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Flashcards in Spine Deck (57)
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1
Q

What are some diagnostic studies for the spine?

A

X-ray, CT scan, MRI, myelography, EMG, discogram

2
Q

Prognosis of pain imaging studies

A

c. Used to evaluate discogenic pain ofter underestimated by mri esp in c spine
d. A provocative study
e. Discs that are anatomically normal with saline or contrast injection should not be painful
f. Painless tears common in c and t spine but not in lumbar
g. Pain with injection that mimics clinical syndrome are asscociated with annular tears
h. Indications are disc and end plate abnormalities on other imaging studies clinically significant
i. Pressure sensitive injection
j. Experienced person doing study

3
Q

What are some inflammatory conditions of the spine?

A

RA, lupus, ankylosing spondylitis –autoimmune disease – collagen

4
Q

Radiculopathy?

A

Radicular pain is usually sciatica

5
Q

Myelopathy?

A

Thoracic herniations are not common

Myelopathy- happens higher in spine such as compression of SC

6
Q

Stenosis?

A

Spinal claudication- signs of lumbar stenosis

Narrowing of bone channel occupied by spinal nerves or spinal cord. Degenerative

7
Q

What is double crush syndrome?

A

Problems in 2 different areas

8
Q

What is spondylolisthesis?

A

Vertebrae bulges anteriorly

9
Q

What is Batzins plexus?

A

Group of veins

10
Q

What are some other issues with the spine?

A

Ankylosis spondylitis RA

xvi. Facet arthropathy
xvii. Annular tears
xviii. Discitis
xix. Vertebral osteomyelitis
xx. Epidural Abscess
xxi. Tuberculosis
xxii. Primary vs metastatic
xxiii. Osteopenia
xxiv. Parathyroid disease

11
Q

What do you want to note when asking about the history of a spinal injury?

A

Timing of onset
Trauma?
Change in activities
Patterns of pain (temporal, geographic)

12
Q

Pain with injection that mimics clinical syndrome are associated with

A

Annular tears

13
Q

Painless tears are most common in

A

C and t spine

14
Q

Does myelopathy happen higher or lower in spine?

A

Higher- compression of SC

15
Q

Do steroids cause osteoporosis?

A

Yes

16
Q

Where is DDD most commonly found?

A

Lumbar

17
Q

Age of onset?

A

20 and above.

18
Q

What is the predictable pattern of DDD?

A
Dehydration
Increased thiccckness
Fibrosis
Cant absorb shock
Tears A.F.
Disc collapse
Compression of vert
19
Q

What are the risk factors of DDD?

A
Age
BMI
Genetics
Obesity, smoking
Psychosocial factors
Arthrosclerosis

High impact sports, trauma, work/environment puts ppl at greater risk

20
Q

What is bulbcavernosus reflex?

A

Bulbocavernosus reflex is used to test for integrity of sacral sensory and motor fibers as well as sacral cord segments - s2-s4
“Spinal shock”
When this returns, spinal shock over.
Usually lasts 48 hours

21
Q

What is anterior cord syndrome?

A

Loss of motor pain and temp sensations
Proprioception intact
Poor prognosis

22
Q

Posterior cord syndrome?

A

Decreased sensation and proprioception

Motor intact

23
Q

Central cord?

A

usually in CS
Sacral sparing
Weakness in UE

24
Q

Brown-Sequard

A

Ipsil motor and proprioception loss
Contralateral sensory loss
Good prog

25
Q

What is cauda equine syndrome?

A

Compression of spinal nerve roots

26
Q

What are some symptoms of cauda equina?

A

Pain in upper sacrum, parenthesia buttock, genitals, B&B incontinence, sexual dysfunction
RED FLAG- surgical emergency

27
Q

Lumbar disc herniation can present with

A

Pain with spinal ROM, radicular pain, weakness, numbness paresthesias in distribution of compressed nerve

28
Q

What position would be more painful for someone with a hearniation?

A

Flexion

29
Q

What are some meds to help with herniations?

A

Non steroidal, steroid, epidural, muscle relaxers, anti-inflammatory

30
Q

What are some other factors to help with back pain?

A

Lifestyle management, ID other risk factors

31
Q

What is a discectomy?

A

Surgical removal or herniated disc

32
Q

Who decides if pt needs a discectomy?

A

PT and doc except in presence of cauda equina syn

33
Q

Cauda equina syndrome presents as

A

Profound weakness, BB incontinence, urinary retention

34
Q

What are indications for ALIF?

A

Painful degenerative lumbar disc disease

Often combined with post approach for better stabilization

35
Q

What’s a good conservative tx for a pt with cervical disc herniation?

A

PT would emphasize cervical traction

Meds

36
Q

Surgical tx for cervical herniation?

A

Ant cervical discectomy

Ant cervical fusion with instrumentation

37
Q

Post op care after cervical discectomy/fusion?

A

Low load for 3 mo

UE strengthening 4 wks post op

38
Q

What are the goals of vertebral compression fx?

A

Pain reduction, reduce deformity

39
Q

How does vertebroplasty differ from kyphoplasty?

A

Vertebroplasty- cement insertion with no reduction in fx

Kyphoplasty- attempts reduction with balloon

40
Q

What are indications for vertebroplasty and kyphoplasty?

A

Trauma, tumor, osteoporosis, complications, allergic rxn, nerve damage, PE, cement leakage into epidural space, DO WITHIN 8 WKS of fx

41
Q

What are some indications of PLIF?

A

Spondlyolisthesis, discogenic low back pain, radicular pain

42
Q

What are the advantages of PLIF?

A

Ant fusion without 2 incisions, decompression

43
Q

Does ALIF or PLIF have a better stabilization approach?

A

ALIF

44
Q

What percentage of the adult population will experience back pain?

A

80%

45
Q

What is a major red flag?

A

Loss of bowel/bladder control

46
Q

What is associated with disc degeneration?

A

Spinal stenosis, spondylolisthesis, LE SandS predominates

47
Q

What is spinal stenosis? What population is most affected?

A

Narrowing of canal, >65 y.o

Accumulation of material, bony overgrowth, fragmentation of disc

48
Q

LE S&S can be

A

Neurogenic and vascular

49
Q

Spondylolisthesis is most commonly found

A

L4-5, ant slippage, (+) association with F gender and greater facet jt angle.

50
Q

What are the psychosocial considerations for a poor surgical outcome?

A

3+ of the 5 Waddell signs

  1. Discrepancy b/w seated and lying SLR
  2. Superficial widespread nonanatomical tenderness
  3. Pain w axial loadingof head or rotation of shoulders and pelvis together
  4. No dermatology snesory deficits “my whole leg is numb”
  5. Overreaction on exam

Use cautiously- doesnt exclude organic causes of pain.

51
Q

What conclusions can be made about Waddell signs?

A

WS doesnt correlate with psychological distress, does not discriminate organic from nonorganic problems, WS may rep an organic phenomenon, WS are associated with poorer tx outcome, WS associate w greater pain levels, WX not associated with 2ndary pain, WS demonstrate some methodological problems

52
Q

What are the special considerations for women and men?

A

Women- cyclic pain, abn menstruation, fibroids, ectopic pregnancy
Men— >50 yo with LBP or suprapubis pain,
dysuria- initiating/stopping flow, change in freq, nocturnal (ask about color smell) incontinece, hematuria, sex dysfunction

53
Q

RED FLAGS screen!!

A

Systemic S&S, associated S&S, B&B, saddle anesthesia, decreased DTR (can be decreased in extremities, ok if sym), progressive sx, pain out of proportion, no MOI, unable to alleviate sx (constant pain), should not have acute lvl pain at chronic stage (6 wks)
Trauma

54
Q

Yellow flags screen

A

Decreased MMT, difficulty describing pain, sx beyond expected timeframe, take thorough hx

55
Q

Vascular screen?

A

Throbbing, absent pulse, increased w activity, relieved w rest, spinal pos, tropic changes (color texture temp) arterial in origin

56
Q

Neurogenic

A

Burning, pulse intact (spinal stenosis pulse should be intact), may respond to prolonged rest, INCREASED WITH EXT, DECREASED W FLEX, no tropic, subtle ms weakness, accumulation of space occupying degenerative material

57
Q

Spondylolysis vs spondylolisthesis

A

Spondylolysis- break in vert, can be asymptomatic

Spondylolisthesis- ant slippage (avoid ext)