the spine Flashcards

1
Q

how many vertebrae are there?

A
  • 33 total
  • C7
  • T12
  • L5
  • S5
  • Coccyx 4
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2
Q

how many spinal nerves are at each level?

A
  • C8
  • T12
  • L5
  • S5
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3
Q

T4 dermatome

A
  • nipple line
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4
Q

T10 dermatome

A
  • belly button
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5
Q

L4 dermatome

A
  • toes
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6
Q

S1 dermatome

A
  • Achilles
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7
Q

what does AP view of c spine assess

A
  • alignment

- rotation

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8
Q

what does lateral view of c spine assess

A
  • alignment
  • subluxation
  • sponlyolysthesis
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9
Q

what does odontoid view of c spine assess

A
  • used in trauma for C1- C2 clear space around odontoid
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10
Q

what does oblique view of c spine assess

A
  • facet joints for spondylolysis
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11
Q

what does fuchs view of c spine assess

A
  • modified odontoid through soft tissue of neck
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12
Q

what does swimmers view of c spine assess

A
  • C6 C7 visualization in larger person

- arm close to cassett

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13
Q

odontoid fx

A
  • aka peg or dens fx
  • fx through odontoid process of C2
  • most common fx of upper c spine
  • mechanism variable but often d/t flexion loading
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14
Q

Associated injuries of odontoid fx

A
  • atlas fx

- transverse ligament rupture- considered unstable

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15
Q

conservative tx for odontoid fx

A
  • halo brace X 3 months

- will do well if pt is younger, small displacement, or dx early

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16
Q

operative tx for odontoid fx

A
  • posterior atlantoaxial arthrodesis with wire and bone graft
  • anterior screw fixation
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17
Q

cervical spondylosis

A
  • combo of DDD and osteophyte formation
  • common at C5-6* or C6-7
  • DD and facet arthropathy -> radiculopathy
  • often have associated disc herniation
  • graded as levels 1-4
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18
Q

imaging for cervical spondylosis

A
  • plain films to assess for alignment, disc space narrowing, anatomical anomalies
  • MRI best but ONLY for interventional purposes
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19
Q

treatment for cervical spondylosis

A
  • pain control- no narcs
  • high dose steroids with taper
  • PT
  • light activity
  • epidural steroid inj
  • surgery - discectomy and fusion of affected vertebrae
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20
Q

herniated nucleus pulposis (HNP) in c spine

A
  • neck pain that radiates or causes numbness
  • radicular pain with compression of neural structures
  • extremity weakness or numbness
  • varying level of pain
  • worse with flex/ ext
  • often stiff and uncomfortable
  • positive spurling’s sign
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21
Q

Hangman’s fracture

A
  • noose placed with knot towards side of neck
  • virtually never seen in suicide
  • d/t hyperextension and distraction
  • involves pars interarticularis of C2 bilaterally
22
Q

clinical presentation of hangman’s fx

A
  • often from post- traumatic neck pain after high velocity hyperextension (MVA)
  • neurologic impairment not usually seen
23
Q

radiographic findings for hangman’s fx

A
  • bilat lamina and pedicle fx at C2
  • associated anterolisthesis of C2 on C3
  • ext of fx to transverse foramina- possible vertebral a injury
  • CT best imaging modality
24
Q

tx of hangman’s fx

A
  • ABCs
  • maintain c spine precautions
  • treat other injuries
  • early consult to spine/neuro
  • hard collar first then soft collar
  • ORIF
  • halo brace
25
jefferson fx
- burst fx of C1 through anterior and posterior arches - d/t axial loading which causes occipital condyles to be driven into lateral masses of C1 - i.e. diving head first into shallow pool - not normally assoc with neuro deficits - often associated with other C spine injuries and C2 fx - possible vertebral artery injury
26
imaging of jefferson fx
- xray shows asymmetry in odontoid view with displacement of lateral masses away from dens - significant displacement (>6 mm)= ligament injury - CT to assess fx - MRI if fx not seen and to eval ligament injury
27
treatment for jefferson fx
- if no transverse atlantal ligament injury then can tx with hard collar immobilization - if ligament injury it is considered unstable -> halo immobilization, posterior C1-2 lateral mass internal fixation, transoral internal fixation
28
what does AP view of lumbar spine assess
- alignment and rotation
29
what does lateral view of lumbar spine assess
- alignment - subluxation - spondylolisthesis
30
what does coned down (spot) view of lumbar spine assess
- zooms in on L4 and L5
31
what does oblique view of lumbar spine assess
- articular facet - pars interarticularis - pedicles
32
LBP
- most common cause of disability in pts < 45 - second most common cause for PCP visit - 80% resolves after 2 weeks - 90% resolves after 6 weeks
33
si/sx of LBP
- sudden vs gradual onset - usually around low back with radiation to buttocks - +/- radiation to LE and radicular sx - if radiates does it go past knee? - +/- LE weakness (usually d/t pain)
34
physical exam for LBP
- if pt is more comfortable standing then do most of PE while theyre standing - save maneuvers most likely to cause pain for last - caution of waddell's signs- correlate to non-organic LBP
35
what are Waddell's signs?
1. tenderness 2. stimulation 3. distraction 4. regional 5. overreaction
36
treatment for LBP
- pain control- no narcs - PT - light activity
37
surgical indications for LBP
- cauda equina syndrome- emergency - HNP not responding to conservative tx - cancer - infection - severe spinal deformity
38
HNP of lumbar spine
- LBP +/- radiation of pain and/or numbness - L4-5 and L5-S1 most often affected - pain with flexion or prolonged sitting - radicular pain with compression of neural structures - extremity weakness and pain
39
PE of HNP in lumbar spine
- pt may prefer to stand - LBP at level of affected disc is worse with activity - pain with flex or ext - check motor, sensory and reflexes - + SLR on affected side, contralateral SLR is indicator for severe herniation - must r/o cauda equina
40
sciatica
- shock like pain radiating down posterior aspect of legs often below the knees
41
imaging for HNP in lumbar spine
- xrays to assess alignment, disc space narrowing, OA, anatomic anomalies - MRI best but ONLY for interventional purposes
42
treatment of HNP in lumbar spine
- pain control- limit narcs - high dose PO steroids - PT - light activity - epidural steroid injection - discectomy
43
spondylolysis
- defects in pars interarticularis of neural arch that connects superior and inferior articular facets - aka pars defect - more common in men - d/t stress fx or high energy trauma with hyperext of lumbar spine - 90% occur at L5 - may be uni or bilat
44
clinical presentation of spondylolysis
- more in adolescent atheltic population- swimmers and gymnasts - commonly asymptomatic - if symptomatic have pain that is worse with ext and/or rotation of spine - scotty dog sign on oblique view
45
treatment for spondylolysis
- sx often resolve with conservative tx - bracing 6-8 months - surgical repair if not responding to bracing or L5 pars defect
46
spondylolisthesis
- displacement of vertebral body in relation to inferior vertebra - often at L5/S1* and L4/L5 - anterolisthesis or retrolisthesis - graded by meyerding classification
47
meyerding classification
- grades spondylolisthesis - Grade I= < 25% displaced - grade II= 25-50% displaced - grade III= 50-75% displaced - grade IV= 75-100% displaced - grave V= spondyloptosis
48
spinal stenosis
- narrowing of spinal canal - mostly in older pts - d/t OA, HNP, hypertrophy of ligamentum flavum, or congenital
49
clinical presentation of spinal stenosis
- pain worse with exertion - reprod uni or bilat leg sx after walking several minutes - relieved by sitting- neurogenic claudication - pain usually worse when back ext to relieved by leaning forward
50
PE of spinal stenosis
- pt may prefer to sit - limited ext and may produce pain down legs - check motor, sensory, and reflexes - + SLR on affected side, contralateral SLR is indicator for severe stenosis - need to r/o cauda equina - xray first then MRI only for interventional purpose
51
treatment of spinal stenosis
- pain control- limit narcs - PT - light activity - facet or epidural inj - surgery- spinal decompression, nerve root decompression, spinal fusion