Thoracic Spine Pathology Flashcards
(147 cards)
1
Q
What percent of symptomatic disc herniations are thoracic disc
A
1%
2
Q
What percent are asymptomatic disc protrusion
A
37%
3
Q
What percent of patients returned to premorbid level of function after surgical repair of symptomatic thoracic disc herniation
A
77%
4
Q
Who generally experiences a higher incidence of thoracic spine disorders
A
Females
5
Q
What is the prevalence range of thoracic spine conditions at 12 months
A
15-34.8%
6
Q
What is the prevalence of thoracic spin conditions in adolescents
A
41%
7
Q
What is the general pathophysiology of scoliosis
A
Deformity of spinal column rather than a disease process
8
Q
What is scoliosis named for
A
convexity and region
9
Q
What does a type 1 dysfunction of scoliosis signify
A
Lateral curvature spine
10
Q
What is a nonstructural scoliosis
A
Reversible lateral curvature
11
Q
What is a structural scoliosis
A
Irreversible lateral curvature
12
Q
What does a major curve equal
A
Primary curve
13
Q
What does a compensatory curve equal
A
Secondary curve
14
Q
What are the 3 types of idiopathic curve patterns
A
- Primary Lumbar
- Thoracolumbar
- Primary Thoracic
15
Q
What percent of curve patterns are primary lumbar
A
23.6%
16
Q
What percent of curve patterns are thoracolumbar
A
16%
17
Q
What percent of curve patterns are primary thoracic
A
22.1%
18
Q
Which curve pattern is not severely deforming and is between thoracic and lumbar
A
Thoracolumbar
19
Q
What curve pattern is worst, progresses rapidly and is severe
A
Primary thoracic
20
Q
What curve pattern is most benign and least deforming
A
Primary lumbar
21
Q
How long does it take for a potential increase in the curve for primary thoracic
A
5 years
22
Q
What causes nonstructural scoliosis (3)
A
- Posture
- Pain and muscle spasm
- Limb length discrepancy
23
Q
What are the types of pain and muscle spasm that can cause nonstructural scoliosis (3)
A
- Painful lesion of spinal nerve root
- Painful lesion of spine
- Painful lesion of the abdomen
24
Q
What are the 4 types of structural scoliosis
A
- Idiopathic scoliosis
- Osteopathic scoliosis
- Neuropathic scoliosis
- Myopathic scoliosis
25
What are the types of idiopathic scoliosis (3)
1. Infantile
2. Juvenile
3. Adolescent
26
What percent of all scoliosis is idiopathic scoliosis
85%
27
When does infantile scoliosis occur
Birth to 3 years
28
When does juvenile scoliosis appear
4-9 years
29
When does adolescent scoliosis occur
10 to end of growth period
30
What are the 2 types of osteopathic scoliosis
1. Congenital
| 2. Acquired
31
What are the divisions of congenital osteopathic scoliosis (2)
1. Localized
| 2. Generalized
32
What causes acquired osteopathic scoliosis (3)
1. Fractures
2. Dislocations
3. Rickets
33
What are the types of neuropathic scoliosis (2)
1. Congenital
| 2. Acquired
34
What is an example of congenital neuropathic scoliosis
Spina bifida
35
What is an example of acquired neuropathic scoliosis
Cerebral palsy and paraplegia
36
What are the 2 types of myopathic scoliosis
1. Congenital
| 2. Acquired
37
What causes congenital myopathic scoliosis
Hypotonia of neuromuscular origin
38
What is an example of congenital myopathic scoliosis
Spinal muscular atrophy
39
What is an example of acquired myopathic scoliosis
Muscular dystrophy
40
What pecent of the population has idiopathic scoliosis
0.5%
41
Which gender more commonly has infantile idiopathic scoliosis
Boys
42
Which gender more commonly has juvenile and adolescent idiopathic scoliosis
Girls
43
What are the characteristics of idiopathic scoliosis (3)
1. Rapid progression in adolescents
2. Can be slow, insidious, and painless
3. As curve progresses wedge-shaped vertebrae form
44
Where do wedge shaped vertebrae form in people with idiopathic scoliosis
Concave side
45
How much does the degree of idiopathic change per year
As little as 1 degree
46
What is a normal curve for idiopathic scoliosis
Less than 10 degrees
47
What is a mild lateral curve for idiopathic scoliosis
Less than 30 degrees
48
What is a severe lateral curve for idiopathic scoliosis
Greater than 40 degrees
49
When is idiopathic scoliosis normally detected
roughly 30 degrees of curve
50
What is the Cobb Method
Find apex of curve then draw a right angle above and below apex and measure curve at cross of right angles
51
What is the angle measure during the Cobb method
Cobb angle
52
How do you address idiopathic scoliosis nonoperatively
Excercise, body cast, and braces
53
What are the 2 types of braces
1. Milwaukee
| 2. Boston
54
What is the Milwaukee brace used for
Primary thoracic
55
What is the Boston brace used for (2)
1. Lumbar
| 2. Thoracolumbar curves
56
What is the operative method to fix idiopathic scoliosis
Internal spinal instrumentation and fusion
57
When was Harrington Rodding found
1962
58
What are the 2 systems used for spinal fusion
1. Cotrel-Dubousset (CD) system
| 2. Texas Scottish Rite Hospital (TSRH) system
59
How long does the body cast have to be on to ensure consolidation of the fusion
3 months
60
When do you do nonoperative interventions of idiopathic scoliosis
20-40 degrees
61
When do you do operative interventions of idiopathic scoliosis
greater than 40 degrees
62
How old should the child be to perform operative intervention
10
63
What are the 2 types of osteochondrosis
1. Scheuermann's disease
| 2. Calve's disease
64
Scheuermann's disease is osteochondrosis of what
Secondary centers of ossification in the spine
65
What is another name for the secondary centers
Pressure epiphysis
66
Calve's disease is osteochondrosis of what
Primary center of ossification in the spine
67
What is idiopathic avascular necrosis effecting the epiphyses
Osteochondrosis
68
What occurs with osteochondrosis (3)
1. Avascular necrosis of subchondral bone
2. Loss of blood supply
3. During pathological process epiphysis may permanently deform
69
What ages is osteochondrosis most common in
3-10
70
Who gets osteochondrosis more boys or girls
Boys
71
Where is osteochondrosis more common lower or upper limbs
Lower limbs
72
What are the 4 phase of osteochondrosis
1. Early phase of necrosis (avascularity)
2. Phase of revascularization with bone deposition and resorptin
3. Phase of bone healing
4. Phase of residual deformity
73
True or False:
| Osteochondrosis heals spontaneously
True
74
True or False:
| The onset of osteochondrosis is idiopathic
True
75
What occurs during the early phase of necrosis (3)
1. Loss of BV to epiphysis
2. Death of marrow and osteocytes
3. Articular cartilage lives and grows
76
What occurs during the phase of revascularization with bone deposition and resorption (3)
1. Revascularization of epiphysis
2. Woven bone forms
3. Pathological fractures arise
77
What occurs during the phase of bone healing (2)
1. Resorption ceases and deposition continues
| 2. Biologic plasticity
78
What occurs during the phase of residual deformity (2)
1. Contour now unchanged
| 2. Function can continue for some years
79
What is Scheuermann's disease
Growth disturbance of epiphyseal plates anteriorly
80
What does Scheuermann's disease result in
Increased kyphosis
81
When is Scheuermann's disease most common
Puberty to late teens
82
How many joints does Scheuermann's disease involve
3-4
83
True or False:
| Scheuermann's disease can be inherited
True
84
What are the clinical features of Scheuermann's disease (4)
1. Poor posture/rounded shoulders
2. Moderate back pain
3. Increase thoracic kyphosis and lumbar lordosis
4. Tenderness over spinous processes
85
True or False:
| When growth ceases the symptoms of Scheuermann's disease subside but the deformity remains the same
True
86
What are the types of intervention for Scheuermann's disease
Milwaukee brace for moderate cases and spinal instrumentation and fusion for more severe cases
87
Which disease is more common Calve's or Scheuermann's
Scheuermann's disease
88
What ages does Calve's disease most commonly occur in
2-8
89
True or False:
| Calve's disease is almost always limited to one vertebral body
True
90
What is avascular necrosis secondary to Langerhans cell histiocytosis that creates discrete but destructive lesions in bone
Calve's disease
91
What are the clinical feature of Calve's disease (3)
1. Mild back pain
2. Slight kyphosis and muscle spasm
3. Wafer thin vertebrae on x-ray
92
How long does it take for reossification of bone to complete restoration of the vertebra
2-3 years
93
What is postural syndrome
Prolonged end range stress place on normal tissues
94
What age group usually gets postural sydrome
20-35 year olds with a sedentary lifestyle
95
Who gets postural syndrome more commonly
Females
96
How do you correct postural syndrome
Correct posture
97
What is compression of the neurovascular bundle as it emerges from the thorax and enters the limb
Thoracic outlet syndrome
98
Where is the thoracic outlet
Space between clavicle and the first rib compartmentalized by the scalenes
99
What vein enters from the arm and exits between clavicle, first rib, and anterior scalenes
Subclavian
100
What exit between the anterior and middle scalenes and first rib
brachial plexus and subclavian artery
101
What forms the scalene triangle
Base: First rib
Anterior: Anterior scalene
Posterior: Middle scalene
102
How do the scalenes cause narrowing of the scalene triangle (4)
1. Shortening
2. Tightening
3. Hypertrophy
4. Spasm
103
How does the first rib cause narrowing of the scalene triangle
Inhalation
104
What is the clavicle space between
Clavicle and first rib
105
What can cause narrowing of the clavicular space (2)
1. Cervical rib
| 2. Clavicle fracture malunion affecting normal mechanics
106
What is a cervical rib
Rib off of C7 vertebrae
107
What percent of the population as a cervical rib
0.2%
108
What causes narrowing of the pectoralis minor
Shortening or tightening of the pectoralis minor or hyperabduction
109
How can the corocoid process cause narrowing of the pectoralis minor (2)
1. Tethered
| 2. Compression
110
What are the signs of thoracic outlet syndrome (6)
1. Numbness or paresthegias
2. Weakness of hand
3. Pallor or cyanosis
4. Cold to touch
5. Heaviness fatigue
6. Intermittent
111
What is the conservative intervention for thoracic outlet syndrome
PT
112
What are some surgical interventions of thoracic outlet syndrome (3)
1. Cervical rib resection
2. First rib resection
3. Scalenectomy
113
What are the most common types of thoracic spine and rib fractures
Compression
114
What are signs of wedge compression fractures
Mild local tenderness
115
Which type of x-ray is most beneficial for wedge compression fractures
Lateral
116
What are the types of interventions for wedge compression fractures
Cast, bed rest, and AROM
117
True or False:
| Ligaments are intact and spinal cord is relatively stable for burst compression fractures
True
118
True or False:
| Spinal cord or cauda equina injury can result from burst compression fractures do to fragments of fracture
True
119
Signs of burst compression fracture
Severe local tenderness
120
Which type of x-ray is most beneficial for burst compression fractures
Lateral
121
What are the interventions for burst compression fractures
No reduction needed, surgery to remove fragments, bed rest, and plaster body cast
122
How long is a person on bed rest with burst compression fractures
First few weeks
123
How long does a person have a plaster body cast for burst compression fractures
8 weeks
124
How do fracture dislocations occur
High velocity injuries
125
What are signs of fracture dislocations
Shock and neurological deficit evident
126
What is the intervention for fracture dislocations
Treat neurologic compromise first and open reduction internal fixation (ORIF) with bone grafting
127
Signs of rib fractures
Local pain, aggravated breathing, coughing, and sneezing,
128
What x-rays are best for detecting rib fractures
plain radiographs
129
What are the interventions for rib fractures
Immobilize chest and PT maybe
130
Do rib fractures suck
YES'M!!!!!!!!
131
Is idiopathic scoliosis something someone is born with or acquires
Born with
132
How do you classify deformities
Based on what movements cause symptoms to improve or worsen
133
What happens on the concave and convex side of scoliosis
Concave: Muscles shorten
Convex: Muscles lengthen
134
What is a type I scoliosis (4)
1. Idiopathic
2. Congenital
3. Structural
4. Chronic
135
What is a type II scoliosis (2)
1. Non-structural
| 2. Acute
136
Do you normally see a type II scoliosis in the thoracic region and why
No, because of the ribs
137
Is this S was the scoliosis how would you note the top curve
L Thoracic convexity
138
What do you use to determine the direction of rotation caused by a scoliosis
The vertebral body not the spinous process
139
Nonstructural scoliosis is type I or type II
Type II
140
Structural scoliosis is type I or type II
Type I
141
What is it called when a disorder reaches a peak then heals spontaneously
Self limiting disorder
142
What is the extrusion of the nuclear material of the disc that becomes hardened called
Schmorl's Nodes
143
What plane does a scoliosis occur in
Frontal/Coronal
144
What planes does Scheueramnn's disease occur in
Sagittal/Median
145
True or False:
| Fusion of the spinal column uses the patient's own bone or bone from a cadaver
True
146
What type of scoliosis, type I or type II, is an s shaped curve
Type I
147
What type of scoliosis, type I or type II, is a more distinct angle
Type II
