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Flashcards in Spine orthopaedics and trauma Deck (57)
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1

Which myotome facilitates hip flexion?

L1/2

2

Which myotome facilitates knee flexion?

L3/4

3

Which movements does the L5 myotome facilitate?

Foot dorsiflexion and extensor hallicus longus

4

Which myotome facilitates plantarflexion?

S1/2

5

What is sciatica?

Buttock and/or leg pain in a specific dermotomal distribution accompanied by neurological disturbance

6

What is shown on this MRI?

Slipped disc

7

What is a slipped.herniated disc?

A tear in the annulus fibrosis of an intervertebral disc allows the nucleus pulposis to bulge out beyond the damaged outer rings

8

What are some of the causes of disc herniation?

Age-related degeneration

Trauma

Lifting injuries

Straining

9

What direction is spinal disc herniation usually in and why?

Postero-laterally

The presence of the posterior longitudinal ligament prevents the disc from herniating directly posteriorly

10

What is the presentation of an acute disc tear?

Typically occurs after lifting heavy object

Acute onset back pain

Worse on coughing

11

How does sciatica present?

 Lower back pain

Buttock pain and numbness

Pain or weakness in various parts of the leg and foot 

"pins and needles"

Tingling and difficulty moving or controlling the leg

12

What causes sciatica?

Compression or irritation of one of the five nerve roots of the sciatic nerve e.g. by a herniated disc causing compression

 

13

How is disc prolapse managed?

Conservatively intially

Consider surgery if not resolving after 3 months

Surgery is to treat leg pain

14

How is backache managed conservatively?

Anti-inflammatory and/or muscle  relaxant
Physiotherapy

Xray
Return to normal activity
 

15

What are the red flag symptoms with back pain?

First back pain age <20 or >50
Non-mechanical, constant pain

History of cancer

History of steroids
Systemic upset/weight loss
Structural deformity
Saddle anaesthesia/paraesthesia and loss of bowel and bladder control
Severe pain longer than 6 weeks
 

16

What is cauda equina syndrome?

A serious neurologic condition in which damage to the cauda equina causes acute loss of function of the lumbar plexus

17

How does mechanical back pain present?

Recurrent relapsing and remitting back pain with no neurological symptoms
Worse on movement, relieved by rest

Aged between 20-60 and have had previous 'flare ups'

18

What are some of the causes of mechanical back pain?

Obesity

Poor posture

Poor lifting technique

Lack of physical activity

Depression

Degenerative disc prolapse

Facet joint OA

Spondylosis

19

What is spondylolysis?

The intervertebral discs lose water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA

20

Why is bed rest not advised in mechanical back pain?

This will lead to stiffness and spasm of the back which may exacerbate disability

21

What are the symptoms of an L3/L4 prolapse and what nerve is compressed?

L4 root entrapped

Pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk

22

What are the symptoms of an L4/L5 disc prolapse and which nerve is compressed?

L5 nerve root entrapment

Pain down dorsum of foot

Reduced power Extensor Hallucis Longus and tibialis anterior

23

What are the symptoms of an L5/S1 prolapse and which nerve is compressed?

S1 nerve root entrapment

Pain to sole of foot, reduced power planarflexion, reduced ankle jerks

24

What is spinal stenosis?

When the cauda equina of the lumbar spine has less space due to a combination of bulging discs, bulging ligamentum flavum and osteophytosis

25

What is the primary symptom of spinal stenosis?

Claudication

26

How does spinal claudication differ from vascular claudication?

The claudication distance is inconsistent

The pain is burning (rather than cramping)

Pain is less walking uphill (spine flexion creates more space for the cauda equina)

Pedal pulses are preserved

27

What are the symptoms of cauda equina syndrome?

Bilateral leg pain

Paraesthesiae or numbness and complain of “saddle anaesthesia”

Urinary retention/incontience

Constipation/bowel incontinence

28

What is the management of cauda equina syndrome?

Urgent MRI

Urgent discectomy

29

How are osteoporotic fractures of the lumbar spine managed?

Usually conservatively

30

What cervical spine pathology are children with Down's syndrome at risk of developing?

Atlanto‐axial (C1/C2) instability with subluxation potentially causing spinal cord compression