Spine Disorders
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54 terms
Terms | Definitions |
|---|---|
 Annulus Fibrosis | Protective outer, fibrous tissue and fibrocartilage forming the circumference of the intervertebral discs |
| Nucleus Pulposus | Gel-like interior portion of the disc - distributes/absorbs pressure |
| Spondylosis | Condition that includes degenerative disc disease (DDD) with bulging and occasionally herniation; consequence of age-related degenerative changes |
| Spondylolysis | Fractures of pars interarticularis |
| Spondylolisthesis | One vertebral body shifts (slips) sagittally in relation to its adjacent vertebra |
| Spinal Stenosis | Narrowing of the spinal canal results in compression of neural structures in the cervical and lumbar regions where the diameter of the spinal cord is the largest |
| Cauda Equina Syndrome | Compression, trauma or other damage to the lower lumbar and sacral spinal cord levels as they traverse to exit their respective vertebral bodies; a radiculopathy sx referable to the nerve dermatomes or myotomes |
| Radiculopathy | Disorders of nerve root, lead to sx referable to a dermatome or myotome |
| Sciatica | Often connotes low back pain with radiation into the ipsilateral leg, thereby implying pain radiating along the sciatic nerve which anatomically contains fibers originating in the L4-S2 roots |
| Normal Spinal Curvature and Anatomy | • Normal Curvature: Cervical & lumbar lordosis; thoracic (& sacral) kyphosis • Anatomy: 30 vertebra - 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccyx 31 cord segments- same but 8 cervical; C1-C7 exit above vertebrae, C8-coccyx exit below Conus medularis at L1 level |
| Red Flags for Spine Pain | 1.CA or infection: >50 or <20 -hx of cancer, Immunosuppression Unexplained wt loss/ fever/chills -UTI, IV drug use, back persist with rest 2. Spinal fracture: hx trauma, Prolonged use of corticosteroids or osteoporosis -Age >70 years 3. Cauda equina synd./ neuro.compromise: -Acute onset of urinary/ fecal retention or incontinence -Focal neurologic deficit with progressive symptoms 4. Other: hx of prior local surgery Systemic d/o, bone or arthritic disorder Duration >6 weeks and Thoracic spine pain |
| Spinal Stenosis | • Epidemiology: Age >60 y/o; often in cervical and lumbar regions • Sx: Bilateral leg pain, positive SLR & X-ray Insidious onset that ↑ with standing, ↓ with bending or sitting |
| Spinal Stenosis tx | NSAIDs, muscle relaxants, surgery |
| Herniated Disc | • Epidemiology: Age 30-50 y/o, MC postero-lateral direction • Sx: Bilateral leg pain, positive SLR but negative X-ray Insidious onset that ↓ with standing, ↑ with bending or sitting |
| Herniated Disc tx | NSAIDs, steroids Avoid invasive tx for 3 months, restrict physical activity Local heat, massage, spinal manipulation, exercise, yoga, acupuncture Surgery if no relief, neuro deficit, or severe impairment |
| Muscle Strain | • Epidemiology: Age 20-40 y/o; MCC of lower back pain (LBP) • Clinical Manifestations: Unilateral back pain, negative SLR & X-ray Insidious onset that ↑ with standing, ↓ with bending or sitting |
| Muscle Strain tx | Same as spinal stenosis and herniated disc - no surgery |
| common Referred back Pain | • GI: PUD, pancreas, gallbladder • Vascular: AAA, other aneurysms/occlusions • Renal: Kidney stone/infection, prostatitis • OB/GYN: Pregnancy, pelvic tumor, PID • Ortho: Hip, knee, SI disorders; coccygodinia; mechanical |
| Low Back Pain Special Tests | 1. Straight Leg Raise (SLR) 2. Reverse SLR: 3. Spurling's Test: |
| Straight Leg Raise | (+) is radicular pain that extends below knee on extension Knee is extended and hip is flexed Specificity 85-91% but only 26-52% for dx sciatica caused by herniated disc |
| Reverse SLR | While face down, extend femur (hip) (+) if pain in L3-L4 radiculopathy (leg) |
| Spurling's Test: | Dx acute cervical radiculopathy Compress foramina and reproduce sx Extend neck and rotate head, then apply downward pressure on head (+) pain radiates to limb ipsilateral (same side) to side head is rotated to |
| Low Back Pain Imaging | • Lecturer: Suspected benign condition in which sx severe, >4 weeks, surgery considered Sx of nerve root compression History of neurogenic claudication or other serious condition Other serious condition examples - cauda equine syndrome, fx, infection, tumor |
| Low Back Pain Non-Surgical tx | Avoid invasive tx for 3 months, restrict physical activity Local heat, massage, spinal manipulation, exercise, yoga, acupuncture Surgery if no relief, neuro deficit, or severe impairment |
| Central Cord Syndrome Etiologies | Syringomyelia (spinal cord expanded by CSF); intermedullary tumor Post-traumatic cervical injury in pt with pre-existing cervical spondylosis or herniation |
| Central Cord Syndrome sx | LMN s/sx at level of lesion; UMN s/sx below lesion LMN - hypotonic weakness, ↓ reflexes UMN - hypertonic weakness, spastic paralysis, ↑ reflexes, (+) Babinski Band of loss of temperature & pain sensation at level of lesion Urinary retention |
| Central Cord Syndrome tx | IV steroids, ensure vitals, treat complications - if unstable may need surgery |
| L4 radiculopathy Pain | Across the thigh and medial aspect of the leg to the medial malleolus |
| L4 radiculopathy muscle weakness | Quadriceps- extends knee, tibialis anterior- dorsiflexes foot Patellar reflex L2-L4 |
| L4 radiculopathy sensory loss | Medial part of the leg and reflex loss of knee -dorsum of foot |
| L5 radiculopathy Pain | Posterior aspect of the thigh and lateral aspect of the calf, dorsum of foot |
| L5 radiculopathy muscle weakness | Extensor digitorum longus- extends toes |
| L5 radiculopathy sensory loss | Plantar of foot |
| S1 radiculopathy Pain | Buttock and posterior aspect of the thigh, calf, and lateral border of the foot |
| S1 radiculopathy muscle weakness | Hamstrings- flex kne Flexox hallicus longus- flex great toe loss of achilles reflex |
| S1 radiculopathy sensory loss | Sole or lateral border of the foot -loss of reflex at the Ankle |
| S2-S4 radiculopathy Pain | Posterior aspect of the thigh, buttocks, genitalia |
| S2-S4 radiculopathy muscle weakness | Gastrocnemius, Soleus, Abductor hallucis, Abductor digiti quinti pedis, and Sphincter muscles |
| S2-S4 radiculopathy sensory loss | Buttocks, anal region, genitalia Loss of reflex Anal wink & Bulbocavernosus |
| C5 radiculopathy Pain | Neck, shoulder, and interscapular region; lateral aspect of arm |
| C5 radiculopathy Muscles Weakness | Deltoid, Infraspinatus, Rhomboids -Abd.arms and extr. rotaion |
| C5 radiculopathy Sensory Loss | Lateral border of the shoulder and upper part of the arm Reflex loss: Biceps &Brachioradialis |
| C6 radiculopathy Pain | Shoulder; lateral aspect of the forearm, and the 1st two digits |
| C6 radiculopathy Muscles Weakness | Biceps, and brachioradialis -Flex elbow |
| C6 radiculopathy Sensory Loss | Lateral aspect of the forearm, and the 1st two digits Reflex loss: Brachioradialis & biceps |
| C7 radiculopathy Pain | Interscapular region, posterior of the arm, midforearm |
| C7 radiculopathy Muscles Weakness | Triceps, extensor carpi and digitorum -Extend elbow and fingers |
| C7 radiculopathy Sensory Loss | Midforearm and middle digit -Reflex loss:Triceps |
| C8 radiculopathyn pain | Medial aspect of the forearm and hand |
| C8 radiculopathy muscle weakness | flexor digitorum and flexor Pollic longus -flex finger and thumb |
| C8 radiculopathy sensory loss | Medial aspect of forearm and hand and 4th and 5th digits Reflex loss: Finger flexors (triceps) |
| T1 radiculopathy pain | Medial aspect of the arm to the elbow |
| T1 radiculopathy muscle weakness | Intrinsic hand muscles -Spread fingers |
| T1radiculopathy sensory lost | Medial aspect of arm to the elbow |
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