18 ORR > Spine > Flashcards

Spine Flashcards

(47 cards)

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1
Q

conditions that cause disc degeneration

A
  • nicotine exposure = vasoconstrictive process
  • atherosclerosis = vaso-occlusive
  • end plate sclerosis
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2
Q

mri of healthy vs desiccated disc

A
  • healthy: disc is hydrated, clear demarcation between annulus and nucleus
  • desiccated: darker signals and homogenous
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3
Q

components of spine pe

A
  • inspection
  • gait
  • palpation
  • rom
  • neurologic function
  • special tests
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4
Q

progress of degenerative cascade

A
  • loading joints = progressive collapse of disc
  • loading joints = spondylotic changes = dec joint motion, spinal cord compromise, spondylolisthesis/instability
  • failure of anterior support -> shift load transmission -> post column compensates -> spondylosis
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5
Q

types of herniated nuleus pulposus

A
  • soft disc herniation: posterolateral

- hard disc herniation: disc-osteophyte spurs

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6
Q

neuropathy vs radiculopathy vs myelopathy

A

neuro: peripheral nerve
- sx: weakness, numbness

radiculopathy: spinal nerve root
- sx: weakness, numbeness

myelopathy: spinal cord
- sx: stiffness, incoordination, weakness

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7
Q

nerve root exposure to chemicals of the nucleus + compression = ___

A

radicular pain & dorsal root ganglion apoptosis

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8
Q

conus medullaris vs cauda equina

A

conus medullaris: terminal end of spinal cord (l1-l2)

cauda equina: bundle of spinal nerves that taper out after conus medullaris

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9
Q

differences between conus medullaris syndrome and cauda equina syndrome

A

read

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10
Q

clinical presentation of conus med./cau eq.

A
  • bilateral buttock and le pain
  • bowel and bladder dysfunction
  • saddle anes
  • varying degrees of lower limb dysfunction
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11
Q

regions involved in conus medullaris

A
  • above l2
  • damage to sacral spinal cord: bladder/bowel dysfunction, impotence, saddle anes, loss of achilles reflex
  • no loss of patellar knee reflex
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12
Q

typical symptoms of myelopathy

A
  • numbness, weakness, stiffness, clumsiness
  • paresthesia of ue/le
  • difficulty in fine motor control
  • ataxia and wide based gait
  • leg heaviness
  • inability to perform tandem walk
  • urinary retention, urgency, or frequency

moderate s/sx: poor prognosis

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13
Q

hand signs for myelopathy

A
  • finger escape sign
  • positive ten second test (20x/10s)
  • hoffman’s sign
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14
Q

what is spondylolisthesis

A
  • hen one of your vertebrae slips out of place onto the vertebra below it
  • segmental instability = low back pain
  • > 4.5 mm displpacement
  • 15 deg sagittal displacement on flexion extension views
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15
Q

grading of spondylolisthesis

A

1 0-25%
2 25-50%
3 51-75%
4 76-99%

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16
Q

significance of mri in back pain

A
  • discs can protrude: bulging nucleus with intact nucleus
  • extruded discs: goes through annulus, confined by pll
  • sequestrated discs: disc material is free inside the canal
  • sensitive to changes
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17
Q

non-surgical treatment for back pain

A
  • immobilization
  • analgesics
  • nerve blocks
  • epidural steroid injections
  • patient education
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18
Q

indications for surgical treatment for back pain

A
  • progressive neurologic deficits (motor weakness, unremitting radicular pain)
  • failure of conservative management
  • positive study results and persistent unacceptability
  • bowel and bladder dysfunction
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19
Q

t/f spine is the most common bony site for msk tumors

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A

true, most are metastatic

20
Q

most common primary benign tumors

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A
  • osteoid osteoma
  • osteoblastoma
  • abc
  • eosinophilic granuloma
  • osteochondroma
  • giant cell tumor
  • hemangiom
21
Q

most common primary malignant tumors

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A
  • solitary plasmacytoma!!
  • chondroma
  • chordosarcoma
  • lymphoma
  • ewing’s sarcoma
  • osteosarcoma
22
Q

most common type of malignant spine lesion

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A

metastatic tumors

- breast and prostate, thyroid, lung, kidney

23
Q

t/f the spine is the last source to manifest symptoms of metastasis

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A

false, first source of symptoms. workup is warranted to know spread and grading

24
Q

variables in treating tumors

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A
  • tumor diagnosis
  • stage
  • neuro status
  • prognosis of the tumor
  • spinal stability (surgery)
  • intractable pain (surgery)
25
most common consult among deformities
scoliosis (idiopathic)
26
spinal growth in children with scoliosis
- birth to 5 years: spine gains 10 cm in length | - 5 years to adolescent: growth of 5 cm, 10 cm during growth spurt
27
location of idiopathic scoliosis
- right thoracic curve!! | - left thoracic curve
28
incidence of idiopathic sclerosis
- 3% 10-20 deg - 0.3% >30 deg - 10:1 f to m >30 deg - positive fhx - pain in adults if not treated - >90 deg = cardiopulmonary dysfunction, early death, pain
29
t/f scoliosis causes back pain
false, mostly asymptomatic
30
postural changes in scoliosis
- uneven shoulders or hips - rib hump - ill fitting clothes
31
diagnosis of scoliosis
- inspection of back = asymmetry - leg length discrepancies - trunk shift and head centered - adams forward bending test - scoliometer - forward bending sitting test
32
angle measured in scoliosis xrays
cobb's angle
33
most current and widely used scoliosis classification system
lenke classification
34
treatment options for scoliosis
- observation - bracing (mild to moderate progressive curves) - operative (>50 deg)
35
types of bracing for scoliosis
- milwaukee = apex above t6 - boston underarm brace = apex below t7 and above l2 - cheneau brace - boston brace
36
what is spondylolysis
- defect in pars intecularis - leads to spondylolisthesis - common in children and adolescents - fatigue fracture - tx: surgery
37
s/sx of spodyloslisthesis
- back pain - hamstring tightness - palpable step-off - alteration in gait
38
what is the denis three column theory
- destruction of >2 columns = spinal instability
39
anterior column (denis)
ant longitudinal ligament ant annulus ant 2/3 vertebral body
40
middle column (denis)
post 1/3 of vertebral body post annulus post longitudinal ligament
41
post column (denis)
posterior elements: pedicles, facets, lamina, spinous process post ligaments
42
primary damage in spinal cord injury
- caused by mechanical forces imparted to the spinal column at the time of trauma - result: failure of osteoligamentous spinal column
43
secondary damage in spinal cord injury
- injury of adjacent neural tissue that was initially spared | - affected by patho processed from primary injury
44
components of spinal shock
- hypotension - bradycardia - transient loss of function below level of injury
45
voluntary anal contraction or anal wink tests ___
s4-s5 and if complete or incomplete
46
what is incomplete cord injury
- most caudal segment with motor function at least 3/5 - pain and temp are present OR lowest level of completely normal function
47
prognosis of spinal cord injury
- asia a = 90% incapable of ambulation - asia b = 72% unable to ambulate - asia c/d = 13% can ambulate after 1 year
18 ORR
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