Term
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Definition
• Defined as a sagittal curve > 15o
• Idiopathic- makes up more than 80% of cases
– Infantile < 3 years old
– Juvenile 4-9 years old
– Adolescent 10 plus years old
• Congenital
• Adult (degenerative) |
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Term
| adolescent idiopathic scoliosis |
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Definition
• Females > males – Age 10-14
• Often associated with positive family history
• Tends to progress during puberty growth spurt
• Symptoms
– Usually asymptomatic
– Occasional back pain
– Adams test- school screening
• Physical exam
– Trunk balance
– Thoracic/lumbar prominences
– Neurologic exam typically normal
• Imaging
– PA x-ray – measure curve
– Lateral x-ray – evaluate kyphosis/lordosis
– MRI – recommended for patients with abnormal neurologic exam |
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Term
| treatment for adolescent idiopathic scoliosis |
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Definition
• Bracing
– Prevent progression until skeleton matures
• Curves > 25-40o on initial presentation
• Curves > 25o with documented progression or significant growth potential
• Surgery
– Curve correction and fusion
• Curves > 40o if skeletally immature
• Curves > 50o if skeletally mature |
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Term
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Definition
• Results from congenital anomalies of the vertebral column
• Affects children at earlier age
• Associated with diseases of other organs (e.g. heart, kidney)
• Natural history
– Dependent upon specific deformity
– Results in asymmetric growth of the spine
– May ultimately compromise pulmonary function
• Natural history
– Dependent upon specific deformity
– Results in asymmetric growth of the spine
– May ultimately compromise pulmonary function |
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Term
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Definition
• Occurs in older adults
• Results from asymmetric degeneration of the intervertebral disks
• Curve progression and imbalance may lead to nerve compression and significant disability
• Symptoms
– Pain (back vs. leg)
– Progressive deformity
– Neurologic complaints (stenosis)
• Physical exam
– Trunk imbalance
– Thoracic/lumbar
prominences
– Neurologic deficits
• Non-surgical treatment – Bracing
– NSAIDs
– Physical therapy – Injections
• Surgery
– Decompression and fusion – Higher risk of complications |
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Term
|
Definition
• Deformity in the sagittal plane
• |
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Term
|
Definition
• Nonsurgicaltreatment
– Observation
– Physical therapy
• Stretching/strengthening
– Bracing
• Surgery–fusion – Chronic back pain – Curves > 75o |
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Term
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Definition
• Fracture of the anterior vertebral body
– Older patients – associated with osteoporosis
– Younger patients – occur after high-energy trauma
• Symptoms
– Back pain with no neurologic deficits
• Physical exam
– Focal tenderness
• Imaging
– Radiographs
• Measure kyphosis and collapse
– CT
• Evaluate spinal canal
– MRI
• Used to differentiate between acute and chronic fractures
• Treatment
– Natural history – majority will heal with immobilization
– Bracing
– Vertebroplasty/kyphoplasty
– Surgery
[image] |
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Term
|
Definition
• Description:
– Compression fracture of the bony
ring of vertebra C1, characterized by lateral masses splitting and transverse ligament tear.
• Mechanism
– Axial blow to the vertex of the head
(e.g. diving injury).
• Radiographic features:
– Key radiographic view is the AP open mouth, which shows displacement of the lateral masses of vertebrae C1 beyond the margins of the body of vertebra C2. A lateral displacement of >2 mm or unilateral displacement may be indicative of a C1 fracture. CT is required to define the extent of fracture and to detect fragments in the spinal canal.
• Stability: unstable
• Best seen odontoid view
[image] |
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Term
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Definition
– Bilateral C2 pedicle fracture
• Through pars interaticularis
– Secondary to hyperextension of the neck (unstable)
[image] |
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Term
|
Definition
– Avulsion of C6 or C7
spinous process
– Mechanism is heavy lifting
[image] |
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Term
|
Definition
|
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Term
|
Definition
• Compression of cervical nerve root
• Most frequently arises from disk herniations or spondylosis
-spurling's test
• Imaging
– X-rays, CT may demonstrate degeneration
– MRI – |
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Term
| cervical nerves and pain locations |
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Definition
|
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Term
|
Definition
physical exam- spurling test/foraminal compression test/neck compression test/ quadrant test
-extending the neck
-rotating head
-downward pressure on head
-positive finding eliciting reprocuction of radicular pain into ipsilateral arm of head rotation
-92% sensitive, 95% specific
-low sensitivity but high specificity- not useful as a screening tool, but it does help confirm the diagnosis |
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Term
|
Definition
• Compression of spinal cord
• Etiology
– Herniated disks
– Spondylosis
– Instability/trauma
– Tumors/infection
– Ossification of the posterior longitudinal ligament
• Neck pain and stiffness
– Axial neck pain (often times absent) – Occipital headache common
• Extremity paresthesias
– Diffuse non-dermatomal numbness and tingling
• Weakness and clumsiness
– Weakness and decreased manual dexterity (dropping object,
difficulty manipulating fine objects)
• Gait instability
– Patient feels "unstable" on feet
– Weakness walking up and down stairs
– Gait changes are most important clinical predictor
• Urinary retention
– Rare and only appear late in disease progression
• Physical exam – Motor
• Weakness
– usuallydifficulttodetectonphysicalexam
– lowerextremityweaknessisamoreconcerningfinding
• Finger escape sign
– whenpatientholdsfingersextendedandadducted,thesmallfinger
spontaneously abducts due to weakness of intrinsic muscle
• Grip and release test
– normallyapatientcanmakeafistandrelease20timesin10seconds. myelopathic patients may struggle to do this
– sensory
• Proprioception dysfunction
– duetodorsalcolumninvolvement – occursinadvanceddisease
– associatedwithapoorprognosis
• Decreased pain sensation
– pinpricktestingshouldbedonetolookforglobaldecreaseinsensationor
dermatomal changes
– duetoinvolvementoflateralspinothalamictract
• Vibratory changes are usually only found in severe case of long-standing myelopathy
• Upper motor neuron signs (spasticity) – hyperreflexia
• may be absent when there is concomitant peripheral nerve disease (cervical or lumbar nerve root compression, spinal stenosis, diabetes)
– inverted radial reflex
• tapping distal brachioradialis tendon produces ipsilateral finger flexion
– Hoffmann's sign
• snapping patients distal phalanx of middle finger leads to spontaneous flexion of other fingers
– Sustained clonus
• > three beats defined as sustained clonus
• sustained clonus has poor sensitivity (~13%) but high specificity (~100%) for cervical
myelopathy
– Babinski test
• considered positive with extension of great toe
• Gait and balance
– toe-to-heel walk
• patient has difficulty performing
– Romberg test
• patient stands with arms held forward and eyes closed
• loss of balance consistent with posterior column dysfunction
• Provocative tests
– Lhermitte Sign
• test is positive when extreme cervical flexion leads to electric shock-like sensations that radiate down the spine and into the extremities
-hoffmann's sign, lhermitte's sign
• Imaging – spinal cord compression on MRI (or CT myelogram)
• Natural history – symptoms will progress without surgery
• Treatment – decompression and stabilization
– Anterior – Posterior |
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Term
|
Definition
| hyperextension of distal middle finger results in flexion of thumb, index finger |
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Term
|
Definition
| "electric shock" in extremities with cervical flexion or extension |
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Term
| cervical myelopathy cluster |
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Definition
age >45
gait ataxia
babinski
hoffman's reflex
inverted supinator sign |
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Term
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Definition
• Age
– Benign – younger patients (10-20 years old)
– Malignant, metastatic – older patients
• Location
– Benign – posterior elements
– Malignant, metastatic – vertebral body
• Symptoms
– Fever, chills
– Back pain
– Neurologic complaints
• Physical exam
– Tenderness
– Decreased ROM – Neurologic deficits
• Imaging
– X-rays
– CT
– MRI
– Nuclear medicine/PET scan
• Biopsy
– Image-guided – Open
• Treatment
– Observation/immobilization
– Radiation
– Chemotherapy
– Surgery (decompression and/or fusion) |
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Term
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Definition
• Osteoid osteoma
• Osteoblastoma
• Aneurysmal bone cyst
• Osteochondroma
• Hemangioma
• Giant cell tumor
• Eosinophilic granuloma
• Neurofibroma |
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Term
|
Definition
• Multiple myeloma • Plasmacytoma
• Osteosarcoma
• Ewing’s sarcoma • Chondrosarcoma • Chordoma |
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Term
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Definition
• Metastatic disease – most common spinal tumor
– Breast – Lung
– Thyroid – Kidney – Prostate |
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Term
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Definition
• Vertebral osteomyelitis/diskitis
• Epidural abscess
• Postsurgical
• Organism – pyogenic vs. non-pyogenic
• Spread – hematogenous vs. direct invasion
• Location – lumbar > thoracic > cervical
• Risk factors – Obesity
– Diabetes
– Advanced age – Malnutrition
– Smoking
– Steroids
– IV drug use
• Symptoms – often nonspecific
– Back pain
– Fevers/chills
– Neurologic complaints
• Physical exam
– Focal tenderness – Decreased ROM – Neurologic deficits
• Laboratory studies
– WBC with differential
– Erythrocyte sedimentation rate
– C-reactive protein
• Imaging – X-rays
– CT
– MRI
– Nuclear medicine scans
• Infection – involves disk space
• Tumor – disk space spared
Non-surgical Treatment
• Immobilization
• Antibiotics – critical to identify organism and susceptibilities
• Minimum of 6 weeks of treatment
• Follow labs to assess response
Surgical Treatment
• Irrigation and debridement of infected tissues
• Maintain/restore alignment
• Stabilization
• High risk of complications |
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