The spine and the vertebral column

Question 1

Functions of the spine

Answer 1

• Supports body and head
• Protects spinal cord
• Distribution route for nerves
• Attaches ribs, muscles and pelvic girdle
• Movement

Question 2

What is important to remember about the cervical spine?

Answer 2

7 cervical vertebra but 8 cervical roots - first above c1 and last below c7

Question 3

Where does the spinal column end?

Answer 3

L1/2

Question 4

Where do you perform a lumbar puncture?

Answer 4

L4/5

Question 5

Why does damage to the p/s pathway lead to incontinence?

Answer 5

Associated with S2-4 which control sphincter

Question 6

Embryology of spine

Answer 6

• Neural tube develops early on in the form of somites
• As fetus develops, somites increase in number
• 28 days: fetus looks like it has spinal cord
• Central canal forms when the spinal cord develops
• Central cord syndrome: central canal is too big and becomes fluid-filed - cape like loss of pain and temperature sensation

Question 7

What is spinal bifida?

Answer 7

Incomplete vertebral arch - channel is open

Question 8

Which compound is useful for neural tube development?

Answer 8

Folate

Question 9

Meningocele

Answer 9

Sack of spinal fluid pokes through spine

Question 10

Myelomeningocele

Answer 10

Portion of spine or spinal nerves is exposed

Question 11

What is syringomelia?

Answer 11

Fluid filled abscess arises in spinal cord which gets bigger and bigger

Question 12

Tx syringomelia

Answer 12

Catheter drainage and lower CSF pressure

Question 13

ASIA scale

Answer 13

A is complete loss of motor function, E is normal

Question 14

What is scoliosis?

Answer 14

Lateral curves

Question 15

What is kyphosis?

Answer 15

Slouched shoulders - enhanced thoracic kyphosis

Question 16

Dropped head spine

Answer 16

Weakness of neck extensor muscles (MND, myasthenia graves, myopathy)
Treat by using brace to hold head up

Question 17

Back pain red flags

Answer 17

• History of malignancy
• Unexplained weight loss
• Fever
• Immunocompromised
• IV drug use
• Saddle anaesthesia
• Sphincter dysfunction
• Progressive neurological deficit
• Nocturnal pain

Question 18

Ankylosing spondylitis

Answer 18

Inflammation of the spine

Question 19

Ankylosing spondylitis sx

Answer 19

Back pain and stiffness

Tiredness

Question 20

Discitis

Answer 20

Inflammation between spinal discs

Question 21

Discitis sx

Answer 21

Posture changes
Stiffness in back
Fever
Abdomen pain

Question 22

Herniation

Answer 22

Portion of nucleus pushes through cracks in annulus

Question 23

Herniation sx

Answer 23

If your herniated disk is in your lower back, you’ll typically feel the most pain in your buttocks, thigh and calf. You might have pain in part of the foot, as well. If your herniated disk is in your neck, you’ll typically feel the most pain in your shoulder and arm
Numbness
Tingling
Weakness

Question 24

Spondylosis

Answer 24

Age-related wear and tear of the vertebrae in the neck

Question 25

Lumbago

Answer 25

General lower back pain

Question 26

Spondolisthesis

Answer 26

Vertebra slips out of position, commonly in lower back

Question 27

DEXA scan numbers and osteoporosis

Answer 27

above 1SD is normal, between -1 and -2.5 is osteopenia and below -2.5 is osteoporosis

Question 28

Osteoporosis

Answer 28

Demineralisation and abnormal bone density

Question 29

r/f for osteoporosis

Answer 29

steroid use, low BMI, heavy smoker and drinker

Question 30

Osteoporosis sx

Answer 30

Back pain, caused by a fractured or collapsed vertebra. Loss of height over time. A stooped posture. A bone that breaks much more easily than expected.

Question 31

Treatment osteoporosis

Answer 31

avoid risk factors, vitD and calcium replacement, osteoclast inhibition (olendronate), SERMs (raloxifene), rank receptor inhibition (denosumab)

Question 32

AIDP

Answer 32

Acute inflammatory demyelinating poly-radiculopathy (Guillon barre)

Question 33

What is Guillon Barre ?

Answer 33

Immune system attacking PNS

Question 34

MND sx

Answer 34

Weakness in legs/ankles Slurred speech Muscle cramps

Question 35

Guillon Barre sx

Answer 35

weakness, sensory loss, reflex loss, autonomic failure, respiratory failure

Question 36

Guillon Barre ix

Answer 36

nerve conduction studies (demyelination), lumbar puncture (high protein), vital capacity, ECG, blood tests (campylobacter ABs)

Question 37

Guillon Barre tx

Answer 37

immunomodulation, prevent complications (plasma exchange, not steroids), supportive care on ITU