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157 Cards in this Set
- Front
- Back
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*What is the most common congenital abnormality of the spine? |
Spina bifida |
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*What is another name for spina bifida? |
Neural tube defect |
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T/F: Spina bifida is a complete bony closure of one or more neural arches. |
False, spina bifida is a incomplete bony closure of one or more neural arches. |
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*What is the most frequent site for spina bifida? And why? |
The lumbosacral region because it is the last part of the vertebral column to close. |
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What causes spina bifida? |
Inadequate dietary intake of vitamin folic acid (B9 Folate) before and at time of conception (decreased DNA synthesis) |
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How do you test for decreased DNA synthesis of B9 folate? |
With a blood test or amniocentesis |
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If a blood test or amniocentesis was positive for indications spina bifida, what would the results show? |
An elevated alpha fetoprotein level early (around 16 - 18 weeks) in pregnancy. |
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After a positive blood test or amniocentesis, what is the next step to confirm spina bifida? |
Ultrasonographic evaluation of the fetal anatomy which can detect 95% of cases. |
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What is a new theory regarding the development of spina bifida? |
Both parents must carry gene for defect to develop. |
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The most significant aspect of this abnormality is not the bony defect but rather the: |
Associated neurological deficit that results from the defective development of the spinal cord. |
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*What are four examples of spina bifida related neurological defects? |
(1)Mild muscle imbalance, (2)Sensory loss in lower limbs, (3)Paraplegia, (4)Deformities of limbs due to muscle imbalance |
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How many degrees of spina bifida are there? |
Four |
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What is the mildest form of spina bifida (1st degree) |
Spina bifida occulta |
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What is the incidence of spina bifida occulta? |
Occurs in about 10% of population |
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T/F: In spina bifida occulta, there are usually no external manifestations |
True, the bony deformities are usually hidden until found on an x-ray |
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What is an external sign that could indicate spina bifida occulta? |
Patient may have dimple, hairy patch (faun's beard) or pigmented area in lower back. |
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Will a patient with spina bifida occulta have any neurological deformities? |
They may have mild neurogenic deformity in lower extremity. |
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What is the 2nd degree of spina bifida? |
Spina bifida with meningocele |
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*In spina bifida with meningocele are the meninges or the spinal cord extruding through a larger defect in the neural arches? |
The meninges |
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What is the name for the larger defect in the neural arches? |
Meningocele |
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What is contained in the meningocele? |
CSF and some nerve roots. |
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What is the meningocele covered with? |
Normal skin |
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How much of a neurological deficit is clinically detectable at birth with spina bifida with meningocele? |
Usually little or no neurological deficit clinically detectable at birth. |
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*Will neurological deficits ever present in a patient with spina bifida with meningocele? |
Neurological deficit may develop gradually during the subsequent years of spinal growth. |
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What is the 3rd degree of spina bifida? |
Spina bifida with meningomyelocele |
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*In spina bifida with meningomyelocele are the meninges or the spinal cord extruding through a larger defect in the neural arches?
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Both, the meninges, spinal cord and nerve roots are involved and may either lie free within the sac or constitute part of its wall. |
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How are the overlying muscles and subcutaneous fat effected in spina bifida with meningomyelocele? |
They are usually deficient. |
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How does the covering skin appear in spina bifida with meningomyelocele? |
Thin and translucent |
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*T/F: Spina bifida with meningomyelocel is not associated with serious neurological deficit. |
False |
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*What cranial defect can present with spina bifida with meningomyelocel? |
Hydrocephalus |
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What is hydrocephalus? |
An abnormal accumulation of fluid in the cerebral ventricles causing enlargement of the skull and compression of the brain. |
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How is hydrocephalus treated? |
A shunt is placed in the brain to redirect the CSF. |
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*What are four other complications of spina bifida with meningomyelocele? |
(1)Varying degrees of paralysis, (2)Bowel and bladder incontinence, (3)Sensory and motor loss in L/E’s, (4)Deformities of L/E’s |
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What is the 4th degree of spina bifida? |
Spina bifida with myelocele |
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In spina bifida with myelocele, is there a meningocele? |
No, the spinal cord and nerve roots lie completely exposed as the skin and dura mater have failed to close over the neural tube. |
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What is the prognosis for spina bifida with myelocele? |
Inevitable infection usually results in death during early infancy. |
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What three types of neurological treatment are performed for spina bifida? |
(1)Removal of the sac when feasible as early as possible, (2)Provision of good skin coverage, (3)Hydrocephalus decompression |
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What three types of non-neurological treatment are performed for spina bifida? |
(1)Orthopedic treatment for paralysis (2)*Urological treatment for incontinence, (3)Rehabilitation treatment |
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What are the five regions of the vertebral column? |
(1)Craniovertebral, (2)Cervical, (3)Thoracic, (4)Lumbar, (5)Pelvis (sacrum and coccyx) |
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Is the primary curve kyphotic or lordotic? |
Kyphotic |
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When and where does the secondary curve develop? |
In the cervical spine (lordosis) develops as the child grows. |
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When and where does the last spinal curve develop? |
In the lumbar spine (lordosis) as the child learns to walk. |
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What is the main function of the spinal curves? |
To resist axial compressive forces (be load bearing) |
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Is the resistance to axial compression greater or lesser if there are fewer curves? |
Lesser |
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What is the equation to determine the resistance of a curved column? |
The resistance of a curved column is directly proportional to the square of the number of curves plus one, R=N2+1
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What are the four types of postural alignment? |
(1)Ideal Alignment, (2)Kyphosis-lordosis posture, (3)Flat-back posture, (4)Sway-back posture |
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What is a different term for kyphosis-lordosis posture? |
Hyperkyphosis |
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What is a different term for flat-back posture? |
Hypolordosis |
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What is a different term for sway-back posture? |
Hyperlordosis |
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What seven causes of a kyphosis? |
(1)Poor posture, (2)Trauma (Compression Fractures), (3)Degenerative disease (Arthritis), (4)Infection, (5)Muscular Dystrophy, (6)Neoplasm, (7)Paget’s Disease |
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When can hyperkyphosis occur? |
Hyperkyphosis can occur at any age, although it is rare at birth. |
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What is a dowager's hump? |
Forward curvature of the spine resulting in a stoop, typically in women with osteoporosis, caused by collapse of the front edges of the thoracic vertebrae. |
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What are five symptoms of kyphosis? |
(1)Mild back pain, (2)Fatigue, (3)Tenderness and stiffness in the spine, (4)Round back appearance, (5)Difficulty breathing (in severe cases) |
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How is kyphosis treated? |
(1)Lengthen short muscles (pecs, SCM), (2)Strengthen weak muscles (rhomboids), (3)Postural Advice, (4)Bracing to hold thoracic spine in neutral |
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What are four common causes of hyperlordosis? |
(1)Benign juvenile lordosis (not medically significant), (2)Achondroplasia (Dwarfism), (3)Spondylolisthesis, (4)Irritated lumbar disc |
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Where does spondylolisthesis usually occur? |
L5 vertebrae. It usually slips forward. |
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How might a patient attempt to self correct hyperlordosis caused by an irritated lumbar disc? |
With an antalgic lean. |
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What is the treatment for hyperlordosis? |
(1)Strengthen the muscles which decrease lordosis (Abdominals), (2)Lengthen muscles which increase lordosis (Erector Spinae, TLF - thoracolumbar fascia) |
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*What are the two types of scoliosis? |
(1)Non-structural scoliosis, (2)Structural scoliosis |
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*Is non-structural scoliosis reversible or irreversible? |
Reversible |
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Is there spinal rotation in non-structural scoliosis? |
No, non-structural scoliosis is lateral curvature of the spine without rotation. |
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How is non-structural scoliosis reversed? |
It can be reversed with treatment designed to correct the underlying cause |
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*Is structural scoliosis reversible or irreversible? |
Irreversible |
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Is there spinal rotation in structural scoliosis? |
Yes, structural scoliosis is lateral curvature of the spine with rotation. |
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What are three causes of non-structural scoliosis? |
(1)*Habitual poor posture (eg. dental jobs, non-centered monitors), (2)Pain and muscle spasm, (3)Lower limb discrepancy (LLD) |
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What are three causes of pain and muscle spasm in relation to non-structural scoliosis? |
(1)Painful lesion of spinal nerve root, (2)Painful lesion of the spine, (3)Painful lesion of the abdomen |
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If a patient has pain and muscle spasm might they attempt to reduce the pain? |
With an antalgic lean. |
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What are two examples of LLD? |
(1)Actual shortening of the lower limb, (2)Apparent shortening of the lower limb(pelvic obliquity) |
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What are the three types of structural scoliosis? |
(1)Idiopathic scoliosis, (2)Osteopathic scoliosis, (3)Neuropathic scoliosis |
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*What is the most common type of structural scoliosis? |
Idiopathic scoliosis, comprising 85% of all scoliosis. |
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Is the prognosis for idiopathic scoliosis better or worse if it presents at a young age? |
The younger the diagnosis the worse the prognosis. |
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How is a girl's age of menarche related to idiopathic scoliosis? |
If the scoliosis presents/is diagnosed after her first menstrual cycle, she will have a better prognosis than if it is diagnosed before her first menstrual cycle. |
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What are the two types of osteopathic scoliosis? |
(1)Congenital, (2)Acquired |
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What are the two types of congenital osteopathic scoliosis? |
(1)Hemivertebrae, (2)Osteogenesis imperfecta |
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Is hemivertebrae scoliosis localized or generalized? |
Localized |
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Is osteogenesis imperfecta scoliosis localized or generalized? |
Generalized |
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What is another name for osteogenesis imperfecta? |
Brittle bone disease |
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What are three ways to develop acquired osteopathic scoliosis? |
(1)Fractures & dislocations of the spine, (2)Rickets & osteomalacia, (3)Unilateral pulmonary disease |
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What are the two types of neuropathic osteopathic scoliosis? |
(1)Congenital, (2)Acquired |
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What are the two types of congenital neuropathic scoliosis? |
(1)Spina Bifida, (2)Neurofibromatosis |
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What is neurofibromatosis? |
Tumours growing around the nervous tissue |
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How can neurofibromatosis present? |
Erosions, defects, deformities, pseuedoarthroses |
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What is an example of how someone could get an acquired neuropathic scoliosis? |
A car accident |
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What are three types of acquired neuropathic scoliosis? |
(1)Paraplegia, (2)Cerebral Palsy, (3)Poliomyelitis |
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What type of paralysis does cerebral palsy cause? |
Spastic paralysis |
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What causes poliomyelitis? |
A virus |
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What type of paralysis does poliomyelitis cause? |
Flaccid paralysis |
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How does the body have to appear to be able to say that scoliosis has been compensated for? |
The shoulders are level and are directly above the pelvis. |
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How is scoliosis compensation possible? |
Compensatory curves develop above and below the major curve. |
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What is occurring with the spinal curves when the scoliosis is decompensated? |
The major curve is greater than the sum of its compensatory curves. |
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How does the body present when the scoliosis is decompensated? |
The shoulders are no longer level and there is a lateral shift or list of the trunk to one side. |
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Is the patient aware of the scoliosis during early stages? |
No, the patient is unaware of development at early stages |
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What are three examples of how an undiagnosed scoliosis patient present or complain of? |
(1)One shoulder is higher than the other, (2)One shoulder blade is more prominent than the other, (3)One hip protrudes more than the other |
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*What is the degree of the spinal curvature by the time it can be detected? |
By the time a spinal curvature has progressed sufficiently to be readily detected clinically it has usually reached 30 degrees |
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What would a visual examination show when viewing the posterior side of the body? |
(1)Lateral curvature of the spine, (2) Rotation in the area of the major curve |
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*What is the best position for the patient to be in during an x-ray to detect scoliosis? |
Standing |
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Should patients with idiopathic scoliosis see an orthopaedic surgeon? |
Yes |
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What are three non-surgical treatment methods for idiopathic scoliosis? |
(1)Exercise, (2)Spinal brace, (3)Night brace |
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If the spinal curve is less than 20 degrees, is a brace required? |
No |
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If the spinal curve is 20 - 40 degrees, is a brace required? |
Yes, the brace is worn for 23 hours/day |
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What is the treatment for a spinal curve that is greater than 40 degrees? |
Surgery |
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What are two options for surgically treating scoliosis? |
(1)Spinal instrumentation (Harrington rods), (2)Spina fusion (via bone graft) |
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*What are the two causes of true cervicogenic headaches? |
(1)Hypertonic musculature, (2)Facilitated (irritated) facet joints |
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*What are the two cardinal characteristics of cervicogenic headaches? |
(1)Provocation of attacks by head-neck movements, (2)Unilateral pain always occurring on the same side of the head |
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What is the diagnostic criteria for cervicogenic headaches? |
(1)Pain localized to neck & occipital region (may project to forehead, orbital region, temples, vertex, ears, or shoulder), (2)Pain is precipitated or aggravated by specific neck movements or sustained neck movements (especially rotation) |
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During diagnosis, at least one of the following three responses must be present: |
(1)Resistance to or limitation of passive neck movements, (2)Changes in neck muscle contour, texture, tone, or response to active & passive stretching & contraction, (3)Abnormal tenderness of neck muscles |
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Radiological exams of cervicogenic headaches reveals at least one of the following three: |
(1)Movement abnormalities in flex/ext, (2)Abnormal posture (antalgic lean), (3)Fractures, congenital abnormalities, bone tumours, R.A., or other distinct pathology |
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*What part of the spine would a patient with cervicogenic headaches have movement abnormalities? |
Cervical intervertebral segments |
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Where are the three locations that the cervicogenic disorder can stem from? |
(1)Joints, (2)Muscles, (3)Ligaments |
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What three muscles are commonly involved in cervicogenic headaches? |
(1)Splenius cervicis, (2)Splenius capitus, (3)Semispinalus capitus |
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What are three danger signals that suggest the possibility of a serious disease as a cause of headache? |
(1)Headache story does not fit the pattern of benign primary headaches (constant dull throbbing pain, pain does not go away), (2)Headache began after middle age without previous headache history, (3)Headaches have become progressively more severe |
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What are four other danger signals associated with cervicogenic headaches? |
(1)Association with neurological or general physical symptoms, (2)Patient appearing to be more unwell than expected, (3)Abnormal physical signs, (4)Signs of meningeal irritation are present. |
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*What type of dysfunction can often occur in the neck after trauma (whiplash)? |
Painful intervertebral dysfunction (*PID) |
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*What is the common site of PID injury or irritation? |
C2-3 |
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*Where can C2-3 PID cause pain? |
In the posterior area of the head (C2 and C3 dermatome) |
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*Where can C2-3 PID refer pain? |
The trigeminal dermatomes |
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How/why does C2-3 PID refer pain to the trigeminal dermatomes? |
Because cervical afferent nociception fibers converge with trigeminal fibers at the spinal medullary junction. |
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Where is the most marked overlap of trigeminal and cervical terminals? |
Fibers of the ophthalmic division |
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*What is most likely the cause of cervical spondylosis? |
Age-related changes in the intervertebral discs |
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T/F: Cervical spondylosis is a common degenerative condition of the cervical spine |
True |
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What does cervical spondylosis result from? |
Abnormal bone formation in the neck and degeneration and mineral deposits in the discs between the vertebrae. |
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What is the result of decreased water in vertebral discs? |
Spinal instability and the laying down of new bone. |
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What happens to discs as they age? |
They fragment, desiccate and collapse. |
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Where does the disc degeneration begin? |
In the nucleus pulposus |
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What is the result when the nucleus pulposus begins to breakdown? |
The central annular lamellae buckling inward while the external concentric bands of the annulus fibrosis bulge outward. |
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What does disc buckling result in? |
Increased mechanical stress at the cartilaginous end plates at the vertebral body lip. |
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What occurs after the discs buckle? |
Subperiosteal bone formation in the form of osteophytic bars (bone spurs) |
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Where does the subperiosteal bone form? |
Extend along the ventral aspect of the spinal canal. (In some patients, these bars encroach on neural tissue) |
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What is the most likely function of the new bone? |
Stabilize adjacent vertebrae, which are hypermobile as a result of lost disc material. |
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What causes subchondralsclerosis to develop under the cartilage plate and osteophytes to start appearing? |
Loss of disc height |
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*Where do cervical spondylosis degenerations mostly occur? |
At discs and facets at the levels C5, C6, and C7. |
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*What ROM occurs C5, C6, and C7? |
Most of the flexion-extension movement occurs. |
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Are the nerve roots supplying the upper extremity more or less to be compressed and become symptomatic with cervical spondylosis? |
More likely because they are larger |
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Can the spinal cord become easily compressed between C5-7? |
Yes, because it is larger at this area. |
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When is the onset of cervical spondylosis? |
Onset may be insidious or from specific event. |
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What are four examples aggravating factors of cervical spondylosis? |
(1)Excessive activity(reading, computer work), (2)painting a ceiling, (3)a fall, (4)MVA |
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Patients with cervical spondylosis may complain of: |
Dull aching pain in base of the neck or interscapular region. |
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How was radiating pain differ from referring pain? |
Radiating: Nerve pain, can trace the pain with a finger, radicular pain Referring: Vague, hard to localize, "toothache in their shoulder" |
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How do activities affect the pain of cervical spondylosis? |
Pain is aggravated by movements and may be worse after activities. Some difficulty with movement during exacerbation. |
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How is the pain of cervical spondylosis relieved? |
Pain is relieved by lying down and avoiding certain activities. |
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If a patient experiences radiculopathy with cervical spondylosis what would they complain of? |
Patient may complain of neck pain/stiffness, may radiate down the arm (can still be local pain) |
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What is the radiating pain of radiculopathy felt? |
Compressions of nerve root at intervertebral foramen, radiating pain is felt along the affected nerve root. |
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What is radiculopathy caused by? |
Caused by osteophytes or disc herniation. (Disc herniation at C5-6 affect C6 root and at C6-7affect C7 root.) |
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What are the three P's of radiculopathy? |
(1)Pain, (2)Paresthesia (numbness or tingling), (3)Paresis (weakness) |
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How would paresthesisa present? |
Paresthesia may be felt in one or two digits innervated by the nerve root or slight clumsiness or weakness of the hand. |
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Would paresthesisa result in sensory, motor, or reflex changes? |
It would result in all three. |
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*What are the most common nerve roots involved with cervical spondylosis paresthesia? |
6th and 7th nerve roots are most commonly involved. |
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*Which nerve root comprised 60-70% of radiculopathies? |
7th nerve root 60-70% of radiculopathies, by far the most often involved. |
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Is cervical myelopathy a short or long process? |
Long, it is a progression of degeneration and it takes years to occur. |
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What do patients with cervical myelopathy usually present with? |
Difficulty in walking, with slight unsteadiness of one or both legs. Legs feel stiff and heavy and gives out quickly on activity or exercise. |
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*What do patients with cervical myelopathy complain of? |
Tingling and numbness of the feet and hands. |
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Are the symptoms of cervical myelopathy slow or fast to progress? |
Symptoms began insidiously and progress slowly. |
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What types of movements may be impaired with cervical myelopathy? |
Fine hand movements may be impaired due to corticospinal tracts being compressed. |
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Is there any pain associated with cervical myelopathy? |
There is usually no pain. |
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What are six upper motor neuron signs of cervical spondylosis? |
(1)Increased frequency or dribbling incontinence, (2)Increased muscle tone in lower extremities, (3)Babinski positive, (4)Vibratory & tactile sensation may be impaired from hip down. (5)Flexion of neck may cause electric-like sensation down the spine (Lhermitte’s sign), (6)Hyper reflexia (exaggerated reflex response) |
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What three orthopedic tests would you do to compress the IVF and replicate the pain? |
(1)Spurling's, (2)Jackson's, (3)Maximal Foraminal Compression |
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What are seven other tests you could do on a patient with suspected cervical spondylosis? |
(1)Distraction, (2)Upper limb test, (3)Tinel’s, (4)Valsalva, (5)Shoulder abduction, (6)Lhermitte’s sign, (7)Sharp-Purser Test |
