Spine Flashcards
(18 cards)
Describe the features of a cervical vertebrae
-Bifid spinous process – the spinous process bifurcates at its distal end.
Exceptions to this are C1 (no spinous process) and C7 (spinous process is longer than that of C2-C6 and may not bifurcate).
-Transverse foramina – an opening in each transverse process, through which the vertebral arteries travel to the brain.
-Triangular vertebral foramen
Describe the features of a thoracic vertebrae
-Each thoracic vertebra has two ‘demi facets,’ superiorly and inferiorly placed on either side of its vertebral body.
-On the transverse processes of the thoracic vertebrae, there is a costal facet for articulation with the shaft of a single rib.
-The spinous processes of thoracic vertebrae are oriented obliquely inferiorly and posteriorly.
In contrast to the cervical vertebrae, the vertebral foramen of thoracic vertebrae is circular.
Describe the features of a lumbar vertebrae
- Lumbar vertebrae have very large vertebral bodies, which are kidney shaped. They lack the characteristic features of other vertebrae, with no transverse foramina, costal facets, or bifid spinous processes.
- However, like the cervical vertebrae, they have a triangular-shaped vertebral foramen. Their spinous processes are shorter than those of thoracic vertebrae and do not extend inferiorly below the level of the vertebral body.
How can you classify spinal fractures?
AO classification
Type A – compression injuries
Type B – distraction injuries
Type C – translation injuries
Describe the eponymous cervical fractures
- A Jefferson fracture is the eponymous name given to a burst fracture of the atlas (Fig. 2A). It is caused by axial loading of the cervical spine resulting in the occipital condyles being driven into the lateral masses of C1.
- A Hangman’s fracture, also termed as traumatic spondylolisthesis of the axis, describes a fracture through the pars interarticularis of C2 bilaterally (Fig. 2B), usually with subluxation of the C2 vertebra on C3. These are caused by cervical hyperextension.
- Odontoid peg fractures are common cervical fractures.
What are the risk factors mentioned in the canadian c-spine rules?
> 65 y/o
dangerous mechanism/trauma
paraesthesia in extremities
What differentials are there for cervical neck pain?
Cervical fracture
Cervical spondylosis
Whiplash injury
Cervical dislocation
What is the conservative management of suspected spinal fracture? Why?
-Immobilisation
3 point C spine immobilisation in cervical fracture
Prevents potential spinal cord damage
-Analgesia and physical therapy
Describe a burst fracture
A burst fracture occurs when there is a substantial compressive force acting through the anterior and middle column of the vertebrae, resulting in retropulsion of bone into the spinal canal.
Describe a chance fracture
Chance fractures are vertebral fractures that result from excessive flexion of the spine and involve all three spinal columns.
Common in head on collisions
What differentials are there for mid to lower back pain?
Thoracolumbar vertebrae fracture Disc prolapse Degenerative diseases Malignancy Infection e.g. osteomyelitis
What imaging can be done if there are no risk factors or secondary symptoms that indicate a vertebral fracture?
AP and lateral X ray
What imaging can be done if there are risk factors or secondary symptoms that indicate a vertebral fracture?
CT scan
MRI can also be done to see any damage to surrounding soft tissue structures
What are the stages of disc herniation?
Disc degeneration- disc weakens
Prolapse- nucleus pulposus protrudes but doesn’t escape annulus fibrosis
Extrusion- Nucleus pulposus breaks through annulus fibrosus. remains within disc space
Sequestration- nucleus pulposus breaks through annulus fibrosis and enters spinal canal
What is the main treatment of degenerative disc disease?
Analgesia
What are the 3 stages of degenerative disc disease?
Dysfunction – outer annular tears and separation of the endplate, cartilage destruction, and facet synovial reaction
Instability – disc resorption and loss of disc space height, along with facet capsular laxity, can lead to subluxation and spondylolisthesis
Restabilisation – degenerative changes lead to osteophyte formation and canal stenosis
How does degenerative disc disease present? How does it progress?
Local tenderness Contracted paraspinal muscles Hypomobility Painful extension of back or neck Later: radicular leg pain or paraesthesia
What clinical examination is used to assess for disc herniation in patients presenting with lumbago?
Lasegue test
With the patient lying down on their back, the examiner lifts the patient’s leg while the knee is straight. The ankle can be dorsiflexed and / or the cervical spine flexed for further assessment.
Positive sign is when pain is elicited.
