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Muscluloskeletal Systems > Spine > Flashcards

Flashcards in Spine Deck (42):
1

What is Hoffman's reflex

Hoffmann's reflex, is a finding elicited by a reflex test which verifies the presence or absence of problems in the corticospinal tract. It is also known as the finger flexor reflex. The Hoffman reflex has also been used as a measure of spinal reflex processing (adaptation) in response to exercise training.

The test involves tapping the nail or flicking the terminal phalanx of the middle or ring finger. A positive response is seen with flexion of the terminal phalanx of the thumb.

2

What is the grip and release test?

Grip and release fingers as fast as possible repeatedly for 10 seconds

Any age group should be able to do at least 20 to be classed as normal

Shows clumsiness of hands

3

What are cafe au lait spots?

(What do they look like, other names, what are they seen in?)

Café au lait spots or café au lait macules are flat, pigmented birthmarks. The name café au lait is French for "coffee with milk" and refers to their light-brown color. They are also called "giraffe spots" or "coast of Maine spots".

They are caused by a collection of pigment-producing melanocytes in the epidermis of the skin.

These spots are typically permanent, and may grow or increase in number over time.

Café au lait spots are often harmless, but may be associated with syndromes such as Neurofibromatosis Type 1 and McCune-Albright syndrome.

4

What may help with mechanical back pain?

Activity

5

What pain may be associated with mechanical back pain?

Thigh pain

6

How do you manage mechanical back pain?

(what speciality, managements, work, outcomes)

-Managed in primary care

-Reassurance
-Simple analgesia REGULARLY
-Explanation
-Avoid bed rest, KEEP ACTIVE

-Early return to work

-90% will settle in 6wks, but 60% recur

7

If mechanical back pain fails to settle what management can you consider?

Physiotherapy

May consider:
-Alternative therapy
-Facet joint injections
-Accupuncture

8

What aspects about the workplace increase risk of back pain?

(what other lifestyle factors, what may help?)

Some relation to physical work
-Not as clear cut as one would imagine

Care about bending and lifting is important

Ergonomics has relatively little effect

Smoking increases the problem
-?Reduces disc nutrition

9

What is the most important independent variable in back pain in the workplace?

Job satisfaction

10

What two ways can lumber discs prolapse?

What can they compress?

Posterolateral (common)
-Compress nerve root

Central
-Cauda equina if it comes on quickly

11

Describe the structure of intervertebral discs

Largest avascular structure in the body

Annulus fibrosus
-Tough outer layer

Nucleus pulposus
-Gelatinous core

+ collagen and proteoglycans (very hydrophilic)

Disc overall is kidney bean shaped

12

How do the fibres of the annulus fibrosis (collagen) run?

How does this effect function?

Obliquely and alternately between layers

Resist rotational movements

13

What is the normal aging process of the spine?

Decreased water content of discs

Disc space narrowing

"Degenerative" changes on X-rays

Degenerative changes in the facet joints
-Osteophytes

Aggravated by smoking etc

14

What is spondylolysis?

Spondylolysis (spon-dee-low-lye-sis) is defined as a defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.

15

What is spondylolisthesis?

Spondylolisthesis is the forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a fracture. Backward displacement is referred to as retrolisthesis.
Spondylolysis (a defect or fracture of the pars interarticularis of the vertebral arch) is the most common cause of spondylolisthesis

16

Describe Nerve Root Pain

(How common, how bad is it, distribution, management)

Fairly common

Limb pain worse than back pain

Pain in a nerve root distribution (radicular)
-Dermatomes and myotomes

Again most will settle, about 90% in 3 months

Physiotherapy

Strong analgesia

Referral after 12 weeks
-Imaging MRI

17

Disc problems will be described by radiologists using terms like Bulge, Protrusion, Extrusion, Herniation, Sequestration

Disc Bulge -> nucleus pulposis bulging into annulous fibrosis

Protrusion -> annulous weakened but still intact
-neck of pulposis larger than head

Extrusion -> annulous weakened but still intact
-Head of pulposis larger than neck

Herniation -> through annulus but in continuity

Sequestration -> dessicated disc material free in canal

18

How common are thoracic intervertebral disc prolapses?

(what vertebrae are most commonly effected?)

19

What lumbar vertebrae are most effected?

What is the most common prolapse?

Usually L4/5 (45%)
L5/S1 (40%)
L3/4 (10%)

Most are posterolateral
-Posterior longitudinal Ligament weakest

20

What are the causes of cauda equine syndrome?

Usually due to central lumbar herniated disc

Tumours
Trauma
Spinal stenosis
Epidural abscess
Iatrogenic (spinal manipulation, spinal epidural, surgery)

21

What are the clinical features of cauda equine syndrome?

Injury or precipitating event

Location of symptoms
-Bilateral buttock and leg pain + varying dysaethesia + weakness

Bowel or bladder dysfunction
-Urinary retention +/- incontinence overflow

Saddle anaesthesia, loss of anal tone and anal reflex

High index of suspicion in spinal post-op patients with increasing leg pain in presence of urinary retention

22

How do you investigate cauda equina syndrome?

MRI

If contraindicated, then lumbar CT or myelogram

23

What is the treatment for caude equina syndrome?

Surgical emergency

Operate ASAP
-Within 48hr
(stastistically significant improvement and difference if surgery

24

How many undergoing discectomy for cauda equina syndrome do NOT regain normal urinary function?

How many with motor deficits never regain full power?

How many with sensory deficits never regained normal sensation?

30%

25%

33%

25

How many undergoing discectomy for caude equina syndrome do NOT get normal perianal parasthesiae back?

How many have persistent sexual dysfunction

25%

26%

26

Cervical and lumbar spondylosis sees degenerative change in which two places?

Facet joints
Discs

27

What may cause loss of consciousness in cervical spondylosis?

Vertebral artery passing through foramina transversaria may get nipped/occluded in cervical spondylosis causing may lose consciousness

28

What is the treatment of cervical spondylosis?

Nonoperative

29

Describe the ligaments of the spine

Anterior Longitudinal Ligament
-Along the front of the vertebral bodies (broad, strong)

Posterior Longitudinal Ligament
-Along the backs of the vertebral bodies (i.e. front of the spinal canal; narrower)

Ligamentum Flavum
-Between laminae

Interspinous and supraspinous ligaments
-Between spinous processes

Intertransverse Ligament
-Between transverse processes

30

How do you distinguish spinal claudication from vascular claudication

Spinal usually bilateral

Sensory dysaesthesiae

Poss weakness (foot drop- tripping)

Takes several minutes to ease after stopping walking

Worse walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding bicycle

31

What are the 3 types of spinal stenosis?

Lateral recess stenosis
Central stenosis
Foraminal stenosis

32

What are the treatment options for lateral recess stenosis?

Nonoperative
Nerve root injection
Epidural injection
Surgery

33

What is the treatment of central stenosis?

Nonoperative
Epidural steroid injection
Surgery

34

What is the treatment for foraminal stenosis?

Nonoperative
Nerve root injection
Epidural injection
Surgery

35

What are the symptoms of spondylolysis?

Low back pain

Occasionally radicular symptoms

36

How do you investigate spondylolysis?

Plain radiographs
CT
MRI
Bone scan

37

WHat is the treatment of spondylolysis?

Nonoperative
Injection therapy
Surgery

38

What are the two ways to classify spondylolisthesis?

Radiographic (Meyerding)
Aetiologic (Wiltse)

39

What are the 5 Aetiological (Wiltse) classifications for spondylolisthesis?

Congenital
Isthmic
Degenerative
Traumatic
Pathologic

40

What is spondyloptosis in spondylolisthesis?

Body of L5 sitting in front of S1

41

What are the symptoms of spondylolisthesis?

Often vary with type of spondylolisthesis

42

What is the treatment for spondylolisthesis?

Depends on symptoms
-Conservative with lifestyle changes
-Surgery for persistent pain +/- nerve root entrapment