Flashcards in The Back Deck (20):
Describe the relationship of the nerve root to the vertebra in the cervical spine
Nerve root exits above vertebra (i.e. C4 nerve root exits above C4 vertebra)
7 Cervical vertebrae, 8 cervical nerve roots
Where does the spnal cord terminate?
Conus medullaris (L1)
Describe th relationship of the nerve root to the vertebra in the lumbar spine
Individual nerve roots exit below pedicle of vertebra (i.e. L4 nerve root exits below L4 pedicle)
Define spinal stenosis
Narrowing of spinal canal less than 10mm
What is the gold standard for investigating spinal stenosis?
How is spinal stenosis managed?
Non-operative: vigorous physiotherapy (flexion exercises, stretch/strength exercises), NSAIDs, lumbar epidural steroids
Operative - decompression surgery if conservative methods failed for more than 6 months
How is mechanical back pain defined?
Back pain not due to prolapsed disc or any other clearly defined pathology
At which level are lumbar disc herniations most common?
How is a lumbar disc herniation investigated?
How is a lumbar disc herniation managed? (2)
1. Symptomatic - physiotherapy, NSAIDs (90% resolve in 3 months)
2. Surgical discectomy reserved for progressive neurological deficit, failure of symptoms to resolve within 3 months or cauda equina syndrome due to central disc herniation
When is surgical discectomy for a lumbar disc herniation considered? (3)
1. Progressive neurological deficit
2. Failure of symptoms to resolve within 3 months
3. Cauda equina syndrome due to central disc herniation
What is the distinction between spondylolysis and spondylolisthesis?
Spondylolysis: defect in the pars interarticularis (inferior articular process) with no movement of the vertebral bodies
Spondylolisthesis: defect in pars interarticularis causing a forward slip of one vertebra on another - usually at L5-S1, less commonly at L4-5
How does spondylolisthesis clinically present?
Lower back pain radiating to buttocks
Which vertebrae are most commonly affected in spondylolisthesis?
L5/S1. Followed by L4/L5
When is surgical intervention considered for spondylolisthesis?
When slippage is considered to be at 50-75% (Class III)
What is a "Hangman's fracture?"
Fracture of the C2 pars interarticularis - stable
What is a Burst fracture?
Type of vertebral fracture - extreme axial force causes vertebra to fracture in several places
Which columns are involved in a seatbelt fracture?
All 3 columns
What are the components in each of the 3 columns of the vertebrae (acc. to Denis 3 column model)?
Anterior: Anterior longitudinal ligament, anterior half of vertebral body, anterior annular fibrosis
Middle: Posterior half of vertebral body, posterior annulus/disc
Posterior: spinous process, laminae, facets