The vertebral column and common back problems

Question 1

Why do abnormal curves happen?

Answer 1

Due to developmental abnormalities or pathological conditions (missing half vertebrae and osteoporosis)

Question 2

What is kyphosis

Answer 2

Humpback

Excessive thoracic kyphosis

Question 3

Why does kyphosis happen

Answer 3

Erosion/ fracture of anterior part of one or more vertebrae

Question 4

What are the aims of kyphoplasty

Answer 4

Effective at providing pain relief

Preventing further collapse

Question 5

What is adolescent kyphosis also known as

Answer 5

Sheuermanns disease

Question 6

What happens in adolescent kyphosis

Answer 6

• Epiphyseal growth plates of vertebral bodies more affected in one or more thoracic vertebrae
• Causes wedging of bone and kyphosis

Question 7

Symptoms of adolescent kyphosis

Answer 7

Pain, difficult breathing

Question 8

What % of children are affected by adolescent kyphosis

Answer 8

1%

Question 9

How is adolscent kyphosis treated

Answer 9

Brace

Surgery for curves >60 degrees

Question 10

What is lordosis

Answer 10

Hollow back/ sway back

Anterior rotation of the pelvic produces increased lumbar curvature

Question 11

When can lordosis occur (3)

Answer 11

• Late pregnancy
• Obesity
• Weak hip flexor

Question 12

Symptoms of lordosis

Answer 12

Back ache

Sciatica

Question 13

Shortness and weakening of which muscle is associated with lordosis

Answer 13

Psoas

Question 14

Describe how shortening/ tightening of the psoas can lead to lordosis

Answer 14

• Alterations in body mechanics alignment resulting in excessive and inappropriate muscle exertion
• Increase in normal forward curve or hollow is most common postural defect
• Muscles in lower back shortern and tighten (thoracolumbar fascia and erector spinae muscles)
• Hamstrong and gluteal muscles tightened and often hypertonic

Question 15

What is flat back syndrome

Answer 15

Tight musculature between ribs makes breathing shallow
Hamstrings are tight
Hip flexors weak
Pelvis tilts backwards, pulling column flat

Question 16

What are the 3 consequences of flat back syndrome

Answer 16

• Ankylosing spondylitis
• Degeneratiev disc
• Spinal fusion

Question 17

What is scoliosis

Answer 17

Abnormal lateral curvature of the back

Question 18

What % of the population have scoliosis? What group is it most commonly seen in

Answer 18

3%

Girls around puberty

Question 19

What does scoliosis result from

Answer 19

• Developmental defects
• Asymmetric muscle strength
• Poor posure
• Idiopathic

Question 20

Between what degrees of curvature can a brace be used for scoliosis

Answer 20

20-40

Question 21

What are the options for scoliosis curves of >50 degrees

Answer 21

Vertebral fusion

Harrington rods

Question 22

What should you look for when considering age related degenerative spine disorders (5)

Answer 22

• Osteophytes
• Loss of disc height
• Loss/ increase in curves
• Spinal steonosis
• Ossification of vertebral ligaments

Question 23

What kind of joint in an IV disc

Answer 23

Cartilaginous

Question 24

What is the make up of the nucleus pulposus

Answer 24

70-90% water
Proteoglycans
(avascuclar and aneural)

Question 25

Describe the structure of the annulus fibrosus

Answer 25

alternating layers of type 1 collagen outer 1/3 innervated firmly attached to outer margin of vertebral body

Question 26

Which disc is most commonly herniated

Answer 26

L4/5 | L5/S1

Question 27

Why do herniated/ prolapsed discs cause pain

Answer 27

Nucleus pulposus irritates compresses spinal nerve root

Question 28

What are the symptoms of cauda equina syndrome

Answer 28

``` Low back pain Unilateral/ bilateral sciatica Saddle or perineal hypothesia Bowel bladder disturbances Motor and sensory deficit Reduced or absent lower extremity reflexes ```

Question 29

Treatment for cauda equina syndrome

Answer 29

Laminectomy or discetomy

Question 30

What are the acute complications of a burst disc

Answer 30

Compression of the spinal cord or nerve roots | Instability

Question 31

What are the late complications of a burst disc

Answer 31

Haematoma | Necrosis

Question 32

Where do osteophytes develop around as we age

Answer 32

Margins of the vertebral body | Zygrapophysial joints

Question 33

What is a vascular consequence of OA/ degenerative disc disease

Answer 33

vertebral-basilar artery insufficiency

Question 34

What is diffuse idiopathic skeletal hyperostosis

Answer 34

Ossification of anterior longitudinal ligament with or without osteophytes

Question 35

Is disc height maintained in diffuse idiopathi skeletal hyperostosis

Answer 35

Yes

Question 36

Is the sacroiliac joint involved in diffuse idiopathic skeletal hyperostosis

Answer 36

Nah

Question 37

What is ankylosing spondylitis

Answer 37

Chronic inflammatory disease mainly involving axial skeleton

Question 38

What are the features of ankylosing spondylitis

Answer 38

- Narrowing and sclerosis of both sacroiliac joints - Slerosis and ankylosis of vertebral bodies with no loss of disc space - Bone formation extends across anterior and lateral margins of IV discs

Question 39

What gene is related to ankylosing spondylitis

Answer 39

HLA-B27

Question 40

What is enthescopathy

Answer 40

Attachments of tendons and ligaments into bone

Question 41

Describe the relationship between anklylosing spondylitis and the gut

Answer 41

- HLA B27 influences composition of the endogenous gut flora - B27 predisposes to leaky gut - Leaky gut allows substances trigger cascades of inflammatory reactions