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MS of Back/Spine

Clinical Medicine II-Spring 2012

MC disability under age 45 Back and spine pain
C spine issues causes what pain neck and arm pain
Fxn of intervertebral discs shock absorber and twisting
Anatomy of intervertebral disc annulus fibrosus outside, nucleaus pulposus inside
What do the cervical vertebrae nerves C4,5,6,7,8 and TI control 4: trapezius, rhomboids, 5: deltoid,biceps, 6: wrist extensors, 7:triceps, wrist flexors, 8:finger flexors, T1: intrinsics of the hand
What do L1,2,3,4,5 S1, and S2-5 supply for motor nerves L1& L2: iliopsoas, L3: quads, L4: tibialis anterior, L5: EHL, gluteus medius S1: gastrocsoleus, peronei?, S2-5: rectal exam
Cervical nerve Reflexes tested how?Lumbar? C5: Biceps, C6: brachioradialis, C7, Triceps, L4: patellar, S1: achilies
2 causes of degenerative processes mechanical and pinched nerve with A LOT of overlap
Does pain correlate w/ amount of disc degeneration NO not at all! Amount of pain is NOT reliable
What are spondylogenic causes of low back pain disc degeneration, spondylolisthesis, fractures, inflammatory, infection, tumor
Non spondylogenic causes of low back pain vasculogenic, viscerogenic, neurogenic
Disc disorders degernerated w/fissures and annulus fibrosis, buldging, herniated, thinning, nucleosis pulpolsus: desiccated
Aggreavating factors that ↑disc degeneration smoking, vibration, lots bend, lift, twist, osteoporosis, genetic, occupational
What 3 things should we remember to check w/ back pain in elderly Compression fracture, tumor, infections
How common is back pain in kids? NOT. Must be evaluated eg. Painful sclerosis→not common
Pain that travels or radiates radiculopathy: look at which nerve it is coming from
What is a common problem that results when a nerve root is compressed or irritated radiculopathy: pain, numbness, tingling or weakness
Sprain and Strains mean what? Sprain: muscles Strain: ligaments
Tx low back sprain/strain NSAIDS, slight rest, gradual return to full activity
What should we always consider w/ back sprain/strains as advice wt loss and PT
MC location of a herniated disc & characteristics L4,5 and L5-S1 in age 30-40, sharp shooting pain “sciatic pain”
What should the PE entail w/ suspect disc herniation FULL H&P, deep tendon reflex, motor group test, sensory, nerve root tension: leg raise
What warrants a MRI? Severee pain or ANY neurologic deficit, can toMRI Myelogram, CT, or EMG
Tx of disc herniation 90% heal on their own w/ 3m of onset of sxs, Rest, PT, yoga, pilates RARE surgery unless completely compressed
Degenerative process, arthritis of the spine spondylosis
Posterior aspect of spine known as pars intrarticularis, essentially a stress fracture in vertebral body spondylolysis: common in kids low back pain
One vertebrae slips forward on another spondylolisthesis
MC location of spondylolysis lumbar d/t impact: stress fracture of vertebral body 
What is the scotty dog fracture spondylolisthesis: gradual deformity of spine and narrowing of the vertebral canal
Difference b/w spondylolysis and spondylolisthesis greater sxs w/ listhesis, nerve root compression
What are common fractures in postmenopausal women compression fractures, 25%!!!
Hx of a compression fracture acute onset in low thoracic high lumbar back pain
Tx of compression fracture of the spine mild to mod, 6-12wk immobilization in brace or corset, severe, surgery: vertebroplasty
Injecting a needle into vertebral body and injecting a cement like material Vertebroplasty for severe compression fractures
Common causes or RF’s of compression fractures common cause of spine pain in elderly, malnutrition, corticosteroids, alcohol abuse
What must we do f/u if we find a spinal tumor check for metastatic lesions, lung, breast, prostate are MC
Common types of vertebral body tumors multiple myeloma, chordoma, osteosarcoma, hemangioma
Types of radiographic image for spinal tumors XR, bone scan, MRI, CT guided biopsy
Signs, sxs of spinal stenosis radiation to butt and down legs, worse w/ stand/walking, relieved w/ sitting and resting, Grocery cart sign
Causes of spinal stenosis disc herniation, bone spurs, degerative changes d/t overweight
Non-surgical tx for spinal stenosis activity modification, NSAIDS, epidural steroid injections, PT
Surgical tx for spinal stenosis decompression and stenotic neuroalignments: immediate results
Muscle sprain of the cervical spine, dislocation of intervertebral disks and often damage to the spinal cord cervical fracture: broken neck
Tx for c spine fractures minor: soft collar, severe: fracture/dislocations halo traction and surgical stabilization
Effects of compression of the cauda equina bowel and bladder control, sexual fxn
Causes of cauda equina sxs tumors/lesion, trauma, spinal stenosis (lumbar), inflammatory conditions
Signs of cauda equina weakness, saddle-anesthesia, incontinence common, sexual dysfxn
Tx cauda equina syndrome SURGICAL EMERGENCY spinal decompression, immobilize if caused by trauma
Primary age of onset of scoliosis 10-15yo
Dx of scoliosis H&P and full spine XR usually refer
Tx curves less than 20 degree, 20-40, and >40 <20: observation, 20-40: bracing, >40: surgical correction
Created by: streetsmarts
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