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Systems: MSK AB > Spine Symposium > Flashcards

Spine Symposium Flashcards

(96 cards)

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1
Q

What are the 3 main types of vertebrae?

A
  • Cervical
  • Thoracic
  • Lumbar
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2
Q

Other than vertebrae, what other boy structures do the thoracic vertebrae articulate with?

A

Ribs

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3
Q

What natural curvatures of the spine exist?

A
  • Cervical lordosis
  • Thoracic kyphosis
  • Lumbar lordosis
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4
Q

Name the erector spinae muscles?

A
  • Iliocostalis
  • Longissimus
  • Spinalis
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5
Q

How do spinal nerves exit the vertebral column?

A

Through intervertebral foramen

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6
Q

Where does the spinal cord end?

A

L1 as the conus medularis

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7
Q

What is a dermatome?

A

An area of skin that is mainly supplied by a single nerve

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8
Q

What is a myotome?

A

The group of muscles that a single spinal nerve innervates

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9
Q

What are the mytomes of the upper limb?

A
  • C5: Shoulder abduction (deltoid)
  • C6: Elbow flexion/wrist extension (biceps)
  • C7: Elbow extensors (triceps)
  • C8:Long finger flexors (FDS/FDP)
  • T1: Finger abduction (interossei)
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10
Q

What are the myotomes of the lower limb?

A
  • L2: Hip flexion (iliopsoas)
  • L3,4: Knee extension (quadriceps)
  • L4: Ankle dorsiflexion (tib ant)
  • L5: Big toe extension (EHL)
  • S1: Ankle plantar flexion (gastrocnemius)
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11
Q

What is the association between fractures/dislocations and spinal cord injuries?

A
  • 15% of people with a fracture/dislocation will have SCI

- Majority of people with SCI will have an accompanying column injury

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12
Q

What is the epidemiology of spinal cord injuries?

A
  • 1,000 SCI / year in the UK
  • 50,000 people in the UK living with paralysis
  • M>F
  • Peak 20-29yrs
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13
Q

What are the most common causes of SCI?

A
  • Falls
  • RTAs
  • Sports and recreational activities
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14
Q

How does a complete SCI present?

A
  • No motor or sensory function distal to lesion
  • No anal squeeze
  • No sacral sensation
  • ASIA Grade A
  • No chance of recovery
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15
Q

How do incomplete SCI present?

A
  • Some function is present below site of injury

- More favourable prognosis overall

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16
Q

Why can it not be determined if a SCI is complete or incomplete acutely?

A

Patient may be in spinal shock

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17
Q

What classification system is used in SCI?

A

Asia classification

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18
Q

What is grade A in the ASIA classification system?

A
  • Complete

- No sensory or motor function preserved in sacral segments S4-S5

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19
Q

What is grade B in the ASIA classification system?

A
  • Incomplete

- Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5

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20
Q

What is grade C in the ASIA classification system?

A
  • Incomplete
  • Motor function preserved below the neurological level
  • Majority of key muscles have a grade <3
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21
Q

What is grade D in the ASIA classification system?

A
  • Incomplete
  • Motor function preserved below the neurological level
  • Majority of key muscles have a grade >3
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22
Q

What is grade E in the ASIA classification system?

A

Normal motor and sensory function

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23
Q

Give examples of patterns of SCI.

A
  • Tetraplegia/Quadriplegia
  • Paraplegia
  • Central Cord Syndrome
  • Anterior Cord Syndrome
  • Brown-Sequard Syndrome
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24
Q

How does tetraplegia/quadriplegia present?

A
  • Partial or total loss of use of all 4 limbs and the trunk
  • Loss of motor/sensory function in cervical segments of the spinal cord
  • Respiratory failure due to loss of innervation to the diaphragm (phrenic nerve C3-5)
  • Spasticity
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25
What causes tetraplegia/quadriplegia?
Cervical fracture
26
What is spasticity?
- Increased muscle tone due to an upper motor lesion - Affects spinal cord and above - Injuries above L1
27
How does paraplegia present?
- Partial or total loss of use of the lower-limbs - Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord - Arm function spared - Possible impairment of function in trunk, - Spasticity if injury of spinal cord - Bladder/bowel function altered
28
What causes paraplegia?
Thoracic and lumbar fractures
29
What is paraplegia associated with?
Chest or abdominal injuries
30
Give examples of partial cord syndromes.
- Central cord syndrome - Anterior cord syndrome - Brown-Sequard syndrome
31
How does central cord syndrome present?
- Weakness of arms > legs | - Perianal sensation & lower extremity power persevered
32
How does central cord syndrome occur?
- Older patients (arthritic neck) - Can be caused by a low velocity fall in the elderly - Hyperextension injury - Centrally cervical tracts more involved
33
How does anterior cord syndrome present?
- Damaged anterior spinal artery - Fine touch and proprioception preserved - Profound weakness
34
How can anterior cord syndrome occur?
- Hyperflexion injury | - Anterior compression fracture
35
How can Brown-Sequard syndrome occur?
- Hemi-section of the cord | - Penetrating injuries
36
How does Brown-Sequard syndrome present?
- Paralysis on affected side (corticospinal) - Loss of proprioception and fine discrimination (dorsal columns) - Pain and temperature loss on the opposite side below the lesion (spinothalamic)
37
How are SCI managed?
- Key to the management of a patient with SCI is to prevent a secondary insult. - Particularly in patients with incomplete injuries
38
What neuroprotective interventions are there following primary spinal injury?
- In-field stabilisation - ATLS resuscitation - Pharmacological agents - Prompt medical/surgical care
39
How should spinal injuries be initially managed?
Airway (C-spine control) Breathing - Ventilation and oxygenation - Concomitant chest injuries Circulation - IV fluids - Consider neurogenic shock if low BP and HR, loss of sympathetic tone, vasopressors Disability - Assess neurological function including PR and perinanal sensation - Log rolling - Document
40
What are the features of spinal shock?
- Transient depression of cord function below level of injury - Flaccid paralysis - Areflexia - Last several hours to days after injury
41
What are the features of neurogenic shock?
- Hypotension - Bradycardia - Hypothermia - Injuries above T6 - Secondary to disruption of sympathetic outflow
42
What imaging should be used for spinal injuries?
- X-ray - CT scanning for bony anatomy - MRI if neurological deficit or in children
43
When is surgical fixation used?
In the case of unstable fractures
44
How is surgical fixation carried out?
- Vast majority fixed from posteriorly | - Pedicle screws preferred method
45
What is the long term management for spinal injuries?
- Spinal Cord Injury Unit- intermediate term - Physiotherapy - Occupational therapy - Psychological support - Urological /Sexual counseling
46
What gets compressed in a lateral disc protrusion of the lumbar region?
Nerve roots
47
What gets compressed in a central disc protrusion of the lumbar region?
Cauda equina
48
What type of joint is the interevertebral disc?
Secondary cartilaginous
49
What is the structure of the intervertebral disc?
- Largest avascular structure in the body - Tough outer layer= annulus fibrosus (fibres run obliquely and alternate between layers) - Gelatinous core= nucleus pulposus
50
What type of injury can occur at the intervertebral discs?
Annulus may tear and nucleus may prolapse
51
How are the intervertebral discs connected to the vertebral bodies?
By the ALL and the PLL
52
What types of movement do the intervertebral discs resist?
Rotational movements
53
What are the most common types of disc prolapse?
Postero-lateral
54
What does the nucleus pulposus consist of?
- Mainly water 88% - Collagen - Proteoglycans (very hydrophilic)
55
What occurs during the normal ageing process in regards to the intervertebral discs?
- Decreased water content of discs - Disc space narrowing - “Degenerative” changes on X-rays - Degenerative changes in the facet joints - Aggravated by smoking, etc.
56
What pathological processes can occur with the intervertebral discs?
- Tearing of annulus fibrosis and protrusion of the nucleus - Nerve root compression by osteophytes - Central spinal stenosis - Abnormal movement(spondylolysis, spondylolisthesis)
57
How does nerve root pain present?
- Fairly common - Limb pain worse than back pain - Pain in a nerve root distribution (radicular) - Root tension signs - Root compression signs - Dermatomes & myotomes
58
How should nerve root pain be managed?
- Most will settle, about 90% in 3 months - Physiotherapy - Strong analgesia - Referral after 12 weeks - Imaging including MRI
59
Name 4 disc problems
- Bulge - Protrusion - Extrusion - Sequestration
60
What is a disc bulge?
- Generalised - Common and majority asymptomatic - Small 'bump'
61
Why is a disc protrusion?
Annulus is weakened but still intact
62
What is disc extrusion?
Nucleus pushes through annulus but continuity
63
What is disc sequestration?
Desiccated disc material is free in the canal
64
Where is the most common site of cervical disc prolapse?
C5/6
65
Where do thoracic disc prolapses occur?
- <1% of intervertebral disc prolapses - Mid to lower levels (75% T8-12) - Most at T11/12 - Central, posterolateral and lateral herniations
66
Where do lumbar disc prolapses occur?
- Usually L4/5 (45%), followed by L5/S1 (40%), then L3/4 (10%) - Most are posterolateral (Posterior Longitudinal Lig weakest) - Central disc may give pain in both legs, or may be back pain only
67
How will a prolapsed disc at L5/S1?
Nerve root -S1 Sensory loss -Little toe and sole of foot Motor weakness -Plantar flexion of foot Reflex change -Ankle jerk
68
How will a prolapsed disc at L4/L5?
Nerve root -L5 Sensory loss -Great toe and 1st dorsal web space Motor weakness -EHL Reflex change -None
69
How will a prolapsed disc at L3/L4?
Nerve root -L4 Sensory loss -Medial aspect of lower leg Motor weakness -Quads Reflex change -Knee jerk
70
What is cauda equine syndrome?
A surgical emergency where the cauda equine is compressed
71
What can compression of the sacral nerve roots result in?
Permanent bladder and anal sphincter dysfunction with incontinence
72
What should be done if someone presents with suspected cauda equine syndrome?
- Admission - Urgent MRI scan - Emergency operation within 48 hr of onset - Delay results in permanent dysfunction
73
What is the aetiology of cauda equine syndrome?
- Central lumbar disc prolapse (commonest) - Tumours - Trauma (burst or Chance #, disc) or spinal stenosis - Infection (epidural abscess) - Iatrogenic (spinal surgery or manipulation, spinal epidural injection)
74
What are the clinical features of cauda equine syndrome?
- Injury or precipitating event - Bilateral buttock and leg pain with vary dysesthesia and weakness - Bowel or bladder dysfunction (urinary retention+/- incontinence overflow) - Saddle anaesthesia , loss of anal tone and anal reflex
75
When should you have a high index of suspicion for cauda equine syndrome?
Spinal post-op patients with increasing leg pain in presence of urinary retention
76
What radiological images should be taken in suspected cauda equine?
- MRI | - Lumbar CT myelogram (if MRI contraindicated)
77
What is the treatment for cauda equine syndrome?
OPERATIVE | -Within 48 hours
78
What are the possible outcomes of cauda equine syndrome?
- 30% undergoing discectomy for cauda equina syndrome did NOT regain normal urinary function - 25% with motor deficits never regained full power - 33% with sensory deficits never regained normal sensation - 25% with perianal paraesthesiae did not return to normal - 26% had persitent sexual dysfunction
79
What are cervical and lumbar spondylosis?
Common degenerative change which occurs at the facet joints, discs, ligaments etc. of the spine
80
What can happen in severe spondylosis?
Can compress the whole cord causing myelopathy | -UMN signs in limbs
81
What type of movement do the synovial facet joints of the spine allow?
Mainly flexion and extension
82
What ligaments are there in the spine?
- Anterior longitudinal ligament - Posterior longitudinal ligament - Ligamentum flavum - Interspinous and supraspinous ligaments - Intertransverse ligament
83
Where does the anterior longitudinal ligament run?
Along the front of the vertebral bodies
84
Where does the posterior longitudinal ligament run?
Along the backs of the vertebral bodies
85
Where does the ligamentum flavum run?
Between the lamina
86
Where does the interspinous and supraspinous ligaments run?
Between the spinous processes
87
Where does the intertransverse ligament run?
Between the transverse processes
88
What is lumbar spondylosis?
OA of facet and disc joints (+ degeneration of ligaments etc.)
89
How is spinal claudication distinguished from vascular claudication?
- Usually bilateral - Sensory dysaesthesiae - Poss weakness (drop foot – tripping) - Takes several minutes to ease after stopping walking - Worse walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding bicycle
90
Give examples of types of spinal stenosis.
- Lateral recess stenosis - Central stenosis - Foraminal stenosis
91
What is the treatment for lateral recess stenosis?
- Non-operative - Nerve root injection - Epidural injection - Surgery
92
What is the treatment for central stenosis?
- Non-operative - Epidural steroid injection - Surgery (80% improve)
93
What is important in central stenosis cause?
The shape of the canal (congenital)
94
What is the treatment for foraminal stenosis?
- Non-operative - Nerve root injection - Epidural injection - Surgery
95
What do the symptoms of spondylolisthesis vary with?
Type of spondylolisthesis
96
What is the treatment for spondylolisthesis?
Treatment depends on symptoms - Conservative with lifestyle changes - Surgery for persistent pain +/- nerve root entrapment

Systems: MSK AB (43 decks)

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