functional scoliosis is typically a temporary response to pain in the body, most often caused by a herniated disc.

An individual may completely change their posture based on the pain they are experiencing, which could cause a curve without rotation in their spine.

168
Q

DDD SSx 3

A

Neurological signs

—> Decreased sensation
—> Motor weakness
—> Decreased reflexes

169
Q

symptoms get worse with…

A

Symptoms typically worsen with:

Flexion, sitting, coughing, bearing down

170
Q

symptoms get better with…

A

Symptoms typically decrease with:

Extension, standing, walking

171
Q

Cauda Equina

A

Cauda Equina = “horse tail”

Formed by nerve roots caudal to the level of spinal cord termination at L2

172
Q

Cauda Equina Syndrome

A

Syndrome due to compression of cauda equina

173
Q

Cauda Equina Syndrome cause

A

Trauma, infection, tumour, DJD, DDD/herniation, spinal anesthesia, AS, idiopathic

174
Q

Cauda Equina Syndrome SSx

A

Pain, numbness and tingling, mm weakness, poor lower body reflexes, saddle anaesthesia

Severe cases can lead to paralysis if not treated

175
Q

Lumbarization

A

Nonfusion of the first and second segments of the sacrum

One additional articulated vertebra (L6)

Sacrum consists of one less segment

May be asymptomatic and clinically insignificant

May lead to altered biomechanics

176
Q

Sacralization

A

Developmental abnormality in which the first sacral segment becomes fused with the fifth lumbar vertebra

Leads to extra long sacrum and four lumbar vertebrae

May be asymptomatic and clinically insignificant

May lead to altered biomechanics

177
Q
A

Semester 3 (32 decks)

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