Spine: Injuries And Disorders

Question 1

M/C site of Vertebral fracture

Answer 1

Lower thoracic/ T12

Question 2

M/C site of Vertebral dislocation

Answer 2

Cervical spine (D/t horizontally arranged articular facets)

Question 3

M/C site of Spinal cord injury

Answer 3

Cervical spine (Thickest part of spinal cord)

Question 4

What is Jefferson’s fracture?

Answer 4

Fracture of C1 (Atlas)

Question 5

Cause of Jefferson’s fracture

Answer 5

Axial loading/compression -> Fragments burst away (No neurological damage)

Question 6

What is Hangman’s fracture?

Answer 6

Defined as:
1. Fracture dislocation of C2 over C3
2. Pars interarticularis fracture: Spondylolysis
3. Slipping of C2 over C3: Spondylolisthesis

Question 7

What is Pars interarticularis?

Answer 7

Part of vertebrae between sup and inf articular facets

Question 8

What is Clay Shoveller’s fracture?

Answer 8

Shovelling -> Strong contraction of upper limb muscles -> Avulsion of C7 spinous process (C7 > T1)

Question 9

What is Chance fracture?

Answer 9

AKA Jacknife #/Seatbelt #
Car impact with seatbelt on -> Flexion at lower thoracic, upper lumbar spine with distraction forces -> # of spine (Post to ant)

Question 10

Causative factor of Compression fracture

Answer 10

Osteoporosis

Question 11

Mechanism of Compression fracture

Answer 11

Flexion -> Compression

Question 12

Characteristic features of Compression fracture

Answer 12

Wedging of vertebra (Ant column shortened, post column maintained)

Question 13

Causative factor of Burst fracture

Answer 13

Significant trauma

Question 14

Mechanism of Burst fracture

Answer 14

Axial loading

Question 15

Characteristic features of Burst fracture

Answer 15

Convex ant and post walls

Question 16

M/C prolapsed intervertebral disc (PIVD)

Answer 16

L4-L5 > L5-S1

Question 17

PIVD leads to

Answer 17

Compression of spinal nerves (Spinal cord terminates at L1 level in adults)

Question 18

Types of PIVD

Answer 18

1. Far-lateral: Impinges exiting nerve roots
2. Para central (M/C): Impinges traversing nerve roots

Question 19

C/F of PIVD

Answer 19

1. H/o lifting heavy objects
2. Sciatica (M/C): Pain radiating from back to limbs

Question 20

Progression of Disc prolapse

Answer 20

Degeneration -> Prolapse -> Extrusion -> Sequestration

Question 21

Investigations of PIVD

Answer 21

Straight leg raising test:
Neurological examination
To localise the lesion depending on nerve roots involved
IOC: MRI

Question 22

Treatment of PIVD

Answer 22

Acute case: Rest in Semi-Fowler position
Physiotherapy
Surgery: Disc decompression
1. Laminectomy
2. Laminotomy
3. Discectomy

Question 23

What is Cauda Equina syndrome?

Answer 23

Massive disc prolapse: Multiple nerve root compression

Question 24

C/F of Cauda Equina syndrome

Answer 24

1. Bowel and bladder movement +
2. Saddle anaesthesia

Question 25

Management of Cauda Equina syndrome

Answer 25

Emergency decompression

Question 26

What is Lumbar canal stenosis/Neurogenic claudication?

Answer 26

Degeneration of spine -> Dec in joint stability -> Osteophyte proliferation around joint -> Stenosis

Question 27

C/F of Lumbar canal stenosis

Answer 27

1. Back pain radiating to lower limbs in an elderly patient 2. Pain in walking -> Rest (Pain dec) -> Able to walk 3. Pain: > Worse on extension (Walking, standing upright) > Better on flexion (Sitting/leaning forward)

Question 28

Types of Claudication

Answer 28

1. Neurogenic 2. Vascular

Question 29

Pain in diff claudication starts in

Answer 29

Neurogenic: Starts in the back Vascular: Starts in the calf

Question 30

Standing stationary vs Climbing upstairs in diff claudication

Answer 30

Neurogenic: 1. SS: Causes symptoms 2. CU: Relieves symptoms Vascular: 1. SS: Relieves symptoms 2. CU: Worsens symptoms

Question 31

What is Spondylolysis?

Answer 31

Pars Intra-articularis fracture X ray: ‘Scottish terrier with a collar’ sign

Question 32

What is Spondylolisthesis?

Answer 32

Slipping of one vertebra over other M/C location: L5-S1 Step sign; AKA Beheaded Scottish terrier sign (X ray: Palpable)

Question 33

What is Spondyloptosis?

Answer 33

Listhesis beyond the length of vertebral body X ray: Inverted Napoleon hat sign

Question 34

What is Scoliosis?

Answer 34

Lateral deviation of spine: >10 deg from central axis

Question 35

Types of Scoliosis

Answer 35

1. Structural/Fixed 2. Non-structural/Postural

Question 36

What is Structural/Fixed scoliosis?

Answer 36

Scoliosis persists on bending forward

Question 37

What is Non-structural/Postural scoliosis?

Answer 37

Scoliosis disappears on bending forward

Question 38

Evaluation of Scoliosis

Answer 38

Measurement of Cobb’s angle Cobb’s angle: Measurement to quantify the degree of spinal curvature Angle formed b/w intersection of perpendicular lines drawn from the top and bottom vertebrae of spinal curve

Question 39

Types of Structural scoliosis

Answer 39

1. Idiopathic (M/C) 2. Congenital

Question 40

C/F of Idiopathic Structural scoliosis

Answer 40

1. No visible anomaly on X ray 2. Subtypes: > Infantile > Juvenile > Adolescent (M/C)

Question 41

C/F of Congenital Structural scoliosis

Answer 41

1. Anomalies + on X ray 2. Subtypes: > Failure of formation: ~ Semi segmented ~ Fully segmented ~ Wedge vertebrae > Failure of segmentation: ~ Block vertebrae ~ Unsegmented bar > Mixed: Unsegmented bar with hemivertebrae

Question 42

Treatment of Scoliosis

Answer 42

Braces: Prevents progression of deformity Surgery: 1. Severe abnormality/Inadequate correction 2. Rods and screws used: > Screws inserted into pedicle > Harrington rods connect the screws