Spine

Question 1

Sudden nonradicular neck + shoulder pain, pain anywhere from occiput to cervical-thoracic junction
Worse with motion, may have spasm of trapezius pain
Headache
Can last for months

Answer 1

acute cervical sprain

Question 2

“Whiplash” – trauma of hyperextension → hyperflexion causing ligamentous and flexion/extension injury

Answer 2

acute cervical sprain

Question 3

PE: tenderness, LROM, NORMAL neurovascular exam of neck

XR: AP/lat/odontoid/flexion/extension, rule out fracture instability, loss of cervical lordosis

Answer 3

acute cervical sprain

Question 4

How do you treat an acute cervical sprain

Answer 4

1-2 weeks in a soft collar with short course pain meds, NSAIDs, muscle relaxants, heat/ice, physical therapy, massage

Can take up to 6-12 months to resolve

Question 5

Point tenderness, pain with motion, guarding, radiculopathy, gait disturbance, weakness, loss of bowel/bladder control

Answer 5

cervical fracture

Question 6

Posterior cortex involvement with retropulsion into canal (cervical)

Answer 6

burst fracture

Question 7

C7 spinous process fracture

Answer 7

clay shoveler’s fracture

Question 8

Consider high risk of neurological involvement with

Answer 8

facet subluxation or dislocation

Question 9

C2 traumatic fracture

Answer 9

hangman’s fracture

Question 10

C1 burst fracture with axial loading injury (dive into shallow water)

Answer 10

jefferson’s fracture

Question 11

there’s 3 different types of this cervical fracture of the C2

Answer 11

odontoid fracture

Question 12

High energy trauma - often can cause other trauma – intoxication, closed head trauma, unconscious

Answer 12

cervical fracture

Question 13

Keep immobilized until clear with x-rays and exam
PE: “step off”, +/- ecchymosis, swelling
→ include rectal exam to evaluate sphincter function

XR: AP/lat/odontoid/swimmer’s
CT scan
~ need flex/ext views at follow up appointment for patient who is alert/cleared

Answer 13

cervical fracture

Question 14

Unilateral arm pain with numbness, tingling, paresthesias, weakness, loss of coordination, diminished grip strength

Loss of fine motor skills, bowel or bladder functions

Ass with headaches, neck and shoulder pain

Answer 14

cervical radiculopathy

Question 15

Referred neurogenic pain in distribution of a cervical nerve root
Young = acute HNP
Elderly = foraminal narrowing from DDD or arthritis

Answer 15

cervical radiculopathy

Question 16

Imaging: AP/lat, MRI CT myelogram, EMG/NCV can help with ruling out and finding final diagnosis of –

Answer 16

cervical radiculopathy

Question 17

This is a reminder

Answer 17

to review different radiculopathies compared to their C spine level

Question 18

C5 radiculopathy radiates to

Answer 18

medial shoulder blade and upper lateral arm from neck

Question 19

C6 radiculopathy radiates to

Answer 19

thumb and pointer finger all the way from neck (laterally) and medial shoulder blade

Question 20

C7 radiculopathy radiates to

Answer 20

middle finger down arm from neck and medial shoulder blade

Question 21

C8 radiculopathy radiates

Answer 21

from entirety of medial shoulder blade down posterior arm to middle and pinky fingers and potentially anterior other arm

Question 22

How do you treat cervical radiculopathy

Answer 22

NSAIDs, PT

Neuro deficit needs a referral to specialist

Question 23

Generally bilateral – chronic neck pain worse when upright with popping, grinding
Headache

Answer 23

cervical degenerative disc disease

Question 24

“Arthritis, spondylosis” with ingrowth of bone spurs, ligament hypertrophy,c chronic herniations/bulges, with disc collapse

Answer 24

cervical degenerative disc disease

Question 25

XR: osteophytes, subluxation/listhesis Neuro symptoms = MRI or CT of cervical spine

Answer 25

cervical degenerative disc disease

Question 26

How do you treat cervical degenerative disc disease?

Answer 26

NSAIDS, PT, surgery

Question 27

Radiation to buttocks with a change in position frequently, exaggerated behavior, poor fitness Muscle spasms that are activity-related, non-radiating to legs, not associated with neurological symptoms

Answer 27

low back strain

Question 28

What are RFs for low back strain?

Answer 28

Smoking Personality disorders Low pay

Question 29

Acute low back pain, lumbar strain, mechanical back pain, often from repeated twisting or lifting

Answer 29

low back strain

Question 30

PE: diffuse tenderness in low back/SI region with normal reflexes and strength, with ROM = pain XR: AP/lat to rule out other causes

Answer 30

low back strain

Question 31

How do you treat a low back strain

Answer 31

Avoid physical activity with NSAIDS/tylenol, avoid narcotics, muscle relaxers, steroids PT No improvement after 4 weeks = referral to specialist

Question 32

Recurrent and episodic – Back pain with radiation into one or both buttocks, with mechanical or axial movements +/- intermittent sciatica that interferes with work and mood disturbances, commonly in depression

Answer 32

degenerative disc disease

Question 33

Chronic low back pain w/ symptoms >3 months from weight, trauma, infection, hereditary, or tobacco use

Answer 33

degenerative disc disease

Question 34

PE: pain with palpation, negative SLR, exaggerated behavior XR: AP/lat = disc space collapse, osteophytes, “vacuum sign”

Answer 34

degenerative disc disease

Question 35

How do you treat a degenerative disc disease?

Answer 35

NSAIDs, avoid narcotics with antidepressants, PT, weight loss, tobacco cessation Return to activity, refer to pain management

Question 36

Unilateral abrupt and associated with back pain radiating down to leg, worse with sitting, coughing, or sneezing Relief = lying on back with pillows under knees or fetal position Leaning towards one side

Answer 36

lumbar radiculopathy

Question 37

“Sciatica” with nerve dysfunction of the leg from HNP, stenosis, arthritis

Answer 37

lumbar radiculopathy

Question 38

PE: seated SLR – flip sign – contralateral side could be + Always check reflexes, strength, and sensation XR: AP/lat, MRI

Answer 38

lumbar radiculopathy

Question 39

nerve root L4 radiates to

Answer 39

back of butt down anteriorly of leg with numbness above patella and a bit above

Question 40

nerve root L5 radiates

Answer 40

from sacrum down more lateral leg to lateral calf

Question 41

nerve root S1 radiates

Answer 41

entirely posterior down back of calf and bottom of foot

Question 42

How do you treat lumbar radiculopathy?

Answer 42

NSAIDs, steroids/ESI up to 3 in 6-12 month period, pain meds, rest/PT, surgery

Question 43

Poor walking tolerance due to leg pain, numbness, paresthesia – weakness with walking and standing, “my legs don’t work right” → sit down to find relief → worse with extension (standing, walking, lying) → bending over shopping cart/ leaning forward Proximal to distal NOT like vascular claudication – no absent pulses, or skin changes

Answer 43

spinal stenosis

Question 44

Congenital or acquired narrowing of spinal canal with compression of nerve roots “Neurogenic claudication” MCC: degenerative arthritis or spondylolysis esp >60

Answer 44

spinal stenosis

Question 45

PE: diminished reflexes, weakness Ask about bowel/bladder function, check sphincter tone XR: degenerative changes, instability EMG, MRI/CT myelogram

Answer 45

spinal stenosis

Question 46

How do you treat spinal stenosis?

Answer 46

NSAIDs, steroid dose pack/ESI, PT/water therapy Surgery

Question 47

Stenosis symptoms = weakness, neurogenic claudication Radiculopathy = leg pain HNP, mechanical back pain MC = lower back pain, may have bowel or bladder dysfunction

Answer 47

degenerative spondylolisthesis

Question 48

What are RFs for degenerative spondylolisthesis?

Answer 48

Post trauma Pars deficit Previous surgery on spine Spondylolysis (gymnast, weight lifter, football player)

Question 49

“Spondy” – slippage of one vertebral body in relation to the one below, with “Stair stepping” – anterior slip = canal narrowing – posterior slip = neuroforaminal narrowing Pars + lamina intact but facet joints + disc abnormal

Answer 49

degenerative spondylolisthesis

Question 50

PE: diminished reflexes, weakness, + SLR XR: slipping of vertebrae AP/lat - consider flexion + extension, MRI

Answer 50

degenerative spondylolisthesis

Question 51

How do you treat degenerative spondylolisthesis?

Answer 51

Activity modification, NSAIDs, bracing/orthoses, surgery

Question 52

LBP with acute spasms, pain radiating posteriorly to below the knees Acute or chronic Slippage vs. non-slippage and only fracture

Answer 52

adolescent spondylolisthesis/spondylolysis

Question 53

Gymnast, weight lifter, football players commonly have

Answer 53

adolescent spondylolisthesis/spondylolysis

Question 54

“Pars defect” in between L5 and S1 with defect in pars articularis, fatigue fracture

Answer 54

adolescent spondylolisthesis/spondylolysis

Question 55

PE: diminished lordosis, flattening of the buttocks SLR Tight hamstrings Neuro exam = normal XR: AP/lat/oblique with “Scotty dog collar” flex/extension = spondylolisthesis SPECT imaging to see if active defect MRI = edema in paris

Answer 55

adolescent spondylolisthesis/spondylolysis

Question 56

How do you treat adolescent spondylolisthesis/spondylolysis?

Answer 56

Rigid bracing/rest Refractory = surgery

Question 57

Sudden onset paralysis L2-S4 downward (S2-S4 control bladder and bowel function) Back pain and numbness bilaterally with perineal numbness in saddle Significant weakness, urinary retention or loss of control, radiation of pain bilaterally

Answer 57

cauda equina syndrome

Question 58

Compression of cauda equina → paralysis from L2-S4 and downward from large HNP, epidural hematoma, abscess, trauma MCC: massive lumbar disc herniation

Answer 58

cauda equina syndrome

Question 59

PE: Unable to get out of chair, loss of anal sphincter tone, motor sensory exam XR: MRI/CT myelogram AP/lat, lab work to rule out others

Answer 59

cauda equina syndrome

Question 60

cauda equina syndrome is a -- ----

Answer 60

surgical emergency

Question 61

metastatic disease's MC symptom is

Answer 61

pain

Question 62

metstatic disease is often an

Answer 62

incidental finding

Question 63

XR: first sign = lost of integrity of pedicle – “winking owl” sign Fractures = loss of bone

Answer 63

metastatic disease

Question 64

LBP, radiculopathy due to asymmetric collapse, “hump”, commonly with childhood onset Abnormalities of coronal, axial, sagittal planes Can be degenerative from osteoporosis, spondylolisthesis, DDD

Answer 64

scoliosis

Question 65

XR: AP/lat – measure Cobb angle (>/= 10 degrees) Adams forward bend test = + asymmetry

Answer 65

scoliosis

Question 66

scoliosis tx

Answer 66

NSAIDs, PT, surgery Bracing

Question 67

Rounded upper back May have pain Elderly, Scheuermann’s disease

Answer 67

kyphosis