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MSK SOH > Spine pathologies > Flashcards

Spine pathologies Flashcards

1
Q

Curvatures of the spine

A

Lordosis - cervical, lumbar

Kyphosis - thoracic, sacral

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2
Q

Cervical vertebrace - C1

A

Atlas
No body, no spinner process
Has an anterior and posterior arch instead

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3
Q

Cervical vertebrae - C2

A

Axis

Has an odontoid process which projects superiorly from body

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4
Q

Cervical vertebrae - C7

A

Vertebrae prominens

First palpable spinous process

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5
Q

What kind of joints are intervertebral disc?

A

Secondary cartilagenous joints

Fibrocartilagenous

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6
Q

Function of intervertebral discs

A

Cushion the vertebral bodies from spinal stresses

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7
Q

Intervertebral disc components

A

Outer annulus fibrosis

Inner nucleus pulposus

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8
Q

Intervertebral disc degeneration

A

Degeneration occurs due to ageing

usually at L4/L5 level or L5/S1 level

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9
Q

Facet joints

A

Found between each vertebrae
At cervical level they are horizontal - allows lots of movement
At lumbar level they are vertical - allows limited movement

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10
Q

Motor neurones arise from anterior/posterior aspect of spinal cord

A

Anterior

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11
Q

Sensory neurones arise from anterior/posterior aspect of spinal cord

A

Posterior

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12
Q

What do anterior and posterior nerve roots join to form?

A

Mixed spinal nerve

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13
Q

Cauda equina region

A

Spinal cord ends at L1 where it becomes the caudal equine region

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14
Q

Red flags in history

A 
constant back pain for over 6 weeks 
pain troublesome at night
systemic upset
history of cancer
history of steroid use
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15
Q

x-ray overview

A

Usually normal

Most x-ray abnormalities are degenerative changes which may not be the cause of the patient’s presenting symptoms

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16
Q

MRI overview

A

Common to get false +ves

Only required if red flags in Hx present or if considering surgery

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17
Q

Mechanical back pain - definition

A

Recurrent relapsing and remitting back pain

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18
Q

Mechanical back pain - who gets it

A

Middle aged

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19
Q

Mechanical back pain - cause

A

Obesity
Poor posture
Poor lifting technique
Degenerative disc prolapse

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20
Q

Mechanical back pain - clinical features

A

Pain worse with movement

Pain worse at the end of the day

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21
Q

Mechanical back pain - management

A

Analgesia
Physio
Severe: spinal stabilisation surgery

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22
Q

Nerve root back pain - definition

A

Motor loss, sensory loss

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23
Q

Nerve root back pain - clinical features

A

Affects the leg more than the back
Unilateral pain
Paraesthesia (tingling, burning sensation)
Pain occurs when nerve is stretched

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24
Q

Nerve root back pain - management

A

Physio
Analgesia - but this is not effective as pain is neuropathic
Amitriptyline, gabapentin, pregablin

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25
Complete spinal cord injury
No sensory or voluntary motor functions below the level of the injury - (reflexes are unaffected as these are an involuntary motor function)
26
Incomplete spinal cord injury
Some sensory and motor functions are still present distal to the level of the injury
27
Sciatica - definition
Pain produced due to compression or irritation of the sciatic nerve
28
Sciatica - cause
Prolapsed disc | Degenerative disc disease
29
Sciatica - commonly affected areas
Lower lumbar spine Buttocks Thigh Leg
30
Sciatica - nerve roots affected
L4 L5 S1
31
Sciatica - clinical features
Usually affects one side of the lower body Pain originates in lower back Pain radiates along the path of the sciatic nerve in a dermatomal distribution - [thigh, leg, foot] Pain is described as tingling or burning sensation Pain relieved when lying down or walking Pain worsened when standing still or sitting
32
Sciatica - L4 root entrapment symptoms
Pain worse in thigh region Pain down to medial ankle Reduced knee jerk
33
Sciatica - L5 root entrapment symptoms
Pain down to the dorsum of the foot Numbness at the web between the big toe Foot drop
34
Sciatica - S1 root entrapment symptoms
Pain down to plantar surface of foot Reduced plantar flexion - unable to raise heel off of the ground Reduced ankle jerk reflex
35
Sciatica - examination
Reduced reflexes | Positive sciatic stretch test
36
Sciatica - investigations
MRI scan
37
Sciatica - management
Analgesia Severe: Gabapentin If pain doesn't subside over time: surgery
38
Prolapsed disc - definition
AKA slipped disc. Acute tear in the outer annulus fibrosis of an intervertebral disc which causes the inner nucleus pulposus to rupture out of its enclosed space. The prolapsed disc material can enter the spinal canal, squashing the spinal cord or spinal nerves (sciatica)
39
Prolapsed disc - cause
Usually after lifting a heavy object | Falling from a height and landing on buttocks
40
Prolapsed disc - commonly affected areas
Cevical spine | Lumbar spine
41
Prolapsed disc - who gets it
Young/middle aged adults
42
Prolapsed disc - clinical features
Patient may be completely asymptomatic Episodic back pain - worse on coughing Sciatica like pain - as described elsewhere Neck pain Weakness Cauda equina signs and symptoms (described elsewhere)
43
Prolapsed disc - investigations
CT | MRI
44
Prolapsed disc - management
Most settle themselves Conservative management - bed rest, NSAIDs, muscle relaxants, physic Surgical management - if patient isn't improving by 3 months
45
Cauda equina syndrome - definition
Clinical emergency Compression of the cauda equine nerve roots (which are located at the lumbrosacral spinal level) If the nerve roots are compressed for a long period of time, permanent damage can be caused
46
Cauda equina syndrome - causes
Prolapsed disc Spinal stenosis Tumour
47
Cauda equina syndrome - clinical features
Bilateral sciatica leg pain Loss of bladder and bowel function - incontinence, urgency Saddle anaesthesia (numbness around sitting area)
48
Cauda equina syndrome - examination
PR exam | Check reflexes
49
Cauda equina syndrome - investigations
Clinical diagnosis but imaging helps identify the cause - MRI - CT scan - Myelogram X-ray of SC after injection of contrast
50
Cauda equina syndrome - management
Surgical decompression | - must treat and get pressure off the nerves as soon as possible
51
Spinal stenosis - definition
Narrowing of the spaces within mainly the cervical and lumbar spine. This can put pressure on the nerves that travel through the spine
52
Spinal stenosis - cause
``` Osteoarthritis due to wear and tear via the formation of osteophytes Prolapsed discs Tumours Spinal injuries Manual workers Obese people ```
53
Spinal stenosis - clinical features
Pain, tingling, numbness Symptoms gradually worsen over time Difficulty walking down a hill as patient is leaning over and making the space even narrower
54
Spinal stenosis - Investigations
X-ray | MRI
55
Spinal stenosis - management
Analgesia Physio Steroid injections Decompression surgery if symptoms persist
56
Spondylothesis - definition
The forward slip of one vertebrae over the vertebrae below it
57
Spondylothesis - areas of the spine commonly affected
L4, L5, S1
58
Spondylothesis - cause
Physical activity Developmental defect Recurrent stress fracture
59
Spondylothesis - who gets it
Adolescents | Obesity
60
Spondylothesis - clinical features
Lower back pain - especially after exercise | Waddeling gait
61
Spondylothesis - investigations
X-ray
62
Spondylothesis - management
Rest
63
Scoliosis - definition
Sideways curvature of the spine due to spinous processes drifting off to the side
64
Scoliosis - cause
Cerebral palsy Muscular dystrophy Idiopathic
65
Scoliosis - who gets it
Adolescents | Females commonly affected
66
Scoliosis - clinical features
Uneven shoulder height and hip height
67
Scoliosis - investigations
X-ray
68
Scoliosis - management
If mild; leave it | If severe; surgery
69
Spinal osteoarthritis (spondylosis)
Osteophytes can impinge on exiting nerve roots and it can result in sciatica
70
Spinal osteoarthritis (spondylosis) - cause
Disc degeneration | Wear and tear due to old age
71
Spinal osteoarthritis (spondylosis) - clinical features
slow onset stiffness and back pain | Pain may radiate to shoulders and occiput
72
Spinal osteoarthritis (spondylosis) - management
Physio | Analgesia
73
Cervical spine fracture - definition
High C-spine fractures may be fatal (especially if above C3 level)
74
Cervical spine fracture - cause
Usually high energy injury
75
Cervical spine fracture - risks
May be missed in an unconscious patient which could result in spinal cord injury Must put unconscious patient in a C-spine collar and perform X-ray to check for C-spine injury to be safe
76
Cervical spine fracture - investigations
X-ray (3 views are required) | - AP view, lateral view, peg open mouth view
77
Cervical spine fracture - management
Stable: firm cervical collar Unstable: immobilisation in a halo vest (external fixator)
78
Thoraco lumbar spine fracture - cause
Young: High energy injury Old: Low energy injury (osteoporotic wedge fracture)
79
Thoraco lumbar spine fracture - clinical features
Back pain that is worsened with movement | Possible brain injury
80
Thoraco lumbar spine fracture - investigations
X-ray
81
Thoraco lumbar spine fracture - management
Stable, thoracic - brace Stable, lumbar - plaster jacket Unstable thoracic/lumbar - surgery
82
Crush fracture - definition
Vertebral compression fracture
83
Crush fracture - cause
Osteoporosis
84
Crush fracture - clinical features
Spine curves so height of patient decreases
85
Crush fracture - management
Usually conservative: analgesics
86
Chance fracture - definition
seatbelt fracture, from a seatbelt in a car crash
87
Chance fracture - investigations
X-ray MRI CT
88
X-rays
Show some fractures
89
Can you see ligaments on X-rays?
No | - but if vertebral alignment is normal this implies intact ligaments and stable spine
90
Can you see intervertebral discs on x-ray?
No
91
Can you see spinal cord on x-ray?
No
92
What is CT scan used for in MSK conditions?
To look for fractures the x-ray has missed | Shows intervertebral discs
93
Investigation of choice for viewing disc prolapse? (2)
CT scan | MRI scan
94
What is the best mode of imaging to view soft tissue disorders?
MRI scan

MSK SOH (24 decks)

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