Flashcards in Spinal Trauma/Clinical Anatomy of the Back Deck (20):
When interpreting a lateral C-spine X-ray, what are you looking to analyse?
Adequacy - Can you see all 7 vertebrae + the top of T1
Alignment - Draw 3 vertical parallel lines along the anterior + posterior border of the 7 vertebral bodies and a third line through the base of each spinous process
Asymmetry - Look for abnormal asymmetry between the 7 cervical vertebrae
What are the main important areas/questions you should ask relating to back pain?
Severity and systemic symptoms
Quality of pain
What is spondylosis?
Osteoarthritis in the synovial joints of the vertebra.
Common in cervical and lumbar regions - the joints become weak
Facet syndrom is a common cause of back pain - what can cause it?
It can be due to degenerative changes in the synovial joint (zygopophysial joint) or the ligamentum flavum. Pain is worse in rotation or lateral flexion
What is spondylolisthesis?
Anterior slip of a vertebra on the lower segment due to weakness of the ligamentum flavum or fracture of pedicle
Commonly L4/L5 or L5/S1 due to spondylosis
There may be impingement of the spinal nerve as it exits through the intervertebral foramen (formed by notch of superior and inferior pedicels)
What is cauda equina syndrome?
It refers to a collection of symptoms and signs that result from severe compression of the descending lumbar and sacral nerve roots within the lumbar cistern
What is the aetiology of cauda equina syndrome: degenerative?
+ Lumbar disc herniation (common)
What is the aetiology of cauda equina syndrome: traumatic?
+ Vertebral fracture or dislocation
+ Epidural haematoma (traumatic, post-operative)
What is the aetiology of cauda equina syndrome: infective?
+ Epidural abscess
What is the aetiology of cauda equina syndrome: malignant?
+ Primary CNS malignancies
What are the features of degenerative changes that may cause lumbar IV disc herniation?
+ Gelatinous NP replaces with fibrous tissue, unable to bear compressive forces
+ Weight transferred to AF causing fissures overt time
+ Once fissure reach peripheries of the IV disc risk of NP herniation
What are features of age-related changes that may cause lumbar IV disc herniation?
Annular tears occur when the water content declines with age, reducing tension in the AF
What are some clinical features of lumbar intervertebral disc herniation
+ Lower back pain (dull ache, worse with flexion)
+ Sciatica - pain pr paraesthesia in the dermatomal distribution of sciatic nerve (nerve roots L4,5, S1, 2, 3) and weakness of those myotomes
+ Usually postero-lateral IV disc herniation, impinging on spinal nerve root, because AF is think and lacks support of posterior longitudinal ligament
+ Anterior herniation of IV disk is often an emergency: cauda equina syndrom or spinal cord stenosis (if above L1/L2)
What are the classifications of vertebral metastasis?
Lytic lesions (bone destruction):
- renal cell carcinoma
- multiple myeloma
Sclerotic lesion (abnormal bone formation appears whiter)
- medullary thyroid cancer
What is osteomyelitis?
Infection of the vertebra (also commonly long bones)
What can cause osteomyelitis?
+ Infection with staphylococcus species (bacteria)
+ In sickle cell disease salmonella species (bacteria)
+ Pott's disease = pulmonary tuberculosis that has spread to the vertebra (uncommon)
How does the bacteria causing oseomyelitis spread?
+ Blood stream (recall blood supply to spin)
+ Direct (from infection in nearby tissue e.g cellulitis - recall veins lack valves in the spine)
+ During operation or procedures on the spine (streptococcus species - skin commensal)
What is discitis?
Infection of the intervertebral disc - similar aetiology and pathophysiology to osteomyelitis of the vertebra
Have a high suspicion of discitis in intravenous drug users with subacute pack pain
In athletes, what is lower back pain commonly caused by?
- ligament injury or strain = muscle or tendon injury
- especially in sports that involve repetitive hyperextension of the back e.g gymnastics, cricket, pole vault, weight lifters
2. Sponylosis and spondylolisthesis of the vertebrae
3. Disc herniation