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Musculoskeletal Pathophysiology > Spine > Flashcards

Flashcards in Spine Deck (73):
1

Scoliosis is named by the ____ portion.

convex

2

Scoliosis is a lateral curvature of the spin with some ___ component.

rotatary

3

Adolescent idiopathic scoliosis - gender and age incidence?

females > males
11-14 years

4

Adolescent idiopathic scoliosis % incidence and clinical presentation:

2% of population
usually appears as a painless and progressive R thoracic curve

5

Hypotonic children may get ____ scoliosis.

neuromuscular

6

Congenital scoliosis accounts for 10-15% of scoliosis and often results from:

failure of normal formation of spine
(hemivertebra)

7

Describe Adams test:

Observation in standing and forward bending
Negative if no indication of rib hump or curvature

8

What is the best way to obtain a definitive diagnosis for scoliosis?

full spine Xray to calculate Cobb Angle

9

What are some predictors of scoliosis progression?

1. AGE: younger and less skeletal maturity
2. GENDER: females
3. SEVERITY: cobb angle > 20 degrees curvature
4. CURVE: lumbar > thoracic

10

Major goals of medical management for scoliosis:

1. prevent curve progression
2. prevent loss of respiratory fxn

11

Management for Scoliosis:
< 20 degrees

observe, exercises, re-examine in 4-6 months

12

Management for Scoliosis:
20 degrees and 5 degrees progression in last 6 months

brace and exercises

13

Management for Scoliosis:
>30 degrees

usually brace immediately

14

Management for Scoliosis:
>40 degrees

operative –usually fusion with pedicle screws, interbody fusions, sublaminar wires

15

Scoliosis orthoses examples:

3 point positions
Boston brace, summit brace

16

Most importnat therex intervention for scoliosis?

flexibility of spine, hips
strength of spinal extensors

17

Classic RA is mostly associated with ___ spinal level.

cervical

18

Ank Spondyltitis progression:

begins with sacro-illiatis (thinning of cartilage and bone condensation at SI joints) and leads to fusion of the spine with flexed trunk, hips, knees

19

Most importnat therex intervention for ank spond?

strengthen extensors and postural education

20

What are two alternative names for spondylosis?

DJD (degenerative joint)
DDD (degenerative disc)

21

Spondylosis vs spondylitis?

OSIS - degenerative changes of the spine
ITIS - spinal rheumatic conditions

22

Vertebral body and anterior disc supports _/_ of the weight of the body. Paired facet joints posteriorly support _/_ of the weight of the body.

2/3; 1/3

23

Peak bone mass is associated with this age range:

20-40 yrs

24

Marked increased menopausal loss of cortical vertebra bone is associated with this age range:

40-60 yrs

25

At 60+ yrs, age-related cortical vertebra bone changes include:

1. bone loss
2. traction or claw osteophytes
3. calcification of ALL/PLL
4. can get bony ankylosis

26

Disc changes at 20-40 yrs include:

nucleus pulposus begin to lose water

27

Disc changes at 40-60 yrs include:

tears in annulus lead to disc space narrowing
increased nucleus pulposus water loss

28

Disc changes at 60+ yrs include:

nucleus fibrotic rather than gelatinous

29

Facet joints tend to be intact in which age group? When does arthrosis change usually begin to occur?

20-40 yrs
40-60 yrs

30

Describe the early destructive phase of spinal degeneration:

Synovitis of facet joints
Circumferential or radial tears in annulus of the disc

31

One segment of the spine is defined as:

2 vertebra and interposed disc

32

Describe the intermediate instability phase of spinal degeneration:

vertebral and peri-facet osteophytes and traction spurs
Laxity of posterior joint capsule and annulus

33

Laxity of posterior joint capsule and annulus can lead to:

spondylo/retrolisthesis
disc herniation

34

Describe the final stabilization phase of spinal degeneration:

1. Fibrosis of the facets and capsule
2. Loss of disc material and height
3. Osteophytes
4. Bony ankylosis of vertebral bodies
5. Stenosis (closing of joint space)

35

What are the 3 phases of spinal degeneration?

1. early destructive
2. intermediate instability
3. final stabilization

36

Describe the degenerative changes of disc and vertebral body:

Disc space narrowing
Vacuum discs
Vertebral sclerosis
Claw osteophytes from vertebral body

37

Describe the degenerative changes of facet joints:

OA of the facet joints
Subluxation of the facet joints

38

At 60+ years, what are changes that occur with the facet joints?

subluxation likely
intervertebral foramen (IVF)
narrowing and decreased disc height

39

What happens with central spinal stenosis?

the central canal narrows and can impinge the SC and caudal equina

40

What happens with lateral spinal stenosis?

the IV foramen narrows and can impinge on spinal nerve roots

41

Clinical presentation of spinal stenosis?

Back pain with unilateral or bilateral radicular symptoms

Loss of trunk mobility

42

What causes spinal instability?

Loss of integrity of the segmental soft tissue structures
Abnormal quantity or quality of motion (can be seen on fluoroscopy)
Degenerative changes
Trauma, rupture or overstretching of ligaments
Spondylolisthesis

43

Describe the clinical presentation of spinal instability:

fBack or neck pain with radicular symptoms
Protective muscle spasm
“Juttering” with motion
May have “step deformity” on palpation

May require bracing or fusion for support

44

What is spondylolysis?

fx of the pars interarticularis

45

What is the radiological feature on X-ray for spondylolysis?

scotty dog "collar" on oblique X-ray

46

What is spondylolisthesis?

ANTERIOR subluxation of vertebral body

47

What levels of the spine is spondylolisthesis?

L4, L5

48

What radiological view is useful for identifying spondylolisthesis?

lateral view

49

Describe management of spondylolisthesis:

Stabilization exercises
Limit spinal extension
Posture to reduce lordosis
Bracing
Fusion

50

Describe this IV disc lesion: Bulge/Protrusion, prolapse

nucleus bulges but outer annular fibers remain intact and contain the nuclear material

51

Describe this IV disc lesion: Extruded

nuclear material breaks through the annulus but is still connected

52

Describe this IV disc lesion: Sequestered

nuclear material has broken away form the disc and is a free mass

53

An IV disc lesion is also known as HNP:

herniated nucleus pulposus

54

Posterior longitudinal ligament is thin in what spinal level?

lumbar

55

Anterior longitudinal ligament is thin at what spinal level?

cervical

56

What is the most common direction of disc herniation?

posterolaterally
(thin PLL in L spine)

57

What direction of disc herniation could lead to bilateral symptoms?

central herniation
*can create cauda equina syndrome if large enough

58

Anterior directed disc herniation may be observed in what spinal level?

cervical

59

Most common age group and gender for disc herniations?

31-50 yrs
somewhat more common in men

60

What are the most common segments for disc herniation?

Cervico-thoracic transition: C4-5, C5-6
Lumbo-sacral transition: L4-5, L5-S1

61

What repetitive motions commonly lead to disc herniation?

lifting, forward bending, twisting, driving

62

Pts presenting with acute lumbar disc dysfxn may have muscle ____.

spasm

63

Clinical presentation for pts with lumbar disc dsyfxn:

May see (lateral) shift of lumbar spine, or forward bent position, gait deviations
+ SLR, Slump tests
+ cervical quadrant tests in neck

64

What pathology is more likely than any other pathology to have neurological sxs below the knee?

Lumbar disc dsyfxn

65

Clinical findings for pts with lumbar disc dsyfxn:

LBP/neck pain with/without radiculopathy
Myotomal, dermatomal, reflex changes possible

66

Describe the most to least comfortable positions for patients with lumbar disc dysfxn:

Lying>walking>standing>sitting

67

Diagnostic evidence for lumbar disc dysfxn:

Plain films – not helpful
MRI - most common
Myelography/CT
EMG
CT discography – painful but can help distinguish between scar tissue and recurrent HNP

68

Conservative management of acute disc lesion:

Limited bedrest – 2 days
Meds - NSAIDS, muscle relaxants
Exercise programs, modalities etc
Pt ed re postures and positions
Epidural steroid injections

69

Common spinal procedures:

Decompression:
Microdiscectomy – usually for HNP
Laminectomy for HNP or stenosis

70

Describe a Posterior Gutter fusion:

place graft strips along the lamina , often now done with pedicle screw fixation

71

Describe Interbody Fusions:

Can be anterior (ALIF) or Posterior (PLIF) use cages

72

Describe post fusion recovery:

braces, no movement in spine for 2-3 months as graft heals

73

Describe post Discectomy/laminectomy recovery

patient mobile very quickly , early spinal mobility