Flashcards in Spine Deck (57):
What are some diagnostic studies for the spine?
X-ray, CT scan, MRI, myelography, EMG, discogram
Prognosis of pain imaging studies
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
What are some inflammatory conditions of the spine?
RA, lupus, ankylosing spondylitis –autoimmune disease – collagen
Radicular pain is usually sciatica
Thoracic herniations are not common
Myelopathy- happens higher in spine such as compression of SC
Spinal claudication- signs of lumbar stenosis
Narrowing of bone channel occupied by spinal nerves or spinal cord. Degenerative
What is double crush syndrome?
Problems in 2 different areas
What is spondylolisthesis?
Vertebrae bulges anteriorly
What is Batzins plexus?
Group of veins
What are some other issues with the spine?
Ankylosis spondylitis RA
xvi. Facet arthropathy
xvii. Annular tears
xix. Vertebral osteomyelitis
xx. Epidural Abscess
xxii. Primary vs metastatic
xxiv. Parathyroid disease
What do you want to note when asking about the history of a spinal injury?
Timing of onset
Change in activities
Patterns of pain (temporal, geographic)
Pain with injection that mimics clinical syndrome are associated with
Painless tears are most common in
C and t spine
Does myelopathy happen higher or lower in spine?
Higher- compression of SC
Do steroids cause osteoporosis?
Where is DDD most commonly found?
Age of onset?
20 and above.
What is the predictable pattern of DDD?
Cant absorb shock
Compression of vert
What are the risk factors of DDD?
High impact sports, trauma, work/environment puts ppl at greater risk
What is bulbcavernosus reflex?
Bulbocavernosus reflex is used to test for integrity of sacral sensory and motor fibers as well as sacral cord segments - s2-s4
When this returns, spinal shock over.
Usually lasts 48 hours
What is anterior cord syndrome?
Loss of motor pain and temp sensations
Posterior cord syndrome?
Decreased sensation and proprioception
usually in CS
Weakness in UE
Ipsil motor and proprioception loss
Contralateral sensory loss
What is cauda equine syndrome?
Compression of spinal nerve roots
What are some symptoms of cauda equina?
Pain in upper sacrum, parenthesia buttock, genitals, B&B incontinence, sexual dysfunction
RED FLAG- surgical emergency
Lumbar disc herniation can present with
Pain with spinal ROM, radicular pain, weakness, numbness paresthesias in distribution of compressed nerve
What position would be more painful for someone with a hearniation?
What are some meds to help with herniations?
Non steroidal, steroid, epidural, muscle relaxers, anti-inflammatory
What are some other factors to help with back pain?
Lifestyle management, ID other risk factors
What is a discectomy?
Surgical removal or herniated disc
Who decides if pt needs a discectomy?
PT and doc except in presence of cauda equina syn
Cauda equina syndrome presents as
Profound weakness, BB incontinence, urinary retention
What are indications for ALIF?
Painful degenerative lumbar disc disease
Often combined with post approach for better stabilization
What’s a good conservative tx for a pt with cervical disc herniation?
PT would emphasize cervical traction
Surgical tx for cervical herniation?
Ant cervical discectomy
Ant cervical fusion with instrumentation
Post op care after cervical discectomy/fusion?
Low load for 3 mo
UE strengthening 4 wks post op
What are the goals of vertebral compression fx?
Pain reduction, reduce deformity
How does vertebroplasty differ from kyphoplasty?
Vertebroplasty- cement insertion with no reduction in fx
Kyphoplasty- attempts reduction with balloon
What are indications for vertebroplasty and kyphoplasty?
Trauma, tumor, osteoporosis, complications, allergic rxn, nerve damage, PE, cement leakage into epidural space, DO WITHIN 8 WKS of fx
What are some indications of PLIF?
Spondlyolisthesis, discogenic low back pain, radicular pain
What are the advantages of PLIF?
Ant fusion without 2 incisions, decompression
Does ALIF or PLIF have a better stabilization approach?
What percentage of the adult population will experience back pain?
What is a major red flag?
Loss of bowel/bladder control
What is associated with disc degeneration?
Spinal stenosis, spondylolisthesis, LE SandS predominates
What is spinal stenosis? What population is most affected?
Narrowing of canal, >65 y.o
Accumulation of material, bony overgrowth, fragmentation of disc
LE S&S can be
Neurogenic and vascular
Spondylolisthesis is most commonly found
L4-5, ant slippage, (+) association with F gender and greater facet jt angle.
What are the psychosocial considerations for a poor surgical outcome?
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.
What conclusions can be made about Waddell signs?
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
What are the special considerations for women and men?
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
RED FLAGS screen!!
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)
Yellow flags screen
Decreased MMT, difficulty describing pain, sx beyond expected timeframe, take thorough hx
Throbbing, absent pulse, increased w activity, relieved w rest, spinal pos, tropic changes (color texture temp) arterial in origin
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