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Ortho PANRE 1

Orthopedics

QuestionAnswer
What ligaments hold atlas to axis & keep it stable? Alar ligaments
If one of the two vert columns is intact, then: the injury is stable
If both columns are disrupted, then: the injury is unstable
Radiology: Trauma: order lateral, AP, & odontoid view; all 7 vertebrae must be seen
Tx Jefferson fx: unstable Cranial traction; halo x 3 months; > 5mm C1-C2 subluxation = C1-C3 fusion
Odontoid fx types type I (rare): avulsion fx of alar ligament; type II & III
Burst Jefferson fx stability: determined by: transverse ligament
Burst Jefferson fx stability: neuro effects Usually neuro intact (fragments burst away; wide breadth of C1 canal)
Burst Jefferson fx: 1/3 of fx assoc with: an axis fx
Burst Jefferson fx: 50% chance that: some other C spine injury is present
Odontoid fx MOA Hyper-flexion or hyper-extension
Hangmans Fx = Traumatic Spondylolisthesis of C2 (bilateral C2 pedicle fx)
Hangmans Fx MOA hyperextension & sudden violent distraction; hyperextension & axial loading; or flexion & compression (usu combination of forces)
Hangmans Fx: Types 4 types (I, II, IIA, III = worst)
Hangmans Fx: Immobilization: rigid cervical orthosis or halo vest system
Hangmans Fx: Traction: used generally for reductions (Gardner-Wells tongs or halo vest system)
Acute Cervical Sprain = Injury to restraining ligaments of cervical spine
Acute C- Sprain grade I (mild): ligaments damaged but not lengthened
Acute C- Sprain grade II (mod): some laxity but not total disrupt
Acute C- Sprain grade III (severe): ligament completely disrupt
Acute C- Sprain: if instability present, may need: 6-12 wks immobilization in rigid orthosis and/or surgery
Cervical Stenosis = narrowing of sagittal diameter of cervical canal
C-stenosis: segments most commonly involved C5 and C6 segments
Cervical Stenosis Types Congenital; Developmental; Acquired
C-stenosis: Congenital = short pedicles, funnel shape of cervical canal
C-stenosis: Developmental = bone size due to stress in weight training
C-stenosis: Acquired = spondylosis, spurs, disc bulge or space narrowing
Cervical Spondylosis = Chronic disc degeneration (arthritis)
Cervical Spondylosis: Represents: nerve root compression
Cervical Spondylosis S/S: neck pain, radicular pain radiating from neck to upper extremity
Cervical Spondylosis Rx: supportive, facet injections, operative decompression
Brachial Plexus = C5, C6, C7, C8, T1
Odontoid fx: tx Reduce fx & hold in halo immobilization (3 months); C1-C2 fusion if severely displaced or non-union; Few advocate acute ORIF dens
Hangmans Fx: Stability: unstable; neuro deficit is surprisingly rare unless C2 - C3 subluxation is severe
Hangmans Fx: Tx will usually stabilize with halo fixation; anterior fusion may be needed due to delayed instability
Hangmans Fx: Operative Tx: occipitocervical fusion; atl-axial fusion; transarticular screw fixation; ant. screw fixation of dens; internal fixation w/ posterior plating of occiput to C2
Evaluation of cervical instability (White & Punjabi ) Vert malalignment; >3.5mm translational displacement; 1.7 mm or greater disk widening
C Spine injuries: Tx Philadelphia collar immobilization (stable); Halo immobilization (stable); Occipito-cervical fusion (unstable)
Most common Spinous Process fx found in: C-spine (Clay Shovelers fx)
Axial blow to the head with force transmitted through the occipital condyles; Forces the lateral masses of C1 outward Jefferson fracture
bilateral C2 pedicle fractures (usually due to combo of forces; eg, hyperextension and sudden violent distraction) Hangman's fracture
Back Pain: lifetime prevalence: 60-80%
Disc degeneration MOA: degeneration overloads facet joints in verts
Disc herniation MOA: herniation impinges nerve roots
Pain: Red Flags > 50 y.o.; kids; Night Pain; Fever, malaise, wt loss; Bladder/ bowel dysfunction; Progressive deficit; Prior ca; Pain > 1 month
Bragards test: Foot dorsiflexion increases back pain
FABER test: Pain in SI joint
70% of LBP is due to: Lumbar Strain
HNP: most common sites L4-5, L5-S1
HNP: MOI: Flexion & rotation; Tears in annulus
Cauda Equina Syn: affects: L2-L4 nerve roots
Cauda Equina Syn: Mechanism: Compression of nerve roots causes paralysis without spasticity (LMN)
Cauda Equina Syn: Etiology: Central disc herniation, abscess, hematoma
Cauda Equina Syn: Sx: Loss of bladder/ bowel control, bilateral LE weakness & sensory deficits
Cauda Equina Syn: Rx: Emergent Surgical Decompression
Spondylolysis = Pars interarticularis stress fx
Spondylolysis: occur most often at: L5
Spondylolysis: x-ray Scotty dog collar only on oblique xray
Spondylolisthesis = Vertebral sliding (dancers, gymnasts)
Spondylolisthesis: PE: Step-off, may be asymptomatic
Spondylolisthesis: Grading Grade I – V (25 to >100%); Isthmic, degenerative
Spondylolisthesis: x-ray Lateral film shows slip
Piriformis Syndrome = Irritation of sciatic n. (L4,5, S1,2,3) beneath piriformis mx
Scoliosis: Xray Cobb angle: Measure angle from tilted vertebrae above & below apex of curve
50% of pts with solid tumors have: mets to spine
Tumor: Highest prevalence: BrCa, lung, prostate, colon, thyroid, kidney ca (hematogenous spread)
Tumor: Sx: Night pain, n. root compression
10% of spinal bone tumors are: primary
Spinal bone tumors: in children, 20% are: malignant
Spinal bone tumors: Primary malignant: Osteosarcoma, Ewing Sarcoma, Chondrosarcoma
Facet Syndrome = n. root compression by loss of disc height & facet hypertrophy
Ankylosing Spondylitis: Sx: Chronic low back pain in young adults; morning stiffness, improves with movement; 20% peripheral joint sx (Enthesopathies common; 25% with anterior uveitis)
Ankylosing Spondylitis: PE: Schobers test (normal is 5 - 7 cm movement)
Ankylosing Spondylitis: X-ray: Erosion & sclerosis on plain films
Ankylosing Spondylitis: Rx: PT, NSAIDs, Sulfasalazine, Infliximab
Schobers Test: Less than 5 cm difference suggests: pathology
Ankylosing Spondylitis = Calcification btw vertebral bodies at edge of discs; gives appearance of bamboo stalk; sclerosis of SI joint
Spine Films/ Frontal: Vert body: Crack in owls eye: in = Chance fx (seat belt fx)
LBP: most common site of disk herniation L5-S1 (also L4-L5)
Created by: Abarnard