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Flashcards in The Back Deck (20):
1

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

2

Where does the spnal cord terminate?

Conus medullaris (L1)

3

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)

4

Define spinal stenosis

Narrowing of spinal canal less than 10mm

5

What is the gold standard for investigating spinal stenosis?

CT myelogram

6

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

7

How is mechanical back pain defined?

Back pain not due to prolapsed disc or any other clearly defined pathology

8

At which level are lumbar disc herniations most common?

L5/S1
then
L4/L5
then
L3/L4

9

How is a lumbar disc herniation investigated?

MRI

10

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

11

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

12

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

13

How does spondylolisthesis clinically present?

Lower back pain radiating to buttocks

14

Which vertebrae are most commonly affected in spondylolisthesis?

L5/S1. Followed by L4/L5

15

When is surgical intervention considered for spondylolisthesis?

When slippage is considered to be at 50-75% (Class III)

16

What is a "Hangman's fracture?"

Fracture of the C2 pars interarticularis - stable

17

What is a Burst fracture?

Type of vertebral fracture - extreme axial force causes vertebra to fracture in several places

18

Which columns are involved in a seatbelt fracture?

All 3 columns

19

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

20

Which column is usually involved in a compression/wedge fracture, and when do these commonly occur?

Compression force causes anterior column to collapse - stable unless other columns affected

commonly found in osteoporosis