54 terms

Spine Disorders

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
Condition that includes degenerative disc disease (DDD) with bulging and occasionally herniation; consequence of age-related degenerative changes
Fractures of pars interarticularis
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
Disorders of nerve root, lead to sx referable to a dermatome or myotome
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