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Spine Flashcards

1
Q

What are chance fractures?

A

trauma fractures of T and L spine due to flexion-distraction mechanism.
A/w high rates of mechanical instability and GI injuries.

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2
Q

In chance fractures how to spinal columns fail

A

Mid and post columns fail under tension
Ant column fails under compression

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3
Q

Comp of chance fracture?

A

Deformity - scoliosis, progressive kyphosis, flat back, post-trauma syringomyelia
Nonunion

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4
Q

Lumbar vertebrae has no _______

A

No transverse foramina, costal facets, bifida spinous processes

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5
Q

What is spondylosis?

A

With ageing, bones and discs degenerate. Bone spurs [osteophytes] may form and spinal canal narrows.
Osteophytes can fuse vertebrae together to minimize movement

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6
Q

Degenerative cycle of spondylosis includes?

A

Disc degeneration - disc bulging, possible disc herniation
Joint degeneration
Ligamentous changes = Ligamentum flavum thickening
Deformity = kyphosis sec to loss of disc height

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7
Q

Neurological manifestations of cervical spondylosis?

A

Cervical radiculopathy
Cervical myelopathy
Lumbar radiculopathy
Lumbar spinal stenosis

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8
Q

Cervical radiculopathy causes?

A

Degenerative cervical spondylosis
Disc herniation - posterolateral herniation commonest

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9
Q

Characteristics of cervical radiculopathy?

A

Unilateral arm pain, numbness + tingling in dermatomal distribution in hand.
Weakness in specific muscle groups
Occipital headache, trapezial or interscapular pain
Neck pain worse with vertebral motion
Pain can radiate to shoulders

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10
Q

Provocative tests for cervical radiculopathy

A

Spurling’s test
Shoulder abduction test
UL tension tests
Valsalva maneuver
Neck distraction test

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11
Q

3 signs of Prolapsed Intervertebral Disc on MRI

A

Disc prolapse w/wo nerve root compression
Narrowed intervertebral height
Dark signal intensity

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12
Q

Marker of severity in PID imaging?

A

Pavlov’s ratio = diameter of spinal canal/diameter of vertebral body.
Normal is above 1. Spinal stenosis shows below 0.8

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13
Q

Evaluation method for scoliosis?

A

Cobb’s angle (T12-L4)
above 10 means scoliosis

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14
Q

Criteria for stable / unstable acute spine fractures?

A

Number of affected columns!
1 = stable
2 or more = unstable
Disruption of post ligamentous complex = chronic unstable

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15
Q

Criteria for stable / unstable acute spine fractures?

A

Number of affected columns!
1 = stable
2 or more = unstable
Disruption of post ligamentous complex = chronic unstable

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16
Q

What is radiculopathy?

A

Nerve root lesion causing neurological effect of affected dermatomes and myotomes

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17
Q

What is Prolapsed Intervertebral Disc?

A

Posterior/postero-lateral bulging of disc with outer part of annulus intact towards spinal canal

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18
Q

What posture lowers/raises intradiscal pressure?

A

Lowest = lying on bed
Highest = sitting and bending forwards simultaneously

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19
Q

Signs of PID on MRI?

A

Disc prolapse w/wo nerve root compression
Narrowed interverterbral height
Dark signal intensity

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20
Q

Surgical principles for PID?

A

Decompression + instrumentation + fusion

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21
Q

What is Ankylosing Spondylitis?

A

Chronic inflammatory disease of unknown etiology affecting spine.
Commonest spondyloarthropathy

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22
Q

Hallmark of ankylosing spondylitis?

A

Synovial joint of SI joint involved at Axial skeleton

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23
Q

Progress of ankylosing spondylitis?

A

Widened with erosions at first, then ankylosis

Bilaterally symmetrical

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24
Q

Genetic factor for Ankylosing Spondylitis?

A

HLA-B 27 positive in >90%

25
Presentation of Ankylosing Spondylitis?
Lower back pain and stiffness, worse in morning. SOB due to costovertebral joint involvement = poor chest expansion Systemic manifestations
26
What does neurogenic claudication point towards in spine?
Lumbar spinal stenosis
27
Clinical presentation of Spondylosis in axial spine?
Neck or back pain Facetogenic pain due to facet joint arthritis - worse on extension and standing Discogenic pain - worse on flexion and sitting Stiffness and reduced ROM Can cause deformities like Kyphoscoliosis
28
Myelopathy vs Radiculopathy?
Myelopathy is compression of spinal cord. Radiculopathy in nerve root lesion causing neurological defect of affected dermatomes and myotomes
29
Some causes of myelopathy/radiculopathy?
PID Bulging intervertebral disc Hypertrophied/infolding of ligamentum flavum Osteophytes/Syndesmophytes
30
Presentation of Cervical Myelopathy?
Chronic Bilateral Shooting radicular pain Patchy numbness>pain Clumsiness Unsteadiness Autonomic dysfunction ## Footnote What abt compared to cervical radiculopathy?
31
Presentation of Cervical Radiculopathy?
Acute Unilateral Pain > Dermatomal numbness
32
Presentation of Lumbar Spinal stenosis?
Chronic Bilateral Back pain + neurogenic claudication Patchy numbness>pain Clumsiness Unsteadiness Autonomic dysfunction | No autonomic dysfunction, loss in postural stability
33
Presentation of lumbar radiculopathy?
Acute Unilateral Shooting radicular pain Pain > Dermatomal numbness | No autonomic dysfunction, loss in postural stability
34
Difference btw paracentral and foraminal herniation?
Cervical = Paracentral & Far lateral prolapse affects same nerve root Lumbar = Paracentral & far lateral prolapse affect different nerve roots
35
Affected **Power** in cervical level patho?
C4 - scapula winging and respiration C5 = Elbow flexion [Biceps, brachioradialis] C6 = Wrist extension [ECRL, ECRB] C7 = Elbow extension [Triceps] C8 = DIP middle finger flexion [FDP] T1 = Pinky abduction [ADM]
36
Affected **Sensory** in Cervical level patho?
C2 = behind ear C3 = on SCM C4 = Clavicles and base of neck C5 = lateral arm, regimental patch C6 = Palmar thumb C7= Palmar middle finger C8 = Palmar pinky T1 = Medial elbow - ulnar side of antecubital fossa
37
**Reflex** affected in Cervical level patho?
C5 = Biceps jerk C6 = Supinator reflex C7, C8 = Triceps jerk
38
**Motor** affected in Lumbar level patho?
L2 = Hip flexion [iliopsoas] L3 = Knee extension [Quads] L4 = ankle dorsiflexion [tibialis ant] L5 = Big toe dorsiflexion [Extensor hallucis longus] S1 = Ankle plantarflexion [gastro, soleus]
39
**Sensory** affected in Lumbar level patho?
L2 = Anteromedial thigh L3 = Medial femoral condyle above knee L4 = over Medial Malleolus L5 = Dorsum of foot, 3rd MTPJ S1 = Lateral aspect of calcaneus [soleus]
40
**Reflex** affected in Lumbar level patho?
L2 ~ L4 = Knee jerk S1 = Ankle jerk
41
Suggestive signs or Cervical spine fracture/injury
Unconscious from head injury Abnormal head position Tenderness on palpation Pain and paraesthesia in limbs (spinal cord or nerve root injury)
42
Which section of spine especially prone to injury? Why?
Thoracolumbar junction! Transition point btw relatively fixed thoracic spine and relatively mobile lumbar spine
43
C1 Burst fracture? Jefferson fracture!
Sudden severe load on head - axial compression - ring of atlas fracture
44
C2 Pedicle fracture? Hangman fracture
Often in RTA when forehead strikes dashboard - bilateral pars articularis fracture - spondylolisthesis
45
Fracture dislocation injury of spine?
Ant + Medial + Post fracture. Translation of one vertebra over another. Mechanism is high energy injury. Commonly thoracolumbar area affected
46
What can be seen in XR of Wedge compression fracture?
Decrease in anterior height. Wedge is when front of vertebral body collapses but the back does not
47
What can be seen in Burst fracture XR?
Uniform loss of vertebral height Burst is vertebrae crushed in all directions
48
What can be seen in Chance fracture XR?
Ant column loss of vertebral body height Transverse fracture extending through pedicles/transverse processes. | From Lat view
49
XR views for cervical spine investigations?
AP Lateral** Open mouth Odontoid.** To view C1 and C2 e.g. their alignment etc.
50
Anatomic lines in Spine lateral view XR?
Ant vertebral line Post vertebral line Spinolaminar line Posterior Spinous line
51
Definitive management for spinal fractures by type?
Stable = Closed reduction KIV open with spine brace Unstable = Surgical decompression + Spinal stabilization Neurological deficit = Surgical decompression Long-term rehab = PT, OT
52
What is cauda equina syndrome? | Emergency!!
Severe compression of nerve roots in thecal sac of lumbar spine. Most commonly **L4-5 level** Most commonly due to acute lumbar disc herniation
53
Early diagnosis of Cauda Equina critical, clinically presents as _____
Characteristic symptoms of saddle-like paresthesias + Acute back and leg pain. Other symptoms include bowel and bladder dysfunction, Lower extremity weakness/arreflexia ## Footnote Saddle paresthesia: S3-S5 proide sensory innervation to rectum, perineum, inner thigh
54
Treatment of acute cauda equina syndrome?
Surgical decompression preferably in 24 hrs. Absolutely within 48 hrs
55
What is spondylolisthesis?
degenerative condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body with intact pars
56
Who and where does spondylolisthesis usually occur?
Most common in females >40yo, at L4/L5 level
57
What shape is inter-vertebral space on imaging?
Usually rectangle shaped. If its like wedge-shaped ish then its narrowing of joint space
58
What can u see on PID in MRI? | CSF is white on T2-MRI
Spinal canal suddenly narrows at one point - look at CSF flow

Ortho (11 decks)

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