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othopaedics > spinal pathologies > Flashcards

spinal pathologies Flashcards

1
Q

adolescent presentation of spinal ortho

A

scolisosis

stress fracture

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2
Q

adult presentation of spinal ortho

A

non-specific back pain
DDD
Inflammatory arthritis

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3
Q

adult >60 presentation of spinal ortho

A

spinal stenosis
osteoporotic #
metastasis

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4
Q

other causes of back pain

A
  • thoracic night pain malignancy
  • infection
  • referred pain pancreatitis, renal, peritonism, AAA
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5
Q

what is a true radicular pain

A

pain that follows the dermatome

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6
Q

red flags of spine history

A
  • neurology CES features
  • immunosuppressed, IVDU
  • malignancy: weight loss and fever
  • trauma
  • change in urinary retention, incontinence (cauda equina)
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7
Q

upper motor neuron lesion vs lower mn

A

upper=hyperreflexia, hypertonia, babinski reflex

lower=hyporeflexia, weakness and muscle wasting

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8
Q 
myotomes
c5
c6
c7
c8
t1
A 
c5=shoulder abduction
c6=wrist extensors and elbow flexion
c7=elbow extensors and wrist flexion 
c8=thumb extension 
t1=finger abduction
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9
Q

myotomes

l1-s2

A 
l1/l2=hip flexion
l3=knee flexion
l4=ankle dorsiflexion
l5=big toe extension
s2=knee flexion
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10
Q

what is tip toe walking caused by

A

s1 weakness

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11
Q

what if heel walking caused by

A

l5 weakness as cant dorsiflex big toe

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12
Q

what causes flexion from the hips when walking

A

ank spond

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13
Q

what is the tape measure test called

A

schober’s test

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14
Q

MRC scale of power

A

grade 5=normal

grade o=no muscle movement

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15
Q

imaging of the spine and what they are for

A

x-ray=hard to interpret
mri=shows oedema and soft tissue
ct=fractures

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16
Q

what does a winking owl sign mean

A

loss of pedicle

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17
Q

case: 40 yr old man with lumbar back pain radiating to thighs and no other hx

A

=non-specific back pain

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18
Q

case: 35 year old female lumbar back pain radiating to right foot 1 week, weak plantar flex and calf reflex, normal perineum sensation

A

loss of s1 dermatome

degenerative disc disease

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19
Q

case 3: 6 month back pain and leg weakness, worse on walking struggle to walk 100 yards

A

spinal stenosis

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20
Q

case 4: 6 day hx of back pain, IVDU and fever

A

spinal infection

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21
Q

case 5: 30 year old female, hx of back pain and 12 hr history painless incontinence with absent anal tone and perineum sensation

A

cauda equina syndrome

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22
Q

what are the main back pathologies

A
  • non specific lower back pain
  • degenerative disc disease
  • spinal stenosis
  • spinal infection
  • cauda equina
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23
Q

non specific lower back pain prevalence

A

50-80% experience an episode at some point

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24
Q

features of a non-specific lower back pain

A
  • no nerve route involvement
  • muscle strain/spasm
  • degneration of spine(but no neuro involvement)
  • large psychosocial component
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25
Q

who do you image for non specific lower back pain 4

A

only those with red flag features

  • neurology
  • immunosuppression
  • malignancy
  • trauma
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26
Q

treatment for non specific lower back pain

A

-mobilise
-physio
-analgesia
-reassure
recovers in own time

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27
Q

degenerative disc disease cause

A
  • disc herniation via degenerative annulus fibrosis into spinal cord
  • bulging of the disc
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28
Q

clinical features of degenerative disc

A
  • nerve route involvement
  • but no bladder involvement
  • l5/s1 most common (heel walk or tip toe)
  • unilateral
  • pain radiates to hip/buttock or thigh
  • worse with walking or axial loading
  • radicular symptoms
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29
Q

management for DDD

A

-conservative for 3 months and 90% settle with analgesia, physio
-non-conservative after 3 months
either discectomy take out herniated bit or laminectomy- remove the back part

30
Q

spinal stenosis what should you think of

A

claudication symptoms but strong pulses

31
Q

cause of spinal stenosis

A

reduction of lumbar spine canal due to degeneration

  • narrow and impinge of nerve roots or cauda equina
  • osteophytes/spondylolithesis
  • soft tissue
32
Q

what is spondylolithesis

A

slipping of vertebrae

-anterior translation

33
Q

clinical features of spinal stenosis

A
  • central crushing= non specific lower limb weakness
  • foraminal stenosis= corresponds to nerve root
  • worse up hill extension and relieved on sitting flexion
34
Q

treatment of spinal stenosis

A

lumbar decompression

35
Q

what causes spinal stenosis in a young person

A

stress fracture in sport causing sponylolysis

36
Q

meaning of sponylolysis

A

fatigue fracture leads to a defect in the pars interarticularsis of the vertbral arch in the pedicle

37
Q

what can spondylolysis lead too

A

spondylolisthesis or slippage of vertebrae

38
Q

who is spondylolysis more common in and where

A

more common in females at L5

39
Q

risk factors for spondylolysis

A

hereditary

over use-gymnast

40
Q

management spondylolysis

A

rest
analgesia
brace
physio

41
Q

where does spondylolithesis usually happen

A

l4/l5

42
Q

causes of spondylolithesis

A
  • congenital
  • isthemic secondary to spondylolysis
  • arthritis degenerative
  • traum
  • pagets
  • iatrogenic post op
43
Q

clinical features of spondylolithesis

A
  • asymptomatic possibly
  • insidious onset lbp and muscle spasm
  • flattening of the back
  • claudication symptoms
44
Q

what is adult pyogenic vertebral osteomyelitis

A
  • also known as discitis

- infection of the intervertebral disc and adjacent vertebrae

45
Q

what is an epidural abscess

A

pus between the dura mater and surrounding adipose in spinal cord
-often seen with discitis

46
Q

what is discitis

A

collection of pus of inflammatory granulation tissue between intevertebral discs

47
Q

what are the risk factors for discitis

A
  • ivdu
  • diabetes
  • recent systemic infection (uti,pneumonia)
  • obesity
  • malignancy
  • immunosuppressive
  • malnutrition
  • smoking
48
Q

pathogens

A

staph aureus

staph epidermidis

49
Q

route of infection for spinal infection

A
  • haematogenous
  • direct
  • local infection
50
Q

clinical presentation of spinal infection

A
  • 1/3 have fever
  • pain that is unrelenting and wakes patient
  • neurology: radiculopathy, myelopathy (spinal cord)
51
Q

investigation of spinal infection

A
  • inflamamtory markers
  • MRI
  • blood culture
52
Q

treatment spinal infection

A
  • antibiotics
  • dont miss endocarditis in sab
  • decompression, debride and stabilise
53
Q

where does the cauda quina start and what does it occupy

A

starts at the conus medullaris at l2

-occupies the lumbar cisterna

54
Q

what goes through the cauda equina

A

the filum terminale

55
Q

prevalence cauda equina

A

1in 65,000

56
Q

causes of cauda equina

A
  • central compression of cauda equina
  • large central disc prolapses
  • inflamamtory, trauma, infection and malignancy less common
57
Q

diagnosis of cauda equina

A
  • perianal/saddle anaesthesia: loss of sensation to the back of the buttocks
  • bladder/ bowel dysfunction
  • reduced or absent anal tone
58
Q

2 types of cauda equina syndrome and prevalence

A

CES-I : incomplete 40%

CES: R with retention 60%

59
Q

what is an incomplete cauda equina

A
  • perianal/ saddle anaesthesia: loss of sensation to back of buttocks
  • and weak anal tone
  • hesitancy or lack of urine control
60
Q

what is a cauda equina with retention

A
  • dense paraesthesia and absent anal tone

- often overflow incontinence

61
Q

range of other symptoms cauda equina syndrome

A
  • lbp
  • bilateral leg pain
  • lower limb paraesthesia &/or motor weakness
  • reduction/absent lower limb reflexes
  • unilateral/bilateral
  • sexual dysfunction
62
Q

diagnosis of cauda equina

A

Emergency MRI

63
Q

treatment of cauda equina

A

emergency decompression in 48 hours

64
Q

poor prognosis cauda equina

A
  • poor if delayed
  • sexual and urinary dysfunction
  • chronic pain and weakness
65
Q

precautions for a spinal injury

A

log roll
lie flat
catheterised

66
Q

management of spinal injury

A 
c-spine immobilise
decompress cord
stabilise fracture
steroids within 1st 8hrs
extensive rehab
catheter if in retention
67
Q

what is tetraplegia

A

injury to cervical spine and impaired arms, legs and spine

68
Q

what is paraplegia

A

injury to thoracic/lumbar and sacral

-get impaired legs, trunk and pelvis

69
Q

what is neurogenic shock

A

loss of sympathetic trunk activity with profound shock (hr and bp)

70
Q

what is a complete injury spine

A

injury with no sparing of motor or sensory function below level

71
Q

what is an incomplete spinal injury

A

injury with some preserved motor and sensory below a certain level

othopaedics (21 decks)

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