SST Flashcards
(119 cards)
1
Q
Deterioration or disease of the spinal cord
A
Myelopathy
2
Q
A cell that forms bone
A
Osteoblast
3
Q
A cell that resorbs bony tissue
A
Osteoclast
4
Q
Deterioration or disease of a nerve root
A
Radiculopathy
5
Q
Being of a density that allows passage of some or all x-rays. Most anatomical structures have some degree of radiolucency
A
Radiolucent
6
Q
Being dense enough to block passage of some or all x-rays
A
Radiopaque
7
Q
The posterior slippage of a vertebra in relation to the inferior adjacent vertebra
A
Retrolisthesis
8
Q
Kyphotic condition resulting from idiopathic aseptic necrosis of the vertebral bodies. Also referred to as juvenile kyphosis
A
Sheuermanns disease
9
Q
Pain in the lower back and hip that radiates into the back of the thigh and leg; results from compression of the L5 or S1 nerve root
A
Sciatica
10
Q
The anterior slippage of a vertebra in relation to the inferior adjacent vertebra
A
Spondylolisthesis
11
Q
A defect in a vertebra, usually in the area of the para interarticularis, in which the vertebral body maintains relatively normal alignment
A
Spondylolysis
12
Q
A spondylolisthesis of L5 in which the vertebral body has slipped entirely off the top of the sacrum and into the pelvic cavity
A
Spondyloptosis
13
Q
The degenerative changes that occur in the articulation points of a vertebra; essentially, arthritis of the spine
A
Spondylosis
14
Q
The narrowing of a tube or passage
A
Stenosis
15
Q
Relative to the spine, a partial or incomplete vertebral slip in relation to the adjacent vertebrae. Commonly referred to as spondylolisthesis
A
Subluxation
16
Q
Inflammation of a synovial membrane
A
Synovitis
17
Q
Posterior spinal muscle group that works collectively to maintain an upright posture
A
Tension band
18
Q
Describe the position of the spine, relative to the pelvis, in the coronal and sagittal planes in normal balance
A
Balanced over the pelvis in the frontal or coronal plane. Balanced over the femoral heads in the sagittal plane.
19
Q
Describe the position of the spine, relative to the pelvis, and the coronal and sagittal planes in imbalance
A
Loss of sagittal balance results in head posture anterior to the hips (kyphotic curve).
Loss of coronal balance results in uneven pelvis and shoulders (scoliotic deformities).
20
Q
Which planes are affected by adolescent idiopathic scoliosis?
A
Coronal and Sagittal
21
Q
List the four broad categories of etiologies of scoliosis
A
1) Neuromuscular curves
2) congenital curves
3) curves resulting from a specific disorder (disease, tumor, or trauma)
4) idiopathic curves
22
Q
Example of Neuropathic disorders
A
1) Polio
2) Spinocerebral dysfunction
3) Cerebral Palsy
23
Q
Example of myopathic disorders
A
1) Arthorgryposis
2) Muscular Dystrophy
24
Q
List the three main categories of idiopathic scoliosis and children
A
1) Infantile (birth to 3 years)
2) juvenile (3 to 10 years)
3) adolescent (10 to 17 years)
25
Briefly describe - classification of curve evaluation process of scoliosis
Curve pattern, curve magnitude (region and direction; major or minor)
26
Briefly describe- risk of progression evaluation process of scoliosis
Takes into account the gender, magnitude, curve pattern, age of onset, and skeletal maturity of patient
27
Briefly describe- treatment by observation evaluation process for scoliosis
Observing the patient for curve progression on a frequent basis
28
Briefly describe - operative treatment evaluation process of scoliosis
Objective is to achieve a solid fusion (arthrodesis) with instrumentation
29
Radiographic technique in which contrast material is injected into the subarachnoid space of the cauda equina and x-rays or CT scans are taken; allows visualization of the neurological structures
Myelogram
30
Describe a structural curve/major curve
Generally at least 10° greater than a minor curve (largest cobb measurement on a standing x-ray)
31
Describe a nonstructural curve/minor curve/compensatory curve
They develop in an attempt to keep the patient's head and trunk balanced in the coronal plane (curves that do not have the largest cobb angle)
32
Describe how a bending film is taken and what it shows
Generally taken in a supine position so the maximum flexibility can be determined. Manual pressure or forcible traction may be applied.
33
Describe how you identify the end vertebrae for a Cobb angle measurement
The last vertebrae on each end of the curve that are tilted into the concavity of the curve. The first vertebra in which the opposite disc space is wider is not considered to be part of the curve, therefore the adjacent vertebra is the end vertebra in the curve
34
What is the difference between a postural and structural kyphosis
Postural kyphosis is poor posture controlled by the patient and corrected by the patient.
Structural kyphosis the patient cannot consciously correct.
35
What are the normal degrees of sagittal curvature in the cervical and lumbar curve of the spine?
Cervical: 20° to 40°
Thoracic: 20° to 40°
Lumbar: 30° to 50°
36
What is Sheuermann's disease?
Common form of primary hyperkyphosis; etiology unknown, genetic; flexion deformity (juvenile kyphosis)
37
Describe the difference between a curve with a smooth radius and a curve with an angular radius
The greater radius is a smoother curve. Angular curve has a greater risk of progression.
38
Describe Marchetti and Bartolozzi's classification system for spondylolisthesis
Developmental or acquired categories; high or low dysplastic; combined with Wiltse's dysplastic and isthmic forms into one category, further into low or high
39
Describe the clinical presentation of a child or adolescent with spondylolisthesis
Low back pain, mild headache (resulting from sports); radicular symptoms in back of thighs; stand with knees and hip partially flexed and walk with a shuffling gait
40
Describe the clinical presentation of an adult with spondylolisthesis
Similar to children; significant back pain or with sciatica; normally older than 50; may cause limping (claudication); decreased vascular circulation
41
On what type of X-ray will you see Napoleon's hat?
AP x-ray
42
On what type of x-ray will you see the Scotty dog sign?
Oblique
43
Describe Meyerding's Grade 1 Spondylolisthesis slip
Less than 25% translation
44
Describe Meyerding's Grade 2 Spondylolisthesis slip
25% to 49%
45
Describe Meyerding's Grade 3 Spondylolisthesis slip
50% to 74%
46
Describe Meyerding's Grade 4 Spondylolisthesis slip
75% to 99%
47
Describe Meyerding's Grade 5 Spondylolisthesis slip
Spondyloptosis
48
Describe "tilt" as this term relates to the modified Newman method
Measured from the anterior inferior corner of the vertebra perpendicular to the line on the anterior surface of the sacrum
49
Describe "slip" as this term relates to the modified Newman method
Measured from the posterior inferior angle of the vertebral body perpendicular to the sacral end plate line
50
Inflammation of the bones and cartilage of a joint due to a degenerative process
Osteoarthritis
51
What is the motion segment?
Composed of the intervertebral disc and facet joints connecting any two vertebrae and is the functional unit of the spine
52
What makes up the three joint complex?
The two facets and intervertebral disc
53
The intervertebral disc acts as ______?
A shock absorber and pivot point for motion
54
The nucleus pulposis is the central gelatinous substance that accounts for ______ percent of the intervertebral disc
40%
55
Which has more water and proteoglycan content- the nucleus or the annulus?
The nucleus
56
Which carries the smallest portion of the compressive load - the cortical shell or the spongy trabecular bone?
The cortical shell
57
The endplate is composed of how many layers?
Two (an inner bony layer and an outer cartilaginous layer)
58
Muscles are the __________ that produce _____________ through ________and __________across a ______ or ________.
Muscles are the active structures that produce spinal movements through bending moments and torque across a joint or motion segment.
59
Muscles also provide significant __________and _________to the spinal column. They resist ________ placed on the body through __________.
Muscles also provide significant dynamic stability and stiffness to the spinal column. They resist external loads placed on the body through isometric forces.
60
The most significant alterations of the disc are:
1) decreased water and proteoglycan content of the nucleus pulposus.
2) decreased water and proteoglycan content of the annulus, not to the extent of the nucleus pulposus
3) distortion of collagen fibers of annulus fibrosus
4) tears in the lamellae, due to distortion of collagen fibers, results in loss of annular strength
61
What are the two most negative effects of sclerosis on the motion segment?
1) decreases amount of nutrients diffusing across endplate into the intervertebral disc (degeneration of the disc)
2) stiffens the endplate and makes it less able to absorb loads transferred from the disc
62
What is another name for traction spurs?
Osteophytes
63
Describe the clinical presentation for degenerative lumbar spinal stenosis
Typically 60 to 70 years old; L3-L4 and L4-L5; back pain almost always present; buttock and leg pain; symptom = neurogenic claudication
64
What is neurogenic claudication and how can it be relieved?
Brought on by and intensified by walking and standing upright. Thought that narrowing of the spinal canal causes increasing pressure on the neural and vascular structures, leads to decreasing blood flow to the legs and buttocks.
65
What is the difference between neurogenic claudication and vascular claudication?
Neurogenic claudication causes back pain first, followed by pain descending down the legs.
Vascular claudication starts in the lower legs and extends toward the lower back.
66
What kind of radiographic studies are most commonly used when evaluating lumbar spinal stenosis?
Plain X-rray films, Myelography combined with CT scan, MRI as well
67
What are some of the conservative treatments for mild degenerative lumbar stenosis?
Stretching exercises, biking, water walking, swimming, epidural steroid injection
68
What is the most common cause of spinal stenosis in the cervical region?
Degeneration of the three joint complex
69
What is radiculopathy?
Progressive deterioration of a nerve root (associated with lateral recess or foraminal stenosis)
70
What is myelopathy?
Deterioration of the spinal cord (caused more by central stenosis)
71
Describe the clinical presentation of a patient with degenerative cervical stenosis.
40s, 50s, or older; radiculopathy of the C5, C6, or C7 nerve root, on one side only; symptoms = diminished sensation, muscle weakness, arm pain, neck pain, etc.
72
Conservative care for degenerative cervical stenosis is generally limited to what kind of patients?
Individuals who suffer from radicular symptoms only
73
Surgical treatment for degenerative cervical stenosis is generally give to what kind of patients?
Patients with frank myelopathy from degenerative stenosis; patients with significant deformity and/or instability
74
Describe surgical approaches and techniques used for decompression in the cervical region.
Anterior, posterior, or combined; anterior cervical discectomy with or without fusion for single or multiple levels; anterior corpectomy; microdiscectomy; laminectomy; laminoplasty
75
Partial or complete removal of the posterior elements, allowing increased space for neural structures.
Laminectomy
76
Surgical reconstruction of the posterior elements that allows for increased canal space but maintains the posterior arch
Laminoplasty
77
Define instability
The spine can no longer carry loads. There is a loss of the normal relationship between anatomic structures with the resulting alteration of natural function.
78
What are the primary problems that concern surgeons in spinal trauma?
Mechanical instability of vertebral column and actual or potential neurologic injury
79
What is a dislocation?
A misalignment of the normal structure of the anatomic components
80
Describe axial force
A force that pushes the material fibers together in a crushing manner
81
Describe distraction force
A force in which the primary mechanism is a pulling apart of the desk or bony or soft tissue elements. Two types (extension and flexion)
82
Describe extension
A severe backward bending of the neck or trunk
83
Describe flexion
A severe forward bending of the neck or trunk
84
Describe shear force
A force that is parallel to the surface on which acts and results in translation or subluxation movement of the sheared component
85
Describe rotational force
A torsional force that creates a rotational tension on the tissue fibers
86
What is a major fracture?
Involves the vertebral body, pedicles, or lamina, and are considered more serious injuries
87
What is a minor fracture?
Involves the transverse, spinous, and articular processes, and are not considered serious
88
Describe an occipito-atlantal dislocation.
A rare fatal dislocation in which the head is struck and the occiput is subluxed over C1. (Patients do not survive more than a few days)
89
Describe a Jeffersons fracture
A burst fracture of the ring of C1, caused by axial loading combined with extension and rotation
90
Describe a Hangman's fracture
(Posterior arch of C2) Sudden forceful hyperextension of the head and neck that forces the upper cervical vertebrae against the spinal cord resulting in complete neurological loss
91
Describe fractures of the odontoid process
Can involve the tip (Type 1), the waist (Type 2), or base (Type 3) of the C2 odontoid process. Type 1= stable; Type 2 and 3 = unstable
92
Describe Atlantoaxial joint subluxation
Caused by a rotatory-distractive force applied to the atlantoaxial joint. Causes axis to rotate around the odontoid process
93
What is a subaxial injury?
Trauma of the cervical spine below C2
94
Describe a compression fracture
Caused by pure flexion; small portion of the anterior body is compressed
95
Describe a flexion/axial load injury
Often occurs as a fracture/dislocation at C5-C6 from a diving accident (very unstable fracture)
96
Describe extension/axial load injury
Usually results in multiple level laminar fractures and has a much lower incidence of neurologic involvement
97
Describe facet dislocation
(May occur with or without a fracture) potentially serious injury because of spinal canal compromise caused by anterior translation of the superior levels
98
What is a neoplasm?
A tumor
99
What is the difference between primary and secondary tumors?
Primary tumors originate within the bony elements of the vertebrae and are not common. ( benign or malignant). Secondary tumors originate within another organ in the body and then metastasize to the vertebrae.
100
What is metastasis?
The spread of a neoplasm (tumor) from one part of the body to another
101
Most patients with spinal tumors present to the physician with ______.
Back pain
102
List the five types of primary benign tumors
1) Aneurysmal bone cyst
2) Giant cell tumor
3) Hemangioma
4) Osteoid osteoma
5) Osteoblastoma
103
Describe an aneurysmal bone cyst (primary benign tumor)
Lesions are not true tumors
104
Describe a giant cell tumor (primary benign tumor)
Aggressive tumor predominantly in the sacrum
105
Describe a hemangioma (primary benign tumor)
Asymptomatic and found on incidental examination
106
Describe an osteoid osteoma (primary benign tumor)
Relatively common lesion in the spine (posterior elements of lumbar spine)
107
Describe an osteoblastoma (primary benign tumor)
Much more aggressive, not as frequent as osteoid osteomas (posterior elements of lumbar spine)
108
List the three types of primary malignant tumors
1) Chordoma
2) Osteosarcoma
3) Chondrosarcoma
109
Describe a chordoma (primary malignant tumor)
A rare, slow-growing malignant tumor that originates from cells of the primitive nervous system (difficult to surgically remove)
110
Describe and osteosarcoma (primary malignant tumor)
Highly malignant but uncommon spinal tumors that usually occur in a younger patient population (pain)
111
Describe chondrosarcoma (primary malignant tumor)
Rare tumors arising from cartilaginous tissue (painful)
112
List the four types of round cell tumors
1) Plasmacytoma
2) Multiple myeloma
3) Lymphoma
4) Ewing's sarcoma
113
Describe plasmacytoma (round cell tumor)
Solitary lesion or has multiple lesions in the spine. Px older than 50, mostly thoracic
114
Describe multiple myeloma (round cell tumor)
More serious, more common malignancy of bone in adults and is often found in the spine
115
Describe lymphoma (round cell tumor)
(30s - 50s) non-Hodgkin's type; widely disseminated throughout the body, occasionally a solitary lesion is found; invade the interior column. (Back pain)
116
Describe Ewing's sarcoma (round cell tumor)
Highly malignant round cell tumor found mostly in children. 10 to 15 years of age; survival rate less than 20% for five years
117
About half of the osteomyelitis infections in the spine occur in which region of the spine?
Lumbar region
118
What is discitis?
Infection in the disc
119
What is the most frequent treatment of spinal osteomyelitis?
Identify the offending organism and arrive at a correct diagnosis. IV drug therapy with broad spectrum antibiotics (potential oral antibiotics). If surgery is necessary, an anterior approach allows for debridement of infected tissue, decompression of neurologic tissue, and stabilization of the spine with bone struts.
