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Orthopaedics > Spinal conditions > Flashcards

Spinal conditions Flashcards

1
Q

clinical features of mechanical back pain

A

comes on suddely in 60% of cases
-reported bending or lifting episode

v common- 80% of adults get it at some point

can be present with or without assoc leg pain

ALWAYS RULE OUT RED FLAG FEATURES

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2
Q

differential diagnossi for mechanical back pain 10

A

mechanical back pain

OA of spine

prolpased intervertebral disc

spinal stenosis

spondlyolisthesis

discitis

inflammatory causes

malignancy

fracture

referred
-abdo
-hip pevlis SI joints

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3
Q

red flag syx of lower back apin 5

A

age <20 or >50

history of previous malignancy

night pain

history of trauma

systemically unwell
-weight loss
-fever

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4
Q

Ix for mechanical back pain 6

A

no Ix needed unless differential is suspected

patients with short history <6wks do not need routine investigations

prolonged syx or red flags:
-FBC with differential WCC
-ESR
-LFTs
-Bone profile
-Myeloma screen
-CRP

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5
Q

management of mechanical back pain 4

A

promote patient education

early syx control w simple analgesia

early return to normal activities

self referral to physiotherapists

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6
Q

what is nerve root impingement often a consequence of

A

degenerative disc disease

intervertebral disc herniation is most common in 3rd and 4th decades

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7
Q

where do the majority of intervertebral disc herniations occur

A

over 95% occur at L4/5 or L5/S1

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8
Q

basic pathophys of intervertebral disc heriniations leading to nerve root impingement

A

nucleus pulpous prolapses out via a defect in degenerative annulus fibrous

compresses the adjacent nerve root or the exiting nerve root, depending on location of disc herniation

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9
Q

syx of nerve root impingement 2

A

radicular pain passes below the knee and follows the dermatome of the involved nerve root

leg pain caused by hernitated disc is commonly equal to or worse in severity to that of the back pain itself

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10
Q

test for nerve root impingement 1
-diagnostic sign in this test

A

straight leg raising
-pain with SLR due to increased nerve root tension and lack of normal excursion of the root at the herniation site

Lasegue sign (this is the finding found in SLR)
-causes pain in ipsilateral leg distal to knee
-if contralateral leg pain this is a sign of disc herniation

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11
Q

diagnosis of nerve root impingement 1

A

MRI

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12
Q

what are indications for an MRI in a suspected nerve root impingement patient 3

A

patient present with radicular pain >6wks who have failed conservative measures

patients who develop neurologic deficits

bilateral lower limb deficits or peroneal syx
-NEED URGEN REFERRAL TO ORTHOPAEIDS AND EMERGENCY MRI TO RULE OUT CAUDA EQUINA

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13
Q

define radicular pain

A

type of pain that radiates from your back and hip into your legs through the spine

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14
Q

non-surgical management of nerve root impingement patient 4

A

majority non surgically:
-physiotherapy
-analgesic (simple analgesia and NSAIDs)
-muscle relaxants (limited short course initially)
-alternative therapies (acupuncture)

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15
Q

when could surgery be considered for nerve root impingement patient

A

no earlier than 6 weeks from onset of syx
UNLESS:
-cauda equina syndrome
-progressive neurological deficits

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16
Q

absoliute indcations for nerve root impingement surgery 2

A

cauda equina syndrome

progressive neurological deficit

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17
Q

relative indications for nerve root impingement surgery 3

A

intractable radicular pain

neurological deficit not improving conservatively

recurrent sciatica following successful trial of conservative measures

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18
Q

what are 5 serious spinal pathology

A

cauda equina syndrome

infection

tumour and spinal cord compression

spinal injuries

inflammatory conditions (Ank Spon)

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19
Q

red flag spinal pathology features 10

A

<18 or >50 at onset of non-mechanical pain

bilateral radicular leg pain

limb weakness

bladder or bowel dysfunction

peri-anal numbness

Hx of cancer

constituaonal syx

trauma

thoracic pain

history of immuno-compromise or prolonged steroid use

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20
Q

clinical features of cauda equina syndrome 2

A

bilateral syx of paresthia or mscule weakness

enquire about:
-saddle parestehia
-bladder and bowel dysfunction

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21
Q

red flag cauda equina syndrome history compoentes 4

A

back pain w uni/bilateral sciatica

lower limb weakness

altered perianal sensation

faecal or urinary incontinence

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22
Q

examination red flag features of cauda equina syndrome 5

A

limb weakness

other neuro deficits/ gait disturbance

hyper-reflexia, clonus, up-going plantars

urine retention

DRE- saddle anaetehisa, loss of anal tone

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23
Q

investigations of cauda equina syndrome 3

A

full history and exam
-DO PR W SENSATION AND ANAL TONE

bladder scan pre and post void to assess for bladder emptying

if sus of CEs-> urgert MRI

24
Q

managemetn of cauda equina syndrome 1

A

urgent surgical decompression

25
Q

MRI findings in cauda equina syndrome 2

A

complete obliteration of spinal canal space

compression of cauda equina

26
Q

define discitis

A

infection of the disc space

27
Q

define vertebral osteomyeltis

A

infection of vertebral body

28
Q

assoications with discitis and vertebral osteomyelitis 3

A

IV drug use

sepsis from another source

post spinal surgery

29
Q

organisms causing discitis and vertebral osteomyelitis 4

A

staph and strep most common

strep and haemophilus in children

tuberculosis -should be considered

30
Q

clinical presenation of discitis and vertebral osteomyelitis 4

A

fever

generally unwell

back pain (unrelenting)

late cases can have spinal deformity
-kyphosis
-scoliosis

31
Q

investigations of discitis and vertebral osteomyelitis 5

A

blood
-WCC
-ESR
-CRP

imaging
-X-ray- look for deformities
-MRI- increased signal in intervertebral disc or bone/ collection/ assoc epidural abscess

32
Q

management of discitis and vertebral osteomyelitis 3

A

biopsy via CT guided

appropriate IV ANx- minimum 6 wks

surgical treatment occasionally required
-stabilisation
-draining a large abscess

33
Q

spinal tumour clinical presenation 2

A

in adults metastic tumours are most common spinal tumours

present with:
-pain
-neurological

*-always ask red flags

34
Q

spinal tumour investigations 3

A

MRI whole spine
-esp if ptx hx of cancer and new onset back pain

bone scan

serum calcium
-check for hypercalcemia

35
Q

overviwe of malignant spinal cord compression

A

occasionally patients with spine mets present with compression of spinal cord

THIS IS A NEURO EMERGENCY

emergency radiotehrapy or surgical decompression is usually indicated

36
Q

what does spinal injuries include

A

includes fractures, subluxations and dislocations

as a result of direct or indirect trauma

37
Q

state the two classifications for spinal fractures 2

A

high energy injuries
-RTAs, fall from height

low energy
-elderly patients with osteoporosis or metastatic disease

*-note 10-20% of ptx w spinal fractures have a second fracture at another level

38
Q

spinal fracture types based on anatomy 3

A

isolated anterior column fractures
-wedge compression
-tends to be stable

column (burst fractures) or associated ligament injuries tend to be unstable

39
Q

clinical assessment of spinal injuries in patients

A

high energy:
-ATLS perspective
-patients with facial or head injuries should be presumed to have a significant neck injury until proven otherwise
-patients log rolled w C-spine control when spinal injury suspected

40
Q

on examination what are sx of spinal injuries 4

A

bony midline tenderness

clinical deformity or palpable step

boggy swelling or brusing

neurological compromise

41
Q

features of spinal shock 2

A

bradycardia

hypotension

42
Q

diagnosis and imaging for spinal injuries 3

A

XR
-C-spine
-AP/lateral/ peg view

T&L spine
-AP & lateral

CT
-for high energy injruies
-more than 1 column involvement

MRI
-if assessing ligament or spinal cord injuries

43
Q

treatment of stable cervical spinal injuries 2

A

cervical
-cervical collar
-analgesia

44
Q

treatment of stable thoracic and lumbar spinal injuries 2

A

thoracic and lumber
-early mobilisation
-bracing for symptomatic relief

45
Q

treatment of unstable cervical spinal injuries 3

A

HALO jacket

cerivcal collar (extended duration)

ORIF

46
Q

treatment of unstable thoracic & lumbar spinal injuries 3

A

ORIF

bracing (extended duration)

bed rest in medically unfit patients

47
Q

first steps in spinal cord injuries 2

A

surgical decompression

stabilisation

48
Q

define scoliosis

A

lateral deviation or rotational deformity of the spine

49
Q

causes of scoliosis 4

A

idiopathic -most common

neuromuscular

congenital

secondary

50
Q

clinical features of scoliosis 4

A

pain uncommon
-if present should prompt further investigation

rib hump

asymmetrical shoulder height

limb length inequality

chest expansion may be affected in severe deformites

51
Q

treatment of mild curve scoliosis 2

A

majority of idiopathic curves
-conservative treatment

occasionally bracing if risk of progression of curve identified

52
Q

treatment of moderate/severe curve scoliosis

A

more commonly assoc w neuromusclar condtions or congenital curves

-surgical correction to prevent progression
-or to prevent deformity compromising cardio/respiratory function

53
Q

neuromusulcar conditions causing scoliosis

A

ncluding central nervous system disorders such as cerebral palsy and spinal cord injury; motor neuron disorders, for example, spinal muscular atrophy; muscle fiber disorders, for example, Duchenne muscular dystrophy; multifactorial disorders, for example, …

54
Q

define kyphosis

A

exageratted forward rounding of the upper back

55
Q

cause of kyphosis

A

poor posture in childhood

or scheuermanns kyphosis
-vertebrae dont develop properly

56
Q

treatment of kyphosis

A

reduce weight bearing and strenusous activites

rarely- brace or surgery

57
Q

define fixed and flexible kyphosis

A

fixed- cant straighten spine when standing straight
-due to abnormal vertebrae (scheuermanns kyphosis)

felxible- can straighten spine

Orthopaedics (15 decks)

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