Spine Flashcards
(37 cards)
Sagittal plumb line?
Line from C2 cross C7-T1 intervertebral disc, T12-L1 intervertebral disc and posterior superior corner S1
Gibbus
An acute angular deformity of the spine
Kyphosis
Abnormally increases convex curvature of the thoracic spine
Scoliosis
3-D deformity of the spine defined as a lateral curvature of the spine in the coronal plane of more than 10 degree of Cobb angle.
Spine infection : Pyogenic spondylodiscitis
Key features (12 points)
- Acute
- Staph. Aureus / Gram negative (Pseudomonas, E.coli)
- Site = Lumbar
-Origin = Vertebral end plate
-Spread = PLL causing epidural abscess
-Single level
-No skip lesions
-Abundant bone formation
-Segmental deformity
-Involvement 3 columns
-Disc in MRI = destroyed early
-Less osteoporosis
Spine infection : Tuberculous spondylodiscitis
Key features (12 points)
- Chronic
- Mycobacterium tuberculosis
- Site = Thoracic
- Origin = Anterior superior/inferior corners at metaphyseal region
- Spread = ALL causing psoas/paravertebral abscess
- Multilevel
- Skip lesions
- Minimal bone formation
- Angular deformity
- Involve anterior column
- Osteoporosis
- Disc preserved until late
Degenerative spine disease :
- Definition and stage
Definition : Natural aging process of spinal column
Stage :
1. Annular and internal disc disruption
2. Prolapsed disc
3. Spondylosis (Degeneration of vertebra/disc/facet with bone), osteophyte formed at foramina or spinal canal (stenosis)
4. Spondylolisthesis
Wiltse-Newman-Mcnab Classification
I - Congenital = Dysplastic abnormalities in the posterior elements or the upper sacrum cause listless
II - Isthmus = A : Lytic, presumed to be stress fracture of pars
B : A healed version of lytic type, resulting in an elongated but intact pars
C : Acute fracture of pars from high energy
III - Degenerative = Neural arch is intact, olisthesis due to longstanding segmental instability
IV - Traumatic = Fracture other than pars
V - Pathologic = Generalized or localized bone disease leads to olisthesis
VI - Postsurgical
Myerding scale
A classification of degree of anterior displacement
1 = <25%
2 = 25-50%
3 = 50-75%
4 = 75-100%
5 = >100%
Define spondylolysis
Defect in pars articularis with no movement of vertebral bodies
= Oblique view to assess pars (Pars = neck of scotty dog)
5 common primary site for spine metastasis?
- Lungs
- Breast
- Prostate
- Kidney
- Thyroid
- Gastro-intestinal
Harrington classification of metastatic disease of spine
I - No significant neurological involvement (Non-surgical)
II - Involvement of bone without neuro (Non-surgical)
III - Major neuro impairment (sensory/motor) without bone (Indeterminate)
IV - Vertebral collapse with pain resulting from mechanical causes or instability (Surgical)
V - Vertebral collapse or instability combined with major neuro impairment (Surgical)
Prevertebral soft tissue shadow
2cm at C6, 6mm at C2
Atlantodens interval (ADI)
ADI difference in flexion and extension
>3mm = Instability
>6mm = Disruption of alar ligaments
>9mm = High risk of neurological injury
Steel’s rule
1/3 by dens
1/3 by spinal cord
1/3 by free space
Spinal cord injury
- Primary injury
- Secondary injury (Ischaemia & Hypoxia)
a. Local factors
- Compression of spinal cord
- Haemorrhage
- Loss of auto regulation
- Inflammation and edema
b. Systemic factors
- Respiratory compromise
- Hypotension
NASCIS (National Acute Spinal Cord Injury)
NASCIS 2
- Dosage = Bolus 30mg/kg followed by 5.4mg/kg for the next 23 hours
> Steroid given within 8 hours has a better outcome
NASCIS 3
- Dosage = Bolus 30mg/kg followed by 5.4mg/kg for 24 or 48 hours
> Patients who receive steroid treatment within 3 hours showed no difference if steroids is given within 24 or 48 hours
> If between 3-8 hours, will have advantage if steroid continued for 48 hours
Treatment for scoliosis
Based on the degree of curvature
10-20 = Observation
20-45 or progressive = Bracing
>45 degree = Surgical correction
Mechanical pain without instability
1). Symptoms = Musculo-ligamentous pain
Anatomical site = Musculo-ligamentous
Pathophysiology = Musculo-ligamentous injury/sprain
2). Symptoms = Discogenic pain aggravated by activities that increase pressure within the disc
Anatomical site = Intervertebral disc
Pathophysiology = Disc disruption mediated through the sine-vertebral nerve
3). Symptoms = Facet pain - aggravated by hypertension, where facet joints capsule stretches
Anatomical site = Facet joint
Pathophysiology = Facet synovitis or arthrosis
Mechanical pain with instability
Symptom = Pain aggravated with movement
Anatomical site = Spinal unit
Pathophysiology = Disruption of spinal unit (degenerative, spondylolisthesis, fracture, tumor, infection)
Inflammatory pain
Symptoms = Rest pain , night pain
Anatomical site = Spinal unit
Pathophysiology = Inflammatory disease, tumor, infection or metabolic
Neurological symptoms (UNILATERAL)
Sciatica or radicular pain
> lateral recess stenosis
> Radiculopathy = compression of nerve root by prolapse disc and facet hypertrophy
Neurological symptoms (BILATERAL)
Intermittent or neurological claudication, severe can lead to CES
> Central canal stenosis
> Due to posterior osteophytes, anterior disc, hypertrophied facet joints, and ligamentum flavum posteriorly
Upper motor neuron symptoms
>Central canal stenosis (Thoracic, cervical)
>Myelopathy
Red flags in back pain
- Very young <20 years old
- Very old >60 years old
- Night pain or rest pain
- Pain in thoracic spine
- Change in character of pain
- Constitutional symptoms
- Neurological deficits
