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Disorders of the Neck, Back, and Spine
Clinical Medicine Module 5
138
Medical
Graduate
07/22/2009

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Cards

Term
What percentage of the population is affected by cervical disc sx?
Definition
50%
Term
Which C vertebrae are most often affected by cervical disc syndromes?
Definition
more than 90% occur at the level of c5 and c6, the most mobile segments.
Term
How many nn come out of the 7 cervical vertebrae?
Definition
8 nn
Term
What is an extra x-ray view to see the cervical spine?
Definition
odontoid view
Term
fracture along top of odontoid. how do you tx?
Definition
grade I; halo
Term
fx base of odontoid. HOw do you tx?
Definition
grade 3; halo
Term
fx middle of odontoid. how do you tx?
Definition
grade 2; sx right away
Term
which odontoid fx is most unstable?
Definition
grade II
Term
2 major types of cervical disc lesions
Definition
1. soft disc protrusion (herniation). 2. chronic disc degeneration
Term
Most common place for a disc to protrude
Definition
posterior/lateral bulge- soft disc protrusion (herniation)- cervical disc syndrome
Term
Which is the most common major type of cervical disc lesioin?
Definition
chronic disc degeneration
Term
Which type of cervical disc syndrome involves narrowing disc space?
Definition
chronic disc degeneration
Term
What casues soft disc protrusion (herniation))?
Definition
increased mechanical load
Term
What are 2 types of neurological compromise caused by herniation?
Definition
radiculopathy, paresthesias
Term
What results in narrowing of the disc space? In what age groups is this *most common*?
Definition
degenerative disc disease. more common in older age groups
Term
What is the end result of degenerative disc disease?
Definition
cervical spondylosis
Term
sperling's maneuver
Definition
look in corner to one side; follow a little bird as he flies through the sky to the other side. pain in shoulder opposite of direction pt is looking
Term
What is caused by osteophyte growth?
Definition
cervical stenosis
Term
Pt presents w/decreased ROM, localized tenderness, + spurling test, trigger points, and radicular or referred pain to upper or lower extremities. What tests could you order?
Definition
cervical problem. you could order plain radiography, ct, mri, emg- neuro-conduction studies
Term
How do you tx cervical disc syndromes?
Definition
1. rest. 2. moist heat. 3. pt (massage, us, traction) 4. pharmacotherapy (nsaids, narcotics). 5. epidural steroid injections. 6. surgery (decompressive laminectomy, anterior cervical discectomy and fusion)
Term
Which cervical disc syndrome tx involves massage, us, and traction?
Definition
pt
Term
What are 2 pharmacotherapy tx for surgical disc syndromes?
Definition
nsaids, narcotics
Term
What are 2 surgery tx for cervical disc syndromes?
Definition
decompressive laminectomy, anterior cervical discectomy and fusion
Term
What generally causes cervical strain?
Definition
rapid hyperextension of the neck (motor vehicle accidents and falls)
Term
Pt fell 10 days ago and experienced *no major problems at time of fall*. Since that time, pt has had gradual onset of neck stiffness, followed by pain and decreased rom, with minor radiculopathy. PE reveals general muscular tenderness. Neurological examination is normal. What might be this pt's problem? How do you tx?
Definition
cervical strain. brief period of rest, immediate ice, analgesia (nsaids, mm relaxants, narcotics). pt (heat-*rom*-ice)
Term
What is caused by unilateral contraction of neck mm?
Definition
torticollis
Term
The following drug rxns can cause what pathology: phenothiazine (chlopromazine (thorazine), prochlorperazine (compazine)?
Definition
torticollis. drugs are a more common cause.
Term
The following cause what pathology: congenital, inflammatory, idiopathic, tumor, drug rxns, ra?
Definition
torticollis
Term
Lateral views of teh cervical spine show ant subluxation of c2 on c3
Definition
hangman's fx
Term
what is the no one cause of gi bleeding in the world?
Definition
nsaids. don't give them to pts over 60.
Term
What is a metal ring secured to skull w/pins and 2 metal rods attached to a well-fitted plastic jacket. w/this apparatus, it is possible to obtain complete fixation and to arrest almost all movmt of c-spine. the outcome of teis tx varies w/fx healing and fusing w/in 3 mos in 15-85% of pts
Definition
Halo- tx of cervical fx
Term
what abnormality of a pe causes concern when you suspect a cervical strain?
Definition
abnormal neuro exam
Term
loss of lordotic curve on x-ray
Definition
cervical strain
Term
What are the nexus criteria for cervical spine radiography?
Definition
no post. midline c-spine tenderness. no evidence of intoxication or drugs. nml level of consciousness. no focal neuro deficits. no painful distracting injuries. 100% sensitivity over 10,000 pts.
Term
What is the only true mm relaxer?
Definition
valium
Term
What are the 3 questions of the canadian c-spine rule
Definition
are there any high-risk factors that mandate radiography? are there any low-risk factors that would allow a safe assessment of a range of motion? is the pt able to actively rotate the neck 45deg to the left and to the right?
Term
How common is the complaint of back pain? In what age group is it more common? How narrow is the range of causes?
Definition
one of the most common medical and traumatic complaints. more common btwn 30-60 yo. can be caused by a variety of disorders.
Term
What is the definition of scoliosis?
Definition
lat curvature of spine greater than 10 degrees while standing upright
Term
Which type of scoliosis is fixed and non-flexible and does not correct w/side bending?
Definition
structural
Term
Which type of scoliosis is flexible and corrects w/side bending?
Definition
nonstructural
Term
what is a common side effect of halo?
Definition
aspiration pneumonia; don't lay flat if at all possible
Term
What are 3 causes of structural scoliosis? which one is most common?
Definition
congenital abnormality, neurofibromatosis, *idiopathic* most common
Term
What are 3 compensatory mechanisms for nonstructural scoliosis?
Definition
leg length discrepancy. local inflammation. disc disease.
Term
What aspect of dx affects a scoliosis pt significantly?
Definition
pts do much better if the disease process is recognized early.
Term
Many pts have c-spine fx w/fall from what height?
Definition
standing height.
Term
What is COBB ANGLE and why is it importang?
Definition
scoliosis; determines tx. tx- <20deg; observation. 20-40 deg; thoracolumbosacral orthotic (tlso) "milwauukee brace" and exercise. >45 deg, sx.
Term
What is an abnml anterior-post curvature of teh spine? what are 4 common causes?
Definition
kyphosis. disc disease, vertebral disease, osteoporosis, poor posture.
Term
What common source of back pain commoly occurs at l4/5?
Definition
lumbar disc disease
Term
Pt presents w/low back pain that increases w/activity and improves w/rest, radicular pain, and paresthesias. PE reveals increased pain w/bending, localized tenderness, diminished sensation, foot drop, and bowel/bladder disfunction. pt bends away from painful side.
Definition
lumbar disc disease
Term
What does the thoracolumbosacral orthotic "milwaukee brace" tx and how?
Definition
not corrective but assists in preventing progression of scoliosis
Term
Osteophyte formation predominantly at ant/lat aspect of superior and inf margins of vertebral bodies. How would pt present?
Definition
spondlosis. pt presentations range from being asymptomatic to s/s of nn root compression
Term
Pt presents w/pain, sensory changes, motor weakness and atrophy, and reflex changes to lower extremities Which dx studies might you order?
Definition
lumbar nn roots. plain x-rays, ct, mri* best choice, emg
Term
what can cause mild herniation w/o n root compression, herniation w/nn root compression, cauda equina syndrome, chronic degenerative disease w/ or w/o leg symptoms, or spinal stenosis?
Definition
lumbar disc disease
Term
How do you tx lumbar disc disease?
Definition
brief per of rest, exercise and pt, heat-ice, nsaids and anagesia, epidural injection of steroids, surgery (laminectomy, spinal fusion)
Term
What surgeries might be performed for lumbar disc disease?
Definition
laminectomy, spinal fusion
Term
Where is spondylolisthesis most common?
Definition
l5-s1
Term
what is vertebral slipping hat develops in teen years and becomes symptomatic later in life? in what populations is incidence increased?
Definition
spondylolisthesis. football players and gymnasts
Term
Pt presents w/low back pain, paraspinal mm spasm, increased lordotic curve, palpable "step-off" of teh spinous process
Definition
spondylolisthesis
Term
How do you tx a "HOT" LESION (acute)?
Definition
orthotic bracing, restricted activity, attempt bony healing before fibrous nonunion can occur
Term
How do you tx a "COLD" lesion?
Definition
conservative tx: rest, exercise program, nsaids, weight loss, occupational change
Term
In what order should you do reflexes?
Definition
right and left to compare before you move on.
Term
What involves narrowing of the spinal canal and nn root foramina?
Definition
spinal stenosis (mri's probably best)
Term
What could cause secondary spinal stenosis?
Definition
disc disease or arthritis
Term
Pt presents w/neurogenic claudication: low back pain, motor weakness, leg cramping; symptoms worsen w/walking or l/s spine extension; symptoms improve w/rest or l/s spine flexion. How do you tx?
Definition
spinal stenosis. reduction of increased lordotic curve: corset bracing, strengthening exercises, epidural injections, sx: decompression +/- spinal fusion
Term
What is a common cause of lumbar strain?
Definition
acute incident or ongoing chronic factors
Term
What are tx options for tx of lumbar strain?
Definition
1-2 days of rest; heat-stretch-ice; stay active; nsaids and analgesia; tx precipitating factors (obesity, smoking, repetitive movements, high heeled shoes, lack of exercise)
Term
When tx lumbar strain what precipitating factors should be discontinued?
Definition
obesity, smoking, repetitive movements, high heeled shoes, lack of exercise
Term
What is an injury to the spinal cord resulting in a change, either temporary or permanent, in the nml motor, sensory, or autonomic function?
Definition
complete spinal cord injury
Term
What are 3 mechanisms that can cause complete spinal cord injury?
Definition
destruction from direct trauma. compression by bone fragments, hematoma, or disk material. ischemia from damage or impingement on the spinal aa.
Term
what's teh best imaging modality for spinal stenosis?
Definition
(mri's probably best)
Term
What are 2 types of spinal cord injuries?
Definition
complete or incomplete
Term
What type of sci involves absence of sensory and motor functions in the lowest sacral segments?
Definition
complete
Term
What type of sci involves preservation of sensory or motor function below the level of injury, including the lowest sacral segments? What is evidenced by sacral-sparing?
Definition
incomplete sci. sacral-sparing is evidence of the physiologic continuity of spinal cord long tract fibers
Term
What grading of mm strength has normal power?
Definition
5
Term
What grading of mm strength involves submaximal movmt against resistance?
Definition
4+
Term
What grading of mm strength involves moderate movmt against resistance?
Definition
4
Term
What grading of mm strength involves slight movement against resistance?
Definition
4-
Term
What grading of mm strength involves movement against gravity but not against resistance?
Definition
3
Term
What grading of mm strength involves movement w/gravity eliminated?
Definition
2
Term
What grading of mm strength flicker of movement?
Definition
1
Term
What grading of mm strength involves no movement?
Definition
Term
For most spine problems, do not use
Definition
back/neck brace
Term
Which spinal level involves elbow flexors (biceps, brachialis)? DON'T MEMORIZE
Definition
c5
Term
Which spinal level involves wrist extensors (extensor carpi radialis longus and brevis)? DON'T MEMORIZE
Definition
c6
Term
Which spinal level involves elbow extensors (triceps)? DON'T MEMORIZE
Definition
c7
Term
Which spinal level involves finger flexors (flexor digitorum profundus) to the middle finger? DON'T MEMORIZE
Definition
c8
Term
Which spinal level involves small finger abductors (abductors digiti minimi)? DON'T MEMORIZE
Definition
t1
Term
Which spinal level involves hip flexors (iliopsoas)? DON'T MEMORIZE
Definition
L2
Term
Which spinal level involves knee extensors (quadriceps)? DON'T MEMORIZE
Definition
L3
Term
Which spinal level involves ankle dorsiflexors (tibialis ant)? DON'T MEMORIZE
Definition
L4
Term
Which spinal level involves long toe extensors (extensors hallucis longus)? DON'T MEMORIZE
Definition
l5
Term
Which spinal level involves ankle plantar flexors (gastrocnemius, soleus)? DON'T MEMORIZE
Definition
21
Term
At what spiny levels is sensory testing performed?
Definition
between c2 and s4/5
Term
What is sensory scoring for light touch and pinprick?
Definition
0- absent. 1-imaired or hyperesthesia. 2- intact.
Term
What is the most common isci?
Definition
central cord syndrome
Term
What is most frequently identified among older persons w/cervical spondylosis who sustain hyperextension injury?
Definition
central cord syndrome
Term
What results from posterior pinching of the cord by a buckled ligamentum flavum or from anterior compresssion of teh cord by osteophytes? With what may this also be associated?
Definition
central cord syndrome. may also be associated w/fx dislocation and compression fx.
Term
Does central cord syndrome involve greater impairment in the upper or lower extremities?
Definition
upper
Term
How wide is the spectrum of sensory loss w/central cord syndrome?
Definition
varying degrees of sensory loss
Term
What would involve bladder dysfunction and a variable amt of sensory loss below level of injury?
Definition
central cord syndrome
Term
What imaging technique of central cord syndrome involves views of the cervical spine that delineates fx and dislocations, as well as teh degree and extent of spondylotic changes?
Definition
radiographs
Term
What imaging technique for central cord syndromes shows images of cervical spine w/spinal canal compromise?
Definition
ct scanning
Term
What imaging technique for central cord syndromes demostrates direct evidence of spinal cord impingement from bone, disc, or a hematoma?
Definition
mri
Term
What is the primary focus of rehab for central cord syndrome?
Definition
primary focus of pt is preservation of rom and the enhancement of mobility skills. also involves strengthening of any preserved mm function.
Term
What are 4 potential complications of cental cord syndrome?
Definition
neurogenic bladder, spasticity, neuropathic pain, pressure ulcers.
Term
Which potential complication of central cord syndrome involves urinary retention?
Definition
neurogenic bladder
Term
Which potential complication of central cord syndrome involves initial dperession of reflexes, but once period of spinal shock resolves, pts may experience increased spasticity in upper and lower extremities?
Definition
spasticity
Term
Which potential complication of central cord syndrome involves consideration of anticonvulsant medications?
Definition
neuropathic pain
Term
Which potential complication of central cord syndrome involves unrelieved pressure and shear forces on the skin?
Definition
pressure ulcers
Term
What is typically observed w/anterior spinal aa infarction?
Definition
anterior cord syndrome
Term
Ant cord syndrome results in problems where, relative to lesion? What is spared? Why is this?
Definition
paralysis below level of lesion, w/ loss of pain and temperature sensation below the level of the lesion, sparing touch, vibration, and position sense. Posterior columns receive their primary blood supply from the posterior spinal aa
Term
What involves an incomplete lesion of the spinal cord characterized by *ipsilateral* upper motor neuron paralysis and loss of proprioception, w/*contralateral* loss of pain and temperature sensation?
Definition
brown-sequard syndrome. clincial presentations range from mild to severe neurologic deficit
Term
SCIWORA is most common in what age group? What do imaging modalities show?
Definition
MRI, CT, X-rays (including flexion/extension) neative w/neurologic deficit. 1-16 yo.
Term
How do you tx sciwora?
Definition
bedrest. c-collar until nml flex/ext. halo for 1-3 wks recommended by some. no sports for 3 mos.
Term
How serious is cauda equina syndrome?
Definition
neurosurgical emergency
Term
What is formed by nerve roots caudal to the level of spinal cord termination?
Definition
cauda equina
Term
Pt presents w/low back pain, unilateral or usually bilateral sciatica, saddle sensory distrubances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss
Definition
cauda equina syndrome
Term
saddle paresthesias
Definition
paresthesias everywhere that would hit a saddle
Term
What imaging modality is most helpful for ce syndrome?
Definition
MRI>CT- may show actual ce compression. plain radiography not generally helpful- may show destructive changes, disk-space narrowing, or spondylolysis.
Term
What accounts for 30% of worker's compensation payments, w/significant increase in lawsuits and personal injury settlements w/non-specific physical findings (difficult to obtain a specific dx; easy to fabricate)?
Definition
back pain
Term
What are 4 parts of eval for back pain?
Definition
accurate detailed hx. pe. dx studies. tx.
Term
How speciic are the findings generally for back pain?
Definition
generally non-specific
Term
What diagnostic studies can be done for back pain?
Definition
x-rays (low yield of positive results), ct/mri (35% of asymptomatic pts have + results)
Term
What is tx for back pain?
Definition
pt, rehab, work hardening, injections (steroid), surgery
Term
What is the clinical term for reiter's syndrome?
Definition
reactive arthritis
Term
In what pt populations is multiple myeloma more commonly found- age and gender?
Definition
in pts over 40 yo and men 2x as frequently as women
Term
Pt presents w/ *back pain*, weakness, anorexia, weight loss, and *bone pain*, *spine* is most common that progresses to anemia, increased bone pain, renal insufficiency, and bacterial infections (recurrent penumonia and uti's)
Definition
multiple myeloma
Term
"punched out' lesions. where are they more comon?
Definition
multiple myeloma. most common in the *spine*, skull, ribs, and pelvis.
Term
radiologic findings: diffuse osteoporosis secondary to general demineralization. pathologic fx of long bones and vertebral bodies
Definition
multiple myeloma
Term
bence jones proteinuria
Definition
multiple myeloma: xs synthesis and secretion of free monoclonal light chains
Term
anemia, elevated esr, elevated serum calcium, w/excess synthesis and secretion of free monoclonal light chains
Definition
multiple myloma
Term
tx multiple myeloma
Definition
maintain proper ambulation and hydration b/c of increased urine and serum calcium and uric acid. plasma cell tumors can be sensitive to radiation and chemo. extremely poor prognosis despite any tx.
Term
Potential cause of back pain in *IVDA*
Definition
epidural abscess
Term
Pt presents w/fever, low back pain, decreased rom, unknown etiology. ivdu.
Definition
epidura abscess
Term
What is a decrease in total bone mass of the skelton? In what populations was it originally observed? In what populations is it now observed?
Definition
osteoporosis. first observed in older, caucasian females but now clearly seen in female athletic triad.
Term
What is the female athletic triad?
Definition
disordered eating, menstrual dysfunction, osteoporosis.
Term
What is the best imaging modality for osteoporosis?
Definition
dexa scan. bone density measurements
Term
What is teh prevention and tx of osteoporosis?
Definition
exercise, balanced nutrition, hrt (estrogen)(estorge/ca2+ combo), calcitonin, bisphosphonates (alendronate (fosamax), etidronate (didrocal)), fluoride
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