Spine

Question 1

Scoliosis is named by the ____ portion.

Answer 1

convex

Question 2

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

Answer 2

rotatary

Question 3

Adolescent idiopathic scoliosis - gender and age incidence?

Answer 3

females > males

11-14 years

Question 4

Adolescent idiopathic scoliosis % incidence and clinical presentation:

Answer 4

2% of population

usually appears as a painless and progressive R thoracic curve

Question 5

Hypotonic children may get ____ scoliosis.

Answer 5

neuromuscular

Question 6

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

Answer 6

failure of normal formation of spine

hemivertebra

Question 7

Describe Adams test:

Answer 7

Observation in standing and forward bending

Negative if no indication of rib hump or curvature

Question 8

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

Answer 8

full spine Xray to calculate Cobb Angle

Question 9

What are some predictors of scoliosis progression?

Answer 9

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

Question 10

Major goals of medical management for scoliosis:

Answer 10

1. prevent curve progression

2. prevent loss of respiratory fxn

Question 11

Management for Scoliosis:

< 20 degrees

Answer 11

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

Question 12

Management for Scoliosis:

20 degrees and 5 degrees progression in last 6 months

Answer 12

brace and exercises

Question 13

Management for Scoliosis:

>30 degrees

Answer 13

usually brace immediately

Question 14

Management for Scoliosis:

>40 degrees

Answer 14

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

Question 15

Scoliosis orthoses examples:

Answer 15

3 point positions

Boston brace, summit brace

Question 16

Most importnat therex intervention for scoliosis?

Answer 16

flexibility of spine, hips

strength of spinal extensors

Question 17

Classic RA is mostly associated with ___ spinal level.

Answer 17

cervical

Question 18

Ank Spondyltitis progression:

Answer 18

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

Question 19

Most importnat therex intervention for ank spond?

Answer 19

strengthen extensors and postural education

Question 20

What are two alternative names for spondylosis?

Answer 20

DJD (degenerative joint)

DDD (degenerative disc)

Question 21

Spondylosis vs spondylitis?

Answer 21

OSIS - degenerative changes of the spine

ITIS - spinal rheumatic conditions

Question 22

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

Answer 22

2/3; 1/3

Question 23

Peak bone mass is associated with this age range:

Answer 23

20-40 yrs

Question 24

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

Answer 24

40-60 yrs

Question 25

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

Answer 25

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

Question 26

Disc changes at 20-40 yrs include:

Answer 26

nucleus pulposus begin to lose water

Question 27

Disc changes at 40-60 yrs include:

Answer 27

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

Question 28

Disc changes at 60+ yrs include:

Answer 28

nucleus fibrotic rather than gelatinous

Question 29

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

Answer 29

20-40 yrs | 40-60 yrs

Question 30

Describe the early destructive phase of spinal degeneration:

Answer 30

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

Question 31

One segment of the spine is defined as:

Answer 31

2 vertebra and interposed disc

Question 32

Describe the intermediate instability phase of spinal degeneration:

Answer 32

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

Question 33

Laxity of posterior joint capsule and annulus can lead to:

Answer 33

spondylo/retrolisthesis | disc herniation

Question 34

Describe the final stabilization phase of spinal degeneration:

Answer 34

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)

Question 35

What are the 3 phases of spinal degeneration?

Answer 35

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

Question 36

Describe the degenerative changes of disc and vertebral body:

Answer 36

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

Question 37

Describe the degenerative changes of facet joints:

Answer 37

OA of the facet joints | Subluxation of the facet joints

Question 38

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

Answer 38

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

Question 39

What happens with central spinal stenosis?

Answer 39

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

Question 40

What happens with lateral spinal stenosis?

Answer 40

the IV foramen narrows and can impinge on spinal nerve roots

Question 41

Clinical presentation of spinal stenosis?

Answer 41

Back pain with unilateral or bilateral radicular symptoms Loss of trunk mobility

Question 42

What causes spinal instability?

Answer 42

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

Question 43

Describe the clinical presentation of spinal instability:

Answer 43

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

Question 44

What is spondylolysis?

Answer 44

fx of the pars interarticularis

Question 45

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

Answer 45

scotty dog "collar" on oblique X-ray

Question 46

What is spondylolisthesis?

Answer 46

ANTERIOR subluxation of vertebral body

Question 47

What levels of the spine is spondylolisthesis?

Answer 47

L4, L5

Question 48

What radiological view is useful for identifying spondylolisthesis?

Answer 48

lateral view

Question 49

Describe management of spondylolisthesis:

Answer 49

``` Stabilization exercises Limit spinal extension Posture to reduce lordosis Bracing Fusion ```

Question 50

Describe this IV disc lesion: Bulge/Protrusion, prolapse

Answer 50

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

Question 51

Describe this IV disc lesion: Extruded

Answer 51

nuclear material breaks through the annulus but is still connected

Question 52

Describe this IV disc lesion: Sequestered

Answer 52

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

Question 53

An IV disc lesion is also known as HNP:

Answer 53

herniated nucleus pulposus

Question 54

Posterior longitudinal ligament is thin in what spinal level?

Answer 54

lumbar

Question 55

Anterior longitudinal ligament is thin at what spinal level?

Answer 55

cervical

Question 56

What is the most common direction of disc herniation?

Answer 56

posterolaterally | thin PLL in L spine

Question 57

What direction of disc herniation could lead to bilateral symptoms?

Answer 57

central herniation | *can create cauda equina syndrome if large enough

Question 58

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

Answer 58

cervical

Question 59

Most common age group and gender for disc herniations?

Answer 59

31-50 yrs | somewhat more common in men

Question 60

What are the most common segments for disc herniation?

Answer 60

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

Question 61

What repetitive motions commonly lead to disc herniation?

Answer 61

lifting, forward bending, twisting, driving

Question 62

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

Answer 62

spasm

Question 63

Clinical presentation for pts with lumbar disc dsyfxn:

Answer 63

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

Question 64

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

Answer 64

Lumbar disc dsyfxn

Question 65

Clinical findings for pts with lumbar disc dsyfxn:

Answer 65

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

Question 66

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

Answer 66

Lying>walking>standing>sitting

Question 67

Diagnostic evidence for lumbar disc dysfxn:

Answer 67

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

Question 68

Conservative management of acute disc lesion:

Answer 68

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

Question 69

Common spinal procedures:

Answer 69

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

Question 70

Describe a Posterior Gutter fusion:

Answer 70

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

Question 71

Describe Interbody Fusions:

Answer 71

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

Question 72

Describe post fusion recovery:

Answer 72

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

Question 73

Describe post Discectomy/laminectomy recovery

Answer 73

patient mobile very quickly , early spinal mobility