Spine Red Flags Flashcards by Owen Honroth

MSK based spinal flags

fracture
cervical instability
malignancy

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neurological related spine red flags

cervical myelopathy
cauda equina

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cardiovascular related spine flags

vertebral basilar insufficiency
abdominal aortic aneurysm
myocardial infarction
pneumothorax

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infections of the spine

osteomyelitis
sacroiliitis

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what causes spinal fractures

axial loading and trauma

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what % of calcaneal fractures are associated with _________

10%
low thoracic or lumbar fx

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risk factors to consider in spinal fx

trauma
osteoporosis
hx of spinal fracture
hx of cancer

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ages related to spinal fracture risk factors

females >65
males >75

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what in a patient’s history would make you suspicious of osteoprosis

history of osteoporosis
late onset menarche (>16 y/o)
early menopause (<45)
corticosteroid use >3 mo

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if a superficial bone is tender to palpation after trauma, think

fracture

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presentation of cervical fx

neck pain that worsens with motion
instability s/s
possible cord and/or vertebral artery s/s

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during flexion, explain the motion of the dens

will push into the spinal cord during flexion

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high risk factors in the Canadian C-Spine Rule that indicate a CT scan

65 or older
dangerous mechanism
paresthesia in extremities

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dangerous mechanisms can be described as

fall from > 3 feet or 5 stairs
axial load to head
MVC

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In the Canadian C-Spine rules, what are factors that would not allow for safe ROM assessment

not a simple MVC
unable to sit up in ER
inability to ambulate
midline c-spine tenderness
immediate onset of neck pain

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if cervical AROM is less than ____,
CT scans are indicated

45°

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when is the Canadian C-spine rule not applicable

non-trauma cases
glasglow coma scale <15
unstable vitals
age <16
acute paralysis
known vertebral disease
previous C-Spine surgery
pregnancy

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what is the sensitivity of the canadian c-spine rule

90-100%

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what is the NEXUS criteria?

criteria in which all must be negative for CT scan to not be indicated

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what are the criteria in the NEXUS criteria

no posterior midline cervical spine tenderness
no evidence of intoxication
normal level of consciousness
no focal neurological deficit
no painful distraction injury

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sensitivity of the NEXUS criteria

83-100%

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which criteria has been very successful in identifying odontoid fx

NEXUS

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what portion of the body are there more distracting injuries? what are examples

UE>LE

fx, degloving, crush, burns or large visceral injuries

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red flags for a vertebral fx in patients presenting with LBP

> 70 y/o
corticosteroid use
trauma
contusion/abrasion

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what warrants lumbar radiography? which directions?

lumbar compression minor traumatic fx A-P and lateral views

what on an MRI will indicate a pathologic lumbar fracture

abnormal bone marrow signal

what types of scans can be done on a lumbar fx

lumbar radiography CT w/o contrast MRI w/o contrast

IFOMPT upper c-spine instability risk factors

history of trauma infection congenital collagenous compromise inflammatory arthritides recent head/neck/dental surgery

on the beighton scale, what constitutes congenital collagenous compromise

>4 of 9

how would an infection lead to cervical spine instability

alter connective tissue integrity - could erode bone - spondylitis then stenosis - grisel's syndrome

s/s of upper cervical spine instability

occipital HA / numbness and neck pain severe limitation of neck AROM - all planes <45° rotation cervical myelopathy pupil changes dizziness positive ligamentous integrity tests

ligamentous integrity tests related to Upper C-Spine Instability

sharp-purser alar ligament aspinall

what films will be taken for those with upper cervical spine instability

open mouth odontoid - spread of lateral masses of C1/2 lateral c-spine - flexion and extension views

what distances between C1/2 and atlanto dens interval are significant

<3 mm = normal >5mm = increased risk of cord compression >8mm = indicates surgical fixation

film indication for pt with blunt force c-spine trauma

CT scan

when is MRI indicated in the spine

neurological clinical examination findings suspicion of ligamentous / vascular injury

risk factor of spinal malignancy

hx of cancer

s/s of spinal malignancy

progressive/constant severe pain night pain w/ minimal relief systematically unwell unexplained weight loss spine tenderness and warmth neurological s/s

what amount of weight loss in what time frame is significant

5-10% loss over 1-3 mo

what rules out cancer causing LBP

<50 years no explained weight loss no hx of cancer responding to conservative care in a month

if a spinal radiograph shows, _____________ then a contrast MRI is indicated

disc margin destruction bony lesion suggestive of malignancy / infection

what is the cluster associated with cervical myelopathy

>45 y/o ataxic gait babinski's, reverse supinator, hoffman's signs

which gender is cervical myelopathy more prevalent? what is the avg age / what is the most prevalent symptom

male (3:1) 64 UE radicular pain

what film is indicated with myelopathy suggestion

either MRI or CT with contrast

what is a positive Lhermitte sign

sharp shooting sensation in arm and leg when the extended leg is lifted and the c-spine is flexed

what nerve pairs are in the cauda equina

L2-5 S1-5 Coccygeal nerve

risk factors of cauda equina syndrome

disc herniation spinal stenosis surgery tumor trauma hematoma epidural abcess

s/s of cauda equina syndrome

bladder/bowel changes sexual changes sensory disturbances global/progressive LE weakness reduced anal tone

what sensory disturbances are associated with cauda equina syndrome

saddle anesthesia LE L4,5 S1

red flags are more so _____ in cauda equina syndrome? which red flags

sensitive saddle anesthesia reduced anal tone bowel incontinence

common cause of vertebral/internal carotid dissections

tear of tunica intima or outer adventitial layer via vaso vasorum damage intramural hematoma causes blood flow alterations

where is the vertebral artery most commonly injured

C1-2 --> contralateral to rotation

explain VBI testing and its effectiveness

is not very sensitive

instead of normal VBI testing, what should be done when suspecting vascular pathology

peripheral/cranial nerve screen blood pressure assessment palpation/auscultation of common and IC arteries coordination and gait assessment

vertebral artery 5 D, 3 N, 1 A

D: dizziness, dysphagia, dysarthria, drop attack, diplopia N: nausea, numbness in face, nystagmus A: ataxia

age risk factor for MI males and females

male >40, female >50

female only risk factors of MI

increased testosterone before menopause increased HTN during menopause autoimmune disease stress, depression

what prodromal symptoms may precede an MI in women? what timeline?

unusual fatigue sleep disturbances dyspnea indigestion anxiety heart racing UE/LE weakness

s/s of MI

shortness of breath substernal chest pain or squeezing pressure radiating pain in referral distribution angina >30min that is unrelenting pallor / perspiration

risk factor of abdominal aortic aneurysm

>50 y/o male smoker family hx genetic condition weight lifting anticoagulants

what cm measurement is suggestive of an aneurysm

4 or more CM

locations of pain associated with abdominal aortic aneurysm

back abdominal groin posterior thigh

pneumo s/s

dyspnea dry cough change in respiratory movements in affected side neck vein distension sharp, sudden thoracic wall pain referred shoulder / abdominal pain

risk factors for spinal infection

IV drug use recent infection / surgery immunosuppression history of TB

s/s of spinal infection

general infection symptoms unexplained weight loss neuro s/s spinal tenderness

if a radiograph shows disc margin destruction/bony lesion what would be indicated? why?

involved MRI without contrast spinal malignancy or infection

findings associated with vertebral osteomyelitis

deep, constant pain, > with WB spinal rigidity fever, malaise

Spondylarthritis

noninfectious inflammatory, rheumatic condition

extraarticular manifestations of SpA

enthesitis uveitis dactylitis

s/s ankylosing spondylitis

insidious LBP >3 mo SI symptoms / buttock pain awaken in the night morning stiffness >30 min

what is the nickname of ankylosing spondylitis

bamboo spine with a dagger sign