Spinal Flashcards
1
Q
how many vertebrae
A
33
2
Q
how many:
- cervical
- thoracid
- lumbar
- sacral/coccyx
A
7 cervical
12 thoracic
5 lumbar
9 sacral/coccyx
3
Q
what is the natural curvature of the neck
A
cervical lordosis aka anterior curve
4
Q
what is the natural curvature of thoracic spine
A
posterior curve aka thoracic kyphosis
5
Q
natural curve of the lumbar
A
lumbar lordosis aka anterior curve
6
Q
what is normal order of curvature from head to tailbone
A
Lordosis
Kyphosis
Lordosis
7
Q
what bears 80% of load
A
anterior arch–>vertebral body/discs
8
Q
whats in the anterior arch
A
vertebral bodies/discs
takes 80% of weight load
9
Q
pedicle
A
nerve roots
-area b/w body and transverse processes
10
Q
whats in the posterior arch
A
takes on 20% of weight
- pedicle
- transverse process
- superior and inferior articular processes
- lamina
- vertebral foramen
11
Q
what is lamina
A
thin, plate like area b/w spinous and transverse processes
12
Q
what runs thru vertebral foramen
A
vasculature
spinal cord
13
Q
radicular pain
A
pain + numbness + tingling
14
Q
what can we use to figure out what spinal root nerve has a problem
A
dermatome
15
Q
dermatome
A
cutaneous area supplied by a single spinal nerve root
**used to figure out which sensory deficit goes with which nerve root
16
Q
C _ _ and _ keep the ___ alive
A
C 3, 4, 5, keeps the diaphgram alive
17
Q
C5 dermatome
-what does nerve control
A
covers the outer part of the upper arm down to about the elbow
**deltoid
18
Q
C6 dermatome
-what does nerve control
A
covers thumb side of the hand and forearm
**control the wrist extensors (muscles that control wrist extension) and also provides some innervation to the biceps
19
Q
C7 dermatome
-what does nerve control
A
goes down the back of the arm and into the middle finger
**control the triceps (the large muscle on the back of the arm that straightens the elbow) and wrist extensor muscles
20
Q
C8 dermatome
-what does nerve control
A
pinky side of the hand and forearm
**helps control the hands, such as finger flexion (handgrip)
21
Q
L3 dermatome
A
front part of the thigh and inner part of the leg
22
Q
L4 dermatome
A
parts of the thigh, knee, leg, and foot
23
Q
L5 dermatome
A
parts knee, leg, and foot
24
Q
S1 dermatome
A
posterolateral thigh and leg and the lateral foot
25
S2 dermatome
strip of skin along the back of the thigh and the upper calf
***medial aspect
26
spinal stenosis
- what is it
- MCC? other etiologies (4)
- MC in who
- s/s
- what makes s/s worse, better
- Diagnostic test of choice
- management
*narrowing of the spinal canal with impingement of the nerve roots
MCC by:
1. degenerative arthritis
2. spondylolysis
Other etiologies:
* post-surgical
* congenital
* traumatic
* inflammatory
MC in:
*adults over 60
S/S
1. back pain
2. numbness + paresthesias-->rad to buttocks & thighs bilaterally
S/S WORSE W/:
*extension: prolonged standing, walking upright, walking downhill
S/S BETTER W:
* flexion: sitting, leaning forward (over shopping cart), walking uphill, cycling
* *****lumbar flexion increases canal volume******
TOC=MRI
```
Management:
*Pain control
*PT-->cycling, swimming
*steroid injections
*surgical= decompression
laminectomy
******surgery only for refractory or severe cases*****
```
27
Ankylosing Spondylitis
* what is it
* what joints are affected
* RFs (2)
* S/S
* labs
* imaging--initial test? most accurate?
- tx
Ankylosing=stiffness of joints due to FUSION of joints
* *chronic inflammatory arthropathy of axial skeleton
* **spine + sacro iliac joints + progressive spine stiffness
RF:
1. HLA-B27 positivity
2. young males 15-30 YO
S/S:
1. back pain + stiffness + decr ROM-->worse in the am or rest
2. Kyphosis, Sacroilitis **** and large joint arthritis
3. Extrarticular: Achilles tendon enthesitis, dactylitis, **Uveitis,
4. cardiac: AV blocks, aortic regurg,
5. pulm: fibrosis, decr chest expansion
LABS:
1. increased ESR
2. negative rheumatoid factor
3. negative ANA
IMAGING:
1. XR of SI joints is initial test
* *shows sacroiliitis (narrowing of the joint) -->early finding
2. bamboo spine: straightening of the spine (loss of normal lumbar curvature) + squaring and fusion of the vertebrae-->later findings
3. MRI= most accurate test
MANAGEMENT:
* first line: NSAIDS + exercise + PT
* second line: Anti-TNF drugs if no resp to NSAIDS
- -->Etanercept
- --> Adalimumab
- --> Infliximab
28
Herniated Disc aka Nucleus Pulposus
* MC where
* S/S: pain incrs with?
* PE findings
* Diagnosis: TOC imaging?
- TX: first line, 2nd line or worsening,
MC L5-S1
S/S:
* Radicular back pain
- unilateral
- rad down the leg w/ paresthesias or numbness in dermatomal pattern
-pain INCRS with: coughing, straining, bending, sitting, Valsavla
PE
* (+) straight leg raise
* next: figure out which disc is the problem
DIAGNOSIS:
* MRI is TOC
* XR: will see loss of disc height
TX:
* first line=conservative
- -> NSAIDs + continuation of ordinary activities as tolerated
* **if bed rest, should be brief
- PT
- more severe: muscle relaxers or oral steroids
*Corticoid injections if conservative tx fails (aka pain does not improve at all in two weeks OR it gets worse)
* surgical tx:
- ->laminectomy & discectomy if persistent, disabling pain >6 weeks not responding to other tx
29
where is the junction b/w the mobile and non-mobile spine
| -MC spot for?
L5-S1
| **MC spot for herniated disc
30
explain straight leg raise test
| (+) finding means?
raising leg-->positive pain after 30 degrees but before 70 degrees
***dont ask if this hurts and raise leg****
**INSTEAD: ask them, tell me when the pain starts hurting as you move leg upwards
31
straight leg test reveals:
| -anterior thigh pain with sensory loss to the medial ankle-->weak ankle dorsiflexion + loss of knee jerk
-l4 disc herniation
32
straight leg test reveals:
- lateral thigh/leg and dorsum of foot pain
- weak big toe extension
- walking on heels more difficult than on toes
- normal reflexes
L5 disc herniation
33
straight leg test reveals:
- posterior leg/calf and plantar surface of foot
- weak plantar flexion=walking on the toes is more difficult than on heels
- loss of ankle jerk
S1 disc herniation
34
compression fx
- aka
- occur?
- s/s
- diagnosis
burst fx
*occur: from jumping/falling from a great height, also can occur in elderly or bc of CA---- called pathologic lumbar compression fxs
S/S
*localized back pain with focal midline tenderness at level of fx
Diagnosis
* xrays: loss of vertebral height
* MRI or CT is neuro s/s
TX
1. orthopedic & neurosurgery consult to determine appropriate workup and management
2. conservative: observation, analgesics, bracing with gradual return to activity
3. surgical: kyphoplasty may be used if s/s are severe or persistent
35
Spondylolysis
- define
- due to?
- MC where
- MOA
- CM
- MC in who
Pars interarticularis defect due to failure of fusion or stress fx
* MC at L5-S1
* MOA: repetitive hyperextension trauma (football players, gymnasts, weight lifters
CM
* most cases asymptomatic
* low back pain with activity----MC in kids and adolescents
DIAGNOSIS
* xray: lateral views: radioluscent defect in pars
* CT scan
* bone scan
TX
1. low-grade or asympto: observation, no activity or restriction
2. Sympto: PT and activity restriction in some PTs
3. Bracing may be helpful for acute pars stress reaction or failed PT
36
Spondylolisthesis
- what is it
- MOA... MC? other causes
- CM.. MC?
- diagnosis
* Forward slipping of a vertebra on another-->bilateral fracture or defect of the pars interarticularis
* MOA: usually a complication of spondylolysis
* other causes: trauma, malignancy, congenital anomilies
CM
* most are asympto
* lower back pain MC symptom
* nerve compression: sciatica, bowel or bladder dysfunction and neurologic deficits if severe
DIAGNOSIS:
* xray: forward slipping of a vertebra. LATERAL views: used to measure slip angle and grade
* MRI: if neuro s/s present
TX
1. mild: tx like spondylolysis--PT, activity restrction in some cases
2. severe: cases may need surgical intervention
37
spondylolysis vs spondylolisthesis
spondylolysis-->defect of pars interarticularis from stress fx or failure to fuse---scottie dog sign--lumbar oblique projection--mc L5-S1
spondylolisthesis--->forward slipping of the vertebrae on another + bilateral fx or defect of pars interarticularis
38
Cauda Equina Syndrome
* define
* where does SC end
* where does cauda equina start and end
* role of cauda equina
* MCC and other causes
* CM
* diagnosis---toc
* tx
* mix of s/s that occur bc of spinal nerve compression in lumbosacral region
* SC ends at L1 ad L2-->cauda equina aka horses tail starts BELOW and goes from L2-S5
* cauda equina carries motor and sensory nerves and innervates bladder
MCC=lumbar disc herniation
Other causes: spinal inj, tumor, trauma, epidural abscess, epidural hematoma, vertebral fx
*****EMERGENCY--- call ortho/surgery/neuro IMMEDiATELY *******
CM
* back pain PLUS any ONE of the following:
1. radiculopathy: BILAT leg radiation of pain, weakness in multiple root distributions (L3-S1)
2. Involvement of S2-S4 spinal nerve roots: SADDLE ANESTHESIA-->decr sensation to buttocks, perineum and inner surfaces of the thigh----ED too!
3. New onset urinary or bowel retention OR incontinence
4. Decr anal sphincter tone on PE
DIAG
* MRI toc
* if MRI contra (ex pt has pacemaker)---CT
TX---CALL ORTHO/SURGERY/NEURO ASAP
1. emergent decompression
2. Corticosteroids to reduce infalmm
39
anterior thigh pain; weak ankle dorsiflexion; loss of knee jerk
L4 herniation
40
s/s for L4 herniation
* anterior thigh pain
* weak ankle dorsiflexion
* loss of knee jerk
41
lateral thigh/leg and dorsum of foot pain; weak big toe extension. Walking on heels more difficult than on toes. Reflexes normal
L5 disc herniation
42
s/s for L5 disc hern
* lateral thigh/leg and dorsum of foot pain
* weak big toe extension
* walking on heels more diff than toes
* reflexes normal
43
posterior leg/calf and plantar surface of foot; weak plantar flexion = walking on the toes is more difficult than on heels. Loss of ankle jerk
s/s of S1 disc hern
44
s/s of S1 disc hern
* posterior leg/calf and plantar surface of foot pain
* weak plantar flexion
* walking on the toes is more diff than heels
* loss of ankle jerk
