Spine Pathology

Question 1

nerve compression caused by narrowing of the spinal cord or neural foramina

Answer 1

spinal stenosis

Question 2

compression of the actual spinal cord

Answer 2

central stenosis

Question 3

compression of the nerve root as it exits the spinal canal

Answer 3

lateral stenosis

Question 4

where does spinal stenosis most commonly occur?

Answer 4

lumbar spine > cervical > thoracic

Question 5

occurs with exacerbation of pain when walking, lumbar pain is relieved by leaning forward, and pain radiates down one or both legs/arms

Answer 5

spinal stenosis

Question 6

bundle of spinal nerve roots at the end of the spinal cord in the lumbar region that includes the sacral plexus and terminates at L1/L2

Answer 6

cauda equina

Question 7

where does the cauda equina provide motor/sensory? (2)

Answer 7

lower extremities
pelvis for bowel/bladder function

Question 8

a patient presents with severe low back pain that radiates down the leg, has asymmetric LE motor weakness/sensory loss, loss of reflexes in LE, saddle anesthesia (L3-L5), has onset of bowel/bladder dysfunction, and recent onset of sexual dysfunction. Dx?

Answer 8

cauda equina syndrome

Question 9

what is the most consistent sign in cauda equina syndrome?

Answer 9

urinary retention

Question 10

what is the treatment of cauda equina syndrome?

Answer 10

refer to ER or spine surgeon
surgery within 24-48 hours

Question 11

what imaging is used to diagnose cauda equina syndrome?

Answer 11

MRI

Question 12

what is the most common area to have a herniated nucleus pulposus?

Answer 12

lumbar spine

Question 13

when the annulus fibrosus breaks open or cracks and allows the nucleus pulposus to escape

Answer 13

herniated nucleus pulposus

Question 14

diagnose?

Answer 14

severe compression of the spinal cord

Question 15

what spinal levels are the #1 most common areas of a herniated nucleus pulposus?

Answer 15

L4/L5
L5/S1

Question 16

what spinal levels are the #2 most common areas of a herniated nucleus pulposus?

Answer 16

C4/C5
C5/C6

Question 17

a patient presents with back pain that radiates, numbness, tingling to arms/legs, positional changes makes symptoms worse, abnormal reflexes, and decreased sensation. Dx?

Answer 17

herniated nucleus pulposus

Question 18

what imaging gives the definitive diagnosis of herniated nucleus pulposus?

Answer 18

MRI

Question 19

what is the conservative treatment for a herniated nucleus pulposus? (4)

Answer 19

pain meds/therapies
anti-inflammatories
physical therapy
epidural steroid injections

Question 20

what is the treatment for a herniated nucleus pulposus for patients that fail cons. treatment or have weakness on exam?

Answer 20

discectomy +/- laminectomy +/- foraminotomy

Question 21

arthritis of the spine involving changes to the bones, discs, ligaments and joints; the discs of the spine gradually break down, lose fluid, and become stiffer

Answer 21

spondylosis

Question 22

what is visible on an xray of a patient with spondylosis? what can it lead to? (2)

Answer 22

osteophytes (spurs)

central or lateral stenosis

Question 23

a patient presents with neck stiffness and pain, headache, pain in shoulder and arms, cannot fully turn their head/bend their neck, has a grinding noise when neck is turned. Dx?

Answer 23

cervical spondylosis

Question 24

when can spondylosis cause arm/leg pain, weakness, and abnormal reflexes?

Answer 24

if osteophytes press on spinal nerves

Question 25

a patient presents with lower back stiffness and pain, pain in the hips/legs, worsened with increased activity and long sitting. Dx?

Answer 25

lumbar spondylosis

Question 26

what is the first line imaging for spondylosis?

Answer 26

xrays

Question 27

what is the cons. treatment for spondylosis? (4)

Answer 27

NSAIDs physical therapy weight loss epidural steroid injections

Question 28

what is the surgical treatment for spondylosis in patients who fail cons. treatment or have loss of function with weakness? (3)

Answer 28

laminectomy foraminotomy +/- cervical/lumbar fusion

Question 29

fracture through the **pars interarticularis** (weakest portion of the vertebra) that most commonly occurs in L4 or L5, and can occur on one side or both sides of the bone

Answer 29

spondylolysis

Question 30

a small, thin portion of the vertebra that connects the superior and inferior facet joints

Answer 30

pars interarticularis

Question 31

what is spondylolysis also called?

Answer 31

scotty dog

Question 32

many times, patients with spondylolysis will also have some degree of _______

Answer 32

spondylolisthesis

Question 33

a bone in the spinal cerebra slips out of position, either anteriorly or posteriorly

Answer 33

spondylolisthesis

Question 34

what is the most common location of spondylolisthesis?

Answer 34

lower back (lumbar spine)

Question 35

what are the 2 causes of spondylolysis?

Answer 35

overuse genetics

Question 36

Dx?

Answer 36

spondylolisthesis

Question 37

what may spondylolisthesis with a high-grade slip present with?

Answer 37

spinal stenosis

Question 38

what views should an xray be taken for spondylolysis and spondylolisthesis?

Answer 38

flexion/extension views for listhesis oblique view for spondylosis

Question 39

diagnose

Answer 39

L5-S1 spondylosis with spondylolisthesis

Question 40

what is the cons. treatment for spondylolysis and spondylolisthesis? (4)

Answer 40

NSAIDs physical therapy bracing for acute epidural steroid injection for + nerve symptoms

Question 41

what should be considered for patients with spondylolysis/spondylolisthesis?

Answer 41

referral to ortho spine

Question 42

when should fusion surgery be considered for patient's with spondylolysis/spondylolisthesis? (4)

Answer 42

back pain not improved with cons. tx progressively worsening slippage severe, persistent symptoms possible compression of spinal nerves

Question 43

abnormal lateral curvature of the spine

Answer 43

scoliosis

Question 44

what spinal levels is scoliosis most common in and what kind of curvature is most common?

Answer 44

T7/T8 right thoracic curve

Question 45

a patient presents with asymmetry in the shoulder and iliac height, asymmetric scapular prominence, and a flank crease with forward bending showing right thoracic and left lumbar prominence. Dx?

Answer 45

scoliosis

Question 46

what instrument measures trunk asymmetry for scoliosis?

Answer 46

scoliometer

Question 47

when should xrays be taken for scoliosis?

Answer 47

when scoliometer is over 5 degrees

Question 48

what does the cobb's method angle measurement tell us?

Answer 48

curves >15 degrees are significant

Question 49

what is the treatment for scoliosis in mild degrees of < 20?

Answer 49

monitor w/ serial xrays between 3-6 months

Question 50

what is the treatment for scoliosis in moderate-severe degrees > 20?

Answer 50

refer to ortho for monitoring and tx bracing/spinal fusion

Question 51

increased convex curvature of the thoracic spine, AKA hunchback > 45 degrees

Answer 51

kyphosis

Question 52

idiopathic osteochondrosis of the thoracic spine that occurs in children

Answer 52

scheurmann's disease (juvenile kyphosis)

Question 53

what imaging should we get for kyphosis?

Answer 53

standing lateral xrays

Question 54

what is the treatment for kyphosis? (3)

Answer 54

observe q 3-4 months physical therapy bracing in children

Question 55

what is the treatment for kyphosis > 60 degrees or with persistent pain?

Answer 55

Milwaukee brace

Question 56

what is the treatment for kyphosis that is unresponsive to cons. treatment?

Answer 56

surgery

Question 57

in which part of the spine do vertebral fractures most commonly occur?

Answer 57

thoracic spine

Question 58

vertebral fracture that is associated with osteoporosis and no neurological compromise

Answer 58

compression fracture

Question 59

vertebral fracture that is associated with trauma and possible neurological compromise

Answer 59

burst fracture

Question 60

what side of the vertebra do compression fractures occur in?

Answer 60

anterior aspect of vertebra

Question 61

a patient presents with sudden midline back pain that is worse with movement and a thoracic kyphosis deformity. Dx?

Answer 61

compression fracture

Question 62

what is the treatment for a compression fracture? (4)

Answer 62

nutrition/exercise education vit D/calcium osteoporosis tx pain meds

Question 63

what is the treatment for compression fractures when there is >50% loss of vertebral height?

Answer 63

kyphoplasty

Question 64

what side of the vertebra do burst fractures occur in?

Answer 64

both anterior and posterior aspect of vertebrae

Question 65

burst fractures have a high risk of what?

Answer 65

spinal cord compromise

Question 66

what is the treatment for a burst fracture?

Answer 66

surgery

Question 67

inflammatory disease that causes fusion of the vertebra over time, leading to restricted motion of the spine and can cause a hunched forward posture

Answer 67

ankylosing spondylitis

Question 68

a patient presents with kyphosis, restricted lumbar motion, limited motion of shoulders and hip, synovitis of the knee, plantar fasciitis, and achilles tendinitis. Dx?

Answer 68

ankylosing spondylitis

Question 69

what labs should we expect to find in a patient with ankylosing spondylitis?

Answer 69

elevated ESR/CRP HLA-B27 positive

Question 70

which test can we use to examine spine mobility in a patient with ankylosing spondylitis?

Answer 70

schober's test

Question 71

what should we expect to see in imaging of ankylosing spondylitis?

Answer 71

bamboo appearance

Question 72

on xray, you note disappearance of the pedicle. Dx? what is this appearance also called?

Answer 72

metastatic spine tumor winking owl sign