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MBBS Orthopedics > Spine > Flashcards

Spine Flashcards

1
Q

what are the lines on lateral spine x ray

A
  • anterior vertebral
  • posterior vertebral
  • spinolaminar
  • posterior spinous
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2
Q

what is the normal prevertebral space measurements

A

<6mm at C2 (above trachea)

<22mm or 1 vertebral body at C6 (below trachea)

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3
Q

How to localise nerve in radiculopathy

A

Sensory distribution of pain - dermatomal
distribution of tingling and numbness
motor weakness - myotome
screening - squat and rise (L4), heel walking (L5), toe walking (S1)
reflexes - knee jerk, ankle jerk

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4
Q

Clinical exam findings in scoliosis

A

Adam forward bend test

  • imbalance in height of shoulders
  • asymmetrical limb waist distance
  • prominence of hips
  • truncal shift (plum line from C7 spinous process)
  • tilting of shoulder and pelvis
  • limb shortening
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5
Q

Causes of radiculopathy

A
  • PID
  • spondylosis
  • spondylolisthesis
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6
Q

Spondylosis findings on x ray

A
  • narrowing of neural foramen
  • facet joint hypertrophy/ arthritis - bony spurs, syndesmophyte
  • degeneration of intervertebral disc (loss height, bulge)
  • thickening of ligamentum flavum (calcification)
  • end plate sclerosis
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7
Q

causes of myelopathy

A

Degenerative changes
1. degenerative cervical spondylosis
>anterior: protruding disc, posterior syndesmophyte, osteophytes
>anterolateral: jts of luschka
> lateral: cervical facet thickening/ bony spurs
> posterior: ligamentum flavum, spondylolisthesis
2. ossification of posterior longitudinal ligament (OPLL)
3. cervical kyphosis
4. prolapsed intervertebral disc

VITAMINC
- infection (epidural abscess), trauma, tumor, demyelinating disorders, vascular disease, autoimmune (RA)

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8
Q

mgx of myelopathy

A 
Conservative:
- analgesia, collar, physio, gait training
Canal widening/ surgical decompression
- laminectomy, disectomy
Fusion if instability present
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9
Q

Mgx of spinal stenosis

A

education on spine posture

sx:

  • wide laminectomy (decompression)
  • segmental fusion (for spinal instability)
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10
Q

Causes of cauda equina syndrome

A 
central PID 
infection - abscess
neoplasm - tumor, lymphoma
vascular - spinal epidural hematoma, spinal anaesthesia, IVC thrombosis
Trauma
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11
Q

Presentation of cauda equina

A
  • saddle anesthesia
  • bowel, bladder dysfunction
  • bilateral LL weakness
  • radiating pain
  • low back pain and tenderness
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12
Q

Mgx of cauda equina

and potential cx if tx delayed

A

Surgical cx within 48 hours

  • residual weakness
  • permanent urinary/ bowel incontinence
  • impotence
  • sensory abnormalities
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13
Q

PID pathology

- extents of herniation

A

acute posterior or postero-lateral herniation of nucleus pulpous through annulus fibrosis

bulge > extrusion > protrusion > sequestration

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14
Q

Central vs posterolateral vs foraminal prolapse

A

Central

  • only back pain
  • without leg pain
  • bilateral radiculopathy (if prolapse significant)
  • beware cauda equina

Postero-lateral:

  • most common
  • compress transversing nerve root (i.e. L5 in L4/5)

Foramina

  • rare
  • compress exitting nerve root (i.e L4 in L4/5)
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15
Q

Cervical vs lumbar PID

A

for both posterolateral herniation:

  • EXITTING cervical nerve root
  • TRANSVERSING lumbar root

for both, lower level affected

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16
Q

signs for PID on examination

A
  • listing (to relieve pain from nerve compression)
  • paravertebral muscle spasm
  • protective scoliosis
  • loss of lumbar lordosis
  • midline tenderness
  • pain worse on flexion, decreased ROM
  • SLR positive
  • segmental myotomal and dermatomal deficits
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17
Q

Mgx of PID

A 
REST: + physio and analgesia and NSAIDs
REDUCE: traction
SX: removal + rehab
for: cauda equina, failure of conservative tx
- discectomy
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18
Q

Causes of spondylolisthesis

A

SPOTED

  • Spodylolytic: break in pars interarticularis
  • Pathological: neoplasm or infection (TB)
  • Operative: laminectomy for decompression
  • Trauma
  • Elderly: OA (spondylosis)
  • Dysplasia: congenital lumbosacral facet joint dysplasia
19
Q

Classification of spondylolisthesis

A 
Meyerding classification - % translation of VB
I: 0-25%
II: 25-50%
III: 50-75%
IV: 75-100%
20
Q

Mgx of spondylolisthesis

A

Conservative: bed rest and supportive corset
Operastive: spinal fusion (TLIF: transforaminal lumbar interbody fusion)

21
Q

Why does spondylosis cause radiculopathy

A
  • loss of disc height
  • syndesmophyte
  • facet joint hypertrophy
22
Q

Why does spondylosis cause spinal stenosis

A
  • facet hypertrophy
  • thickening of ligamentum flavum
  • bulging of degenerate disc
  • spur formation
  • listhesis
23
Q

Mgx of spondylolysis

A

Conservative

  • activity modification: weight loss, stop bending, lifting, climbing
  • physio
  • intermittent traction
  • collar
  • analgesia

SX
- anterior disc removal with fusion of most painful level

24
Q

Types of scoliosis

A

Postural

Structural

  1. Idiopathic :
    - adolescent thoracic (>10)
    - infantile thoracic (<4)
  2. Osteopathic: due to congenital vertebral anomalies (hemivertebrae, wedge vertebra, block vertebrae)
  3. Neuropathic
  4. Myopathic: in rare muscular dystrophies, spinal muscular atrophy
  5. Syndromic: Ehler danlos, marfan, NF, VACTERL
25
Impt history for idiopathic scoliosis
- menarche - family hx - when it start - severity and progression - previous x rays and treatment - associated symptoms (back pain, neurological symptoms, clumsiness/ weakness, bladder/ bowel function)
26
What is the Risser sign grading and its significance
Extent of ossification and fusion of iliac apophysis of pelvis - suggests skeletal maturity and provides indication for curve progression 0 - premenarchal 1/2 - pubertal 3/4/5 - post pubertal ``` Grade I: 25% II: 50% III: 75% (passed peak of growth spurt) IV: 100% V: iliac apophysis fused to iliac crest ```
27
What is the management of scoliosis
Dependent on cobb's angle <20deg: 4mthly observation with full length spine x ray 20-40deg: - 0/1/2: brace therapy - 3/4/5: observation ``` >40deg: - 0/1/2: sx + post op support >50deg: - 3/4/5: sx 50% correction regarded as satisfactory ```
28
How to measure Cobb angle
lines projected from uppermost and lowermost vertebral bodies in the curve
29
Types of kyphosis
``` Postural Structural - elderly: degenerative - Ankylosing spondylitis - trauma - TB spondylitis - Adolescents: scheurmann disease ```
30
Deficit in brown sequard syndrome
Ipsilateral - LCS: motor - Dorsal: vibration, propioception Contralateral: - pain, temperature (spinothalamic tracts cross at spinal cord level)
31
What is Denis 3 column theory | - what are the columns
Ant column: anterior longit lig, ant annulus, ant 2/3 vert body Mid column: pos 1/3 vert body, post longit lig Pos column: posterior elements (pedicles, facets, lamina, spinous process), pos ligaments 1 column: stable 2 column: +/- 3 column: unstable
32
What is a - compression #/ wedge - burst # - chance #
Compression: anterior stress failure (tumour, infx, osteoporotic) Burst: both ant and mid column (trauma) - neuro involvement is common (retropulsion of fragments into spinal canal) - increase in interpedicular distance Chance: all 3 columns affected - neuro damage uncommon - unstable -
33
What is ASIA impairment scale
A: complete: no motor and sensory B: incomplete: no motor, sensory preserved C: incomplete: some motor (< grade 3) D: incomplete: some motor (> grade 3) E: motor and sensory normal
34
How to differentiate complete vs incomplete spinal cord injury
complete: no fx below lvl of injury (neuro deficit persists after spinal shock ends) incomplete: some degree of function retained (SACRAL SPARING: perianal sensation, sphincter tone, big toe flexion)
35
Cervical spine management in trauma after radiological Ix
if film neg, remove collar and complete exam - palate from occiput to T1 - any tenderness, swelling, step off - if symptomatic: replace collar - if neg - do active ROM (should be full and pain free) > C spine clear - if ROM unable but rest is clear: replace collar and x ray in 2w (flexion-extension views) NOT reliable if patient is obtunded, other distracting injury
36
What is a whiplash injury - s/s - x ray findings - mgx
Sprained neck: hyeprflexion/ extension of neck > soft tissue sprain - pain and stiffness appear 12-48 hours after injury - x ray normal - mgx: analgesia, physio
37
Mgx of compression injury
mild: bed rest + physio marked wedging: thoracolumbar brace else posterior spinal fusion
38
Spinal shock - what is it - when it ends? - how to test?
complete spinal areflexia physiological dysfunction of spinal cord (complete paralysis and anaesthesia, loss of anal reflex) - loss of basal excitatory stimulus from brain to neurons - flaccid areflexic paralysis - bradycardia and hypotension - absent bulbocav reflex bulb-cavernous reflex - signifies end - monitor anal sphincter contraction in response to squeezing the glans penis/ clitoris
39
General management of spine injuries
if incomplete transection: emergency surgical decompression and stabilisation of spine acute mgx reduction: acute closed reduction with axial traction if no sx, bracing and observation rehab general: - skin: prevent pressure sores - bladder: catheterise, bladder training subsequently - bowel: enemas, abdominal exercises - muscles, joints - prevent contractors: physio - reversing contractures: tenotomy - DVT prophylaxis - cardiopulmonary mgx
40
Complication of spinal cord injuries
- skin problems (ulcers) - venous thromboembolism - urosepsis - sinus bradycardia - orthostatic hypotension (no sympathetic tone) - autonomic dysreflexia (by unchecked visceral stimulation): headache, agitation, HTN - MDD
41
features of central cord syndrome
MUD motor more than sensory upper limb > LL distal > proximal
42
ddx of radiculopathy
thoracic outlet syndrome carpal tunnel syndrome or ulnar nerve entrapment rotator cuff lesions cervical tumor
43
what are the causes of lumbar stenosis
- degenerative changes from spondylosis (facet joint hypertrophy, syndesmophytes) - spondylolisthesis - space occupying lesions - abscess, infections - trauma - inflammatory: ankylosing spondylitis, RA

MBBS Orthopedics (13 decks)

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