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Orthopaedics > Spine > Flashcards

Spine Flashcards

(51 cards)

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1
Q

What are the functions of the spine

A

Supports the head and neck
Enables ambulation
Protects the spinal cord

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2
Q

The anatomy of the spinal cord

Bones

A 
Cervical - 7 
Atlas and the axis
5 typical vertebrae
LORDOSIS
Thoracic
12 typical vertebrae 
KYPHOSIS
Lumbar 
5 typical lumbar vertebrae
LORDOSIS
Sarum 
5 fused vertbrae 
KYPHOSIS
Coccyx
Fused typically 4
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3
Q

Features of the cervical vertebrae

A

Axis is a ring
Atlas has the dens
5 typical have a bifid spinous process
Have holes in the transfer processes the transverse foramen which the vertebral artery go through

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4
Q

Features of the thoracic vertebrae

A

Has a heart shaped vertebral body
Has lots of articulation point due to the articulation with the ribs the ribs articulate with the vertebrae on the level and the one below
There’s the costotranverse and the costovertebral articulation areas

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5
Q

Features of the lumbar vertebrae

A

Vertical transverse processes

Pedicel and lamina protect the spinal cord

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6
Q

What is the intervertebral disc and its features

A

It forms a fibrocartilagenous joint with the vertebrae
It is a pad of fibrocartilagenous tissue
Allows for a small amount of movement and acts as a shock absorber
It is concentric layers of fibrocartilage on the outside forming the annulus fibrosis
And the central jelly like substance called the nucleus pulposis
On the top and bottom of the disc is a cartilaginous end plate

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7
Q

Ligaments in the spine

A

Anterior of the spine along the vertebral body - anterior longitudinal ligament
Posterior of the vertebral body - posterior longitudinal ligament
In between the spinous process - interspinous ligament
Anterior to the spinous processes is the ligamentum flavum
Posterior to the spinous processes is the supraspinous ligament

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8
Q

Musculature of the spine

A

3 layers
Superficial - trapeziums and the latissmus dorsi
Intermediate - unusual configurations - serrated muscles
Deep layer important in surgery due to contains bleeding vessels

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9
Q

Features of the nerve roots

A

They exit the spinal cord through the intervertebral foramen
They are covered in meninges - pia, arachnoid and dura
They leave the spinal cord and synapse and the DRG - then they split into the ventral and dorsal root

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10
Q

Blood supply to the spinal cord

A

Segmental vessels come form the aorta
They supply to intercostal region and supply the spinal cord by the vertebral arteries
Can get a spinal stroke they are similar to cerebral strokes in the their clinical presentation and cause - ischaemic and haemorrhagic
Venous drainage is by the batson plexus
Important the site of metastatic haemtogenous spread

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11
Q

What is a radiculopathy

A

Root problem - LMN + pain

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12
Q

What is a myelopathy

A

Cord problem - UMN

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13
Q

What is quadriplegia

A

Loss of function of the UL and LL

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14
Q

What is paraplegia

A

Loss of function of the LL

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15
Q

What is paraparesis

A

Weakness due to cord or root compression

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16
Q

Implication of a above c4 compression

A

Death or loss of ventilation

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17
Q

Implication of C5 compression

A

Quadriplegia

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18
Q

Implication fo c5-T1 compression

A

Dec arm function

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19
Q

Implication so T1-L1 neural compression

A

Paraplegia and autonomic dysfunction

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20
Q

implication of L2-5 neural compression

A

Dec leg function

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21
Q

Implication of L5 and below neural compression

Study These Flashcards
A

Impaired sphincter an sexual function

22
Q

Classification of spinal deformity

Study These Flashcards
A

Idiopathic - infantile 0-3 IIS
Juvenile 3-10 JIS
Adolescent 10-18 AIS
Congenital failure of formation and failure of segmentation
Neuromuscular - DMD, CP - cerebral palsy, CMT, Charcot Marie tooth, SMA - spinal muscular atrophy
Lots of conditions which cause spinal deformity and they differ in severity

23
Q

Scoliosis define

Study These Flashcards
A

Evidence of a 10 degree lateral curvature with vertebra rotation on standing upright radiograph of the spine
Now known that scoliosis is a 3D rotational abnormality

24
Q

Tx scoliosis

Study These Flashcards
A

Brace/cast
3 point fixation to guide the spine in a brace
Also fuse or fixate the spine
With rods and screws

25
What to do when the child is still growing
Insert growing rods as the spine cannot be fused due to vertical growth but also growth of the chest wall which would dec heart and lung size if fused and stopped growing These can be expanded as the patient grows
26
What is cervical stenosis
Tightening of the spinal canal Cervical myelopathy Myelopathy clinical syndrome caused by the compression of the spinal cord Complete damage is rare
27
Consequences of a cervical stenosis
``` Loss of fine motor skills Broad based shuffling game Spasticity UL radioculopathy Brisk reflexes extensor plantars Rare urinary symptoms ```
28
Pathophysiological causes of cervical stenosis
Cervical spondylitis (CSM) Compression usually caused by anterior degenerative changes - osteophytes of discophyte complex Degenerative spondylolithesis - hypertrophy of the ligamentum flavum Congenital stenosis - symptoms usually begin when congenital narrowing combined with spondylitis degeneration changes in older adults
29
What is myelomalacia
Hyperdense region in the spinal cord MRI due to compression
30
What is lumbar spinal stenosis
Reduction in the dimension of of central or lateral lumbar spinal cord Circumferential compression which is progressive
31
Causes of lumbar spinal stenosis
Bone - facets, osteophytes, listhesis compression | Not bone - disc, ligamentum flavum
32
Symptoms of lumbar stenosis
``` Back pain Buttock pain Claudication Leg pain Weakness ```
33
Neurogenic vs vascular claudication
N. Y Postural changes Yes. No Walking upright Inc symp. Inc symp Standing stationary inc symp. Dec symp Sitting Dec symp. Dec symp Stair climbing. Up easier Down easier Pulses Normal. Abnormal
34
What is vascular claudication
Is a mismatch between metabolic demands and the vascular provision
35
What is neurogenic claudication
Mechanical effect of pressure on the nerve
36
What is a transversing nerve root
Traversing nerve root. Another nerve root goes across the disc and exits the spine at the next level below. It is called the “traversing” nerve root.
37
What is an exiting nerve root
Exiting nerve root. The nerve root that exits the spine at a particular level is referred to as the “exiting” nerve root
38
What are radicular symptoms
Pain, numbness, motor weakness In distribution of the dermatome Many settle spontaneously
39
Tx of radiculopathy
``` Con - physio - inc core strength - weight loss - smoking cessation -analgesia - CBT - epidural steroid Surg - ```
40
What are absolute indication for surgery in radiculopathy
Sphincter compromise | Major motor radiculopathy - dec MRC3
41
What are relative indication for radiculopathy surg tx
Failed con mx 6 weeks longer Neurological deficit
42
What are red flags for serious underlying pathology
``` Night pain Prior malignancy Constitutional symptoms Sphincter symptoms Neuro abnormalities Age <20 >55 Non-mechanical back pain Thoracic back pain Structural deformity Recent unexplained weightloss ```
43
What are the serious pathology red flag symptoms can point towards
Causative equine Malignancy Dissecting aneurysm Infection
44
What is cauda equine syndrome features
Bilateral leg pain Saddle anaesthesia Impotence Sensorimotor loss in lower extremities - progressive Neurogenic bladder dysfunction Unwary retention and overflow incontinence due to loss of sensation and sphincter control Rare bowel involvement
45
Spinal trauma/MSCC tx and features
Thoracic back pain as this area most likely to have it Not affected by mechanical back pain due to being largely immobilised by the ribs MRI hole spine Dexamethasone Spinal surgeons onc Surg or radio or chemo depending on cancer and prognosis Palliative care
46
MSCC tx objective
``` Inc QualOL Dec pain Mechanical instability Local trauma control Minimise adverse events Preserve dignity - bladder, bowel, continence ```
47
Inflamma spine conditions
RA - cervical neck - can be v unstable imp in anaesthesia | Ank spond - fuses spine so a minor fracture can have a devastating effect
48
What in spondylolysis
Spondylitis = vertebrae Lysis = break Uni bilateral pars interarticularis deject L3-L5 L5 commonest
49
What is spondylolithesis
Spondyl - vertebrae Lithesis - slip One vertebrae slips over the other causes - dysplastic, isthmic, degen, traumatic, other than pars defect, pathological
50
What happens when you compress the cord
Pain LNM at the site of the lesion UMN. Signs and sensory loss below Or bladder and bowel dysfunction
51
Hat are long tract signs
Spasticity Hyperreflexia Abnormal reflexes - babinski

Orthopaedics (7 decks)

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