Lecture #4 - Bony Conditions of the Spine
120 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

How frequently do fractures occur in the spine?

Infrequently.

Which type of fractures is more common: acute or insidious?

Insidious fractures are more common.

In which region of the spine do insidious fractures most frequently occur?

In the thoracic spine and lumbar spine.

What two structures are primarily associated with spondylolithic fractures?

<p>Pars interarticularis and vertebral end plate.</p> Signup and view all the answers

What is one of the most important elements of a fracture rule-out related to mechanism of injury (MOI)?

<p>Axial compression.</p> Signup and view all the answers

Is it possible for someone to be asymptomatic when presenting with an acute fracture in the vertebral column?

<p>Yes, it is entirely possible.</p> Signup and view all the answers

What does Rust's sign indicate in a clinical assessment?

<p>It indicates a person self-stabilizing their neck due to pain or instability.</p> Signup and view all the answers

What are the three actions mandated upon the presence of Rust's sign?

<p>Stop the assessment, stabilize, and refer for imaging.</p> Signup and view all the answers

What is the primary cause of ankylosing spondylitis?

<p>A progressive inflammatory disease leading to fusion of vertebral joints.</p> Signup and view all the answers

Identify two non-inflammatory types of spondylopathies.

<p>Spondylosis and spinal stenosis.</p> Signup and view all the answers

What critical involvement is necessary for managing spondylopathies?

<p>Referral for further assessment and treatment.</p> Signup and view all the answers

How is spondylolisthesis defined?

<p>A bilateral defect of pars interarticularis with displacement of the vertebral body.</p> Signup and view all the answers

What distinguishes grade 2 sprains from grade 3 sprains?

<p>Grade 2 has moderate damage and decreased strength; grade 3 is a complete tear with substantial loss of function.</p> Signup and view all the answers

Name a common condition associated with acute torticollis.

<p>Whiplash.</p> Signup and view all the answers

Describe the significance of the DTR in diagnosing neurological signs in whiplash.

<p>The presence or absence of deep tendon reflexes (DTR) helps assess neurological function.</p> Signup and view all the answers

What is the effect of spinal stenosis on reflex responses?

<p>Central stenosis may result in hyper-reflexive DTR, while foraminal stenosis can lead to hypo-reflexive DTR.</p> Signup and view all the answers

List the eight palpation structures relevant to assessing spondylopathies.

<p>Spinous processes, transverse processes, facet joints, lumbosacral junction, sacrum, erector spinae, gluteals, hamstrings.</p> Signup and view all the answers

Characterize the pain response associated with a grade 3 sprain.

<p>There is no pain at the moment of injury but significant instability afterward.</p> Signup and view all the answers

What type of fractures are typically associated with osteoporosis in the thoracic spine?

<p>Fragility fractures.</p> Signup and view all the answers

Which two structures in the spine are primarily involved in insidious fractures related to spondylosis?

<p>Vertebral end plate and pars interarticularis.</p> Signup and view all the answers

What are the five Ds and three Ns that are crucial in assessing cervical spine injuries?

<p>Dizziness, dysphagia, dysarthria, double vision, drop attacks; nausea, numbness, neck pain.</p> Signup and view all the answers

What is the significance of axial compression in the mechanism of injury for spinal fractures?

<p>It indicates a force coming from above, potentially leading to vertebral fractures.</p> Signup and view all the answers

In evaluating a patient post-MVC, what does an inability or unwillingness to move their neck indicate?

<p>It is a red flag warranting further investigation.</p> Signup and view all the answers

How does Rust's sign help in clinical assessment of upper cervical stability?

<p>It indicates potential instability as the patient self-stabilizes their neck.</p> Signup and view all the answers

What actions should be taken when Rust's sign is observed during an examination?

<p>Stop the assessment, stabilize the patient, and refer for imaging.</p> Signup and view all the answers

What role does the National radiography utilization study (NEXUS) serve in spinal evaluation?

<p>It serves as the international equivalent of the Canadian C-spine rules.</p> Signup and view all the answers

What are the four inflammatory types of spondylopathies?

<p>Ankylosing spondylitis, sacroiliitis, psoriatic arthritis, and Reiter’s syndrome.</p> Signup and view all the answers

Describe the connection between whiplash and acute torticollis.

<p>Acute torticollis is frequently associated with whiplash and cervical strains.</p> Signup and view all the answers

What is the primary concern in managing spondylopathies?

<p>Referral to a specialist is crucial for effective management.</p> Signup and view all the answers

How does spondylolisthesis differ from spondylosis?

<p>Spondylolisthesis involves displacement of a vertebra, while spondylosis refers to degeneration without displacement.</p> Signup and view all the answers

What are the neurological signs observable in grade 3 whiplash?

<p>Decreased or absent deep tendon reflexes, muscle weakness, and sensory deficits.</p> Signup and view all the answers

List two types of stenosis and their definitions.

<p>Central stenosis is the narrowing of the spinal canal, while foraminal stenosis involves narrowing of the vertebral foramina.</p> Signup and view all the answers

What factors differentiate a grade 2 sprain from a grade 1 sprain?

<p>A grade 2 sprain involves moderate damage and painful loss of function, while grade 1 has slight damage with little loss of function.</p> Signup and view all the answers

What structures in the spine can be impacted by fractures, particularly insidious ones?

<p>Spinous process, transverse process, vertebral arch, pars interarticularis, vertebral end plate, and vertebral body.</p> Signup and view all the answers

Which regions of the spine are commonly affected by acute and insidious fractures?

<p>Acute fractures are common in the cervical spine, while insidious fractures commonly occur in the thoracic and lumbar spine.</p> Signup and view all the answers

What are two key signs of associated symptomology in cases of suspected spinal fractures?

<p>Bilateral paresthesia and headaches.</p> Signup and view all the answers

Explain the importance of the mechanism of injury (MOI) when assessing spinal fractures.

<p>MOI helps determine if axial compression or traumatic forces are present, which are crucial for diagnosing fractures.</p> Signup and view all the answers

What actions are to be taken if Rust's sign is observed during a clinical examination?

<p>Stop the assessment, stabilize the patient, and refer for imaging.</p> Signup and view all the answers

How can a patient present without symptoms, yet have a significant spinal injury?

<p>A patient may be asymptomatic even with a stable acute fracture in the vertebral column.</p> Signup and view all the answers

What is the relationship between spondylosis and the types of spinal fractures?

<p>Spondylosis can be associated with insidious fractures, including stress and fragility fractures.</p> Signup and view all the answers

Identify the two structures primarily involved in spondylolithic fractures.

<p>Pars interarticularis and vertebral end plate.</p> Signup and view all the answers

What is the primary characteristic of ankylosing spondylitis?

<p>Progressive fusion of vertebral joints and bony structures.</p> Signup and view all the answers

How does spondylosis differ from spondylolisthesis?

<p>Spondylosis involves degeneration with no displacement, while spondylolisthesis is a displacement of the vertebral body.</p> Signup and view all the answers

What is the clinical presentation of grade 2 whiplash according to its classification?

<p>Neck complaints of pain, stiffness, and tenderness with musculoskeletal signs.</p> Signup and view all the answers

What is a common consequence of spinal stenosis?

<p>Narrowing of the spinal canal leading to potential nerve compression.</p> Signup and view all the answers

Which two neurological signs are evaluated in grade 3 whiplash?

<p>Decreased or absent deep tendon reflexes (DTR) and muscle weakness.</p> Signup and view all the answers

What differentiates grade 1 sprains from grade 2 sprains?

<p>Grade 1 sprains have little loss of function, while grade 2 sprains are painful with moderate loss of function.</p> Signup and view all the answers

List two non-inflammatory types of spondylopathies.

<p>Spondylosis and spinal stenosis.</p> Signup and view all the answers

What crucial action must be taken for patients with spondylopathies?

<p>Referral for further assessment and management.</p> Signup and view all the answers

Describe the pain response associated with a grade 1 sprain.

<p>Pain is mild to moderate with little loss of function.</p> Signup and view all the answers

What conditions is acute torticollis often associated with?

<p>Whiplash and cervical strains.</p> Signup and view all the answers

What type of fractures may occur as a result of osteoporosis in the thoracic spine?

<p>Fragility fractures.</p> Signup and view all the answers

Which structures in the spine are known to be involved in stress fractures, specifically associated with spondylosis or spondylolisthesis?

<p>Pars interarticularis and vertebral end plate.</p> Signup and view all the answers

When assessing fractures, what does the acronym 'CLear Beads Dangle Near Heads to Note Cranial Signs' help to remember?

<p>The important elements to consider include mechanism of injury (MOI) and associated symptomology.</p> Signup and view all the answers

What is the significance of axial compression in evaluating spinal fractures?

<p>It signifies a potentially serious mechanism of injury due to vertical forces applied to the spine.</p> Signup and view all the answers

What can the inability or unwillingness to move the neck after an MVC indicate?

<p>It can indicate a red flag for serious spinal injury.</p> Signup and view all the answers

What mandates immediate action when Rust's sign is observed in a patient?

<p>Assessment should be stopped, and the patient should be stabilized before referring for imaging.</p> Signup and view all the answers

How does the occurrence of insidious fractures correlate with specific spinal conditions?

<p>They frequently occur in the thoracic spine and lumbar spine associated with osteoporosis, spondylosis, or spondylolisthesis.</p> Signup and view all the answers

What is one reason a patient might present as asymptomatic despite having an acute vertebral column fracture?

<p>The fracture might be stable and not pressing on any neural structures.</p> Signup and view all the answers

What is the primary difference between spondylosis and spondylolisthesis?

<p>Spondylosis involves degeneration of spinal structures without displacement, while spondylolisthesis is characterized by displacement of a vertebral body due to a bilateral defect.</p> Signup and view all the answers

What are the significant spinal issues associated with whiplash?

<p>Whiplash commonly leads to concurrent injuries of contractile and inert tissues of the cervical spine, including strains and ligament involvement.</p> Signup and view all the answers

Describe the clinical presentation of a grade 3 whiplash.

<p>Grade 3 whiplash includes neck pain with neurological signs such as decreased or absent deep tendon reflexes, muscle weakness, and sensory deficits.</p> Signup and view all the answers

How does the narrowing in spinal stenosis impact deep tendon reflexes?

<p>Spinal stenosis results in a narrowing that can lead to hyper-reflexive deep tendon reflexes in central stenosis and hypo-reflexive reflexes in foraminal stenosis.</p> Signup and view all the answers

What distinguishes the inflammation types of ankylosing spondylitis from other spondylopathies?

<p>Ankylosing spondylitis is a progressive inflammatory disease that results in the gradual fusion of vertebral joints, unlike other non-inflammatory spondylopathies.</p> Signup and view all the answers

In managing spondylopathies, what role does referral play?

<p>Referral is crucial in managing spondylopathies to ensure comprehensive evaluation and appropriate interdisciplinary treatment.</p> Signup and view all the answers

What are the defining characteristics of a grade 1 sprain?

<p>A grade 1 sprain involves slight damage with minimal swelling, full strength, and mild to moderate pain.</p> Signup and view all the answers

What is the significance of Baastrup's disease in relation to spondylopathies?

<p>Baastrup’s disease refers to a condition that can cause pain due to the contact between adjacent spinous processes, affecting spinal stability.</p> Signup and view all the answers

List the neurological signs observable in grade 3 whiplash.

<p>In grade 3 whiplash, neurological signs may include decreased or absent deep tendon reflexes, muscle weakness, and sensory deficits.</p> Signup and view all the answers

What are the characteristics of a compression fracture in the spine?

<p>A compression fracture typically results from axial compression, causing the vertebral body to collapse.</p> Signup and view all the answers

What are the implications of experiencing bilateral paresthesia in the context of cervical spine injuries?

<p>Bilateral paresthesia can indicate neurological involvement and may suggest a serious cervical spine injury.</p> Signup and view all the answers

In which regions of the spine do fragility fractures most frequently occur, and what are their associations?

<p>Fragility fractures most frequently occur in the thoracic and lumbar spine, commonly associated with osteoporosis and spondylosis.</p> Signup and view all the answers

How is Rust's sign clinically interpreted and what does it signify?

<p>Rust's sign is the act of a person stabilizing their neck and indicates upper cervical instability requiring immediate concern.</p> Signup and view all the answers

What is the primary role of the NEXUS study in relation to cervical spine examinations?

<p>The NEXUS study serves to provide guidelines for assessing patients with potential cervical spine injuries in the emergency setting.</p> Signup and view all the answers

Identify two common mechanisms of injury that might lead to acute fractures in the spine.

<p>Common mechanisms of injury include motor vehicle accidents (MVAs) and direct traumatic forces.</p> Signup and view all the answers

What is a key feature of acute fractures in terms of patient presentation?

<p>Patients may present with significant pain, and even a lack of neurological symptoms does not exclude the possibility of a fracture.</p> Signup and view all the answers

Which spinal structures are primarily associated with insidious onset fractures related to spondylosis?

<p>The structures primarily involved are the pars interarticularis and the vertebral end plate.</p> Signup and view all the answers

What is the main distinction between spondylosis and spondylolisthesis?

<p>Spondylosis refers to a degeneration of the spine without vertebral body displacement, while spondylolisthesis involves displacement of the vertebral body due to a defect.</p> Signup and view all the answers

What are the implications of spinal stenosis on neurological reflexes?

<p>Spinal stenosis can lead to hyper-reflexive deep tendon reflexes (DTR) in central stenosis and hypo-reflexive DTR in foraminal stenosis.</p> Signup and view all the answers

How does a grade 1 sprain differ from a grade 2 sprain based on damage and loss of function?

<p>A grade 1 sprain involves slight damage and little loss of function, whereas a grade 2 sprain involves moderate damage and painful loss of function.</p> Signup and view all the answers

In what way can acute torticollis be commonly associated with whiplash injuries?

<p>Acute torticollis is frequently linked to whiplash due to the violent motion that affects both contractile and inert tissues of the cervical spine.</p> Signup and view all the answers

What clinical presentations are associated with grade 4 whiplash?

<p>Grade 4 whiplash includes neck complaints with fractures or dislocations, indicating a severe level of injury.</p> Signup and view all the answers

What fundamental principle is critical for managing spondylopathies?

<p>Referral is absolutely crucial for managing spondylopathies to ensure proper assessment and treatment.</p> Signup and view all the answers

Describe the primary characteristics of ankylosing spondylitis.

<p>Ankylosing spondylitis is characterized by a progressive inflammatory disease that leads to the gradual fusion of vertebral joints and bony structures.</p> Signup and view all the answers

What are the six non-inflammatory types of spondylopathies?

<p>The six non-inflammatory types are spondylosis, spinal stenosis (central and foraminal), spondylolisthesis, Baastrup’s disease, and vertebral stress fracture.</p> Signup and view all the answers

What type of symptoms might characterize a patient with grade 3 whiplash?

<p>Symptoms of grade 3 whiplash include neck pain, stiffness, tenderness, and neurological signs such as decreased DTR and muscle weakness.</p> Signup and view all the answers

Which structures are evaluated during palpation for spondylopathies?

<p>The evaluated palpation structures include spinous processes, transverse processes, facet joints, sacrum, and erector spinae, among others.</p> Signup and view all the answers

Which type of fracture frequently occurs in the thoracic spine due to osteoporosis?

<p>Insidious fractures</p> Signup and view all the answers

Rust's sign is an indication of lower cervical instability.

<p>False</p> Signup and view all the answers

What are two common symptoms associated with injuries in the cervical spine?

<p>Headaches and nausea</p> Signup and view all the answers

Insidious fractures in the lumbar spine are often associated with ______.

<p>spondylosis</p> Signup and view all the answers

Match the following structures with their involvement in spinal fractures:

<p>Spinous process = Commonly involved structure Vertebral body = Key fracture site for insidious fractures Pars interarticularis = Associated with spondylolithic fractures Transverse process = Less frequently involved structure</p> Signup and view all the answers

What should be done first if Rust's sign is observed in a patient?

<p>Stop the assessment</p> Signup and view all the answers

An individual may have a stable acute fracture and still be asymptomatic.

<p>True</p> Signup and view all the answers

What mechanism of injury (MOI) is primarily associated with axial compression in the spine?

<p>Motor vehicle accidents (MVA) and other traumatic forces</p> Signup and view all the answers

Which of the following is a progressive inflammatory disease characterized by gradual fusion of vertebral joints?

<p>Ankylosing spondylitis</p> Signup and view all the answers

Spondylosis is associated with joint disorders that contribute to pain and decreased flexibility.

<p>True</p> Signup and view all the answers

A narrowing of the spinal canal is referred to as __________.

<p>spinal stenosis</p> Signup and view all the answers

Match the grades of sprains with their corresponding characteristics:

<p>Grade 1 = Slight damage, little loss of function Grade 2 = Moderate damage, painful Grade 3 = Complete damage, substantial loss of function</p> Signup and view all the answers

Which of the following is NOT a non-inflammatory type of spondylopathy?

<p>Ankylosing spondylitis</p> Signup and view all the answers

Whiplash can involve concurrent injury to both contractile and inert tissues of the cervical spine.

<p>True</p> Signup and view all the answers

Name one type of stenosis and briefly describe it.

<p>Foraminal stenosis - narrowing of the vertebral foramina which can affect nerve roots.</p> Signup and view all the answers

__________ refers to a bilateral defect of the pars interarticularis with displacement of the vertebral body.

<p>Spondylolisthesis</p> Signup and view all the answers

Match the whiplash grades with their presentations:

<p>Grade 0 = No complaint of neck pain, no physical signs Grade 1 = Neck pain only, no physical signs Grade 2 = Neck pain and decreased ROM, MSK signs present Grade 3 = Neck pain with neurological signs, including DTR issues</p> Signup and view all the answers

Which of the following regions of the spine are commonly associated with insidious fractures due to osteoporosis?

<p>Thoracic spine</p> Signup and view all the answers

Acute fractures in the vertebral column rarely occur.

<p>False</p> Signup and view all the answers

What mechanism of injury is primarily associated with axial compression injuries?

<p>Motor vehicle accidents (MVA) and other traumatic forces.</p> Signup and view all the answers

The presence of Rust's sign indicates that a person is _________ their neck for stabilization.

<p>self-stabilizing</p> Signup and view all the answers

Match the types of fractures with their descriptions:

<p>Compression = Bony fragment has torn off Avulsion = Results from axial compression Stress = Associated with spondylosis Fragility = Common in patients with osteoporosis</p> Signup and view all the answers

Which two structures are commonly involved in spondylolithic fractures?

<p>Vertebral end plate</p> Signup and view all the answers

It is sufficient to continue the assessment if a patient shows no Rust's sign after a recent MVC.

<p>False</p> Signup and view all the answers

What are the '5 Ds' and '3 Ns' associated with cervical spine injury assessment?

<p>Dizziness, Diplopia, Dysphagia, Dysarthria, Drop attacks; Nausea, Nystagmus, Numbness.</p> Signup and view all the answers

Grade 3 sprains are characterized by complete damage to the ligament.

<p>True</p> Signup and view all the answers

Name the condition associated with high velocity trauma that affects the cervical spine.

<p>whiplash</p> Signup and view all the answers

The term __________ refers to the narrowing of a spinal canal.

<p>stenosis</p> Signup and view all the answers

Match the type of sprain with its corresponding characteristics:

<p>Grade 1 = Slight damage, little loss of function Grade 2 = Moderate damage, painful Grade 3 = Complete damage, substantial loss of function</p> Signup and view all the answers

Which of the following structures is NOT typically palpated when assessing spondylopathies?

<p>Tibialis anterior</p> Signup and view all the answers

Osteoporosis is characterized by increased bone density.

<p>False</p> Signup and view all the answers

What is one key characteristic of spondylolisthesis?

<p>Bilateral defect of pars interarticularis with displacement</p> Signup and view all the answers

Palpation of the __________ can be crucial for assessing sacroiliitis.

<p>sacrum</p> Signup and view all the answers

Which grade of whiplash includes neurological signs such as decreased or absent DTR?

<p>Grade 3</p> Signup and view all the answers

Study Notes

Bony Conditions of the Spine

  • Fractures: Occur infrequently, with insidious (gradual) types more common, especially in the cervical spine.
  • Types of Fractures:
    • Acute:
      • Compression
      • Avulsion (bone fragment tears off)
    • Insidious:
      • Stress (linked to spondylosis/spondylolisthesis)
      • Fragility
  • Insidious Fracture Locations:
    • Thoracic spine (often linked to osteoporosis)
    • Lumbar spine (often linked to spondylosis/spondylolisthesis)
  • Structures Involved in Fractures:
    • Spinous process
    • Transverse process
    • Vertebral arch
    • Pars interarticularis
    • Vertebral end plate
    • Vertebral body
  • Spondylolytic Fractures:
    • Pars interarticularis
    • Vertebral end plate are involved.
  • Axial Compression: Force from the top of the head, whether the head is aligned or not.
  • Important Fracture Rule-Out Elements (Acronym):
    • MOI: Axial compression, MVA (motor vehicle accident), and other trauma
    • Associated Symptoms: Central/local pain, bilateral paresthesia (tingling), for the neck the 5 Ds and 3 Ns (dizziness, diplopia (double vision), dysphagia (difficulty swallowing), dysarthria (slurred speech), difficulty breathing (dyspnea), nausea, numbness, and tinnitus.
  • Rust's Sign: Self-stabilizing the neck (e.g., grabbing the back of the neck to sit up). Crucially important finding; mandates stopping assessment, stabilizing the patient, and referring for imaging.
  • International equivalent to Canadian C-spine rules: NEXUS (National radiography utilization study).
  • Importance of Rust's Sign: It is a strong indicator of upper cervical instability; no other finding is as crucial. A patient with a potential prior MVC and an inability/unwillingness to move their neck (even without Rust's sign) requires imaging before further assessment.

Spondylopathies

  • Definition: General term for disorders of the vertebrae.
  • Inflammatory Types:
    • Ankylosing spondylitis
    • Sacroiliitis
    • Psoriatic arthritis
    • Reiter's syndrome.
  • Non-inflammatory Types:
    • Spondylosis: Age-related wear and tear on the spine, involving degeneration of discs, vertebrae, and facet joints.
    • Spinal stenosis (narrowing of a canal):
      • Central stenosis
      • Foraminal Stenosis
    • Spondylosis: Defect in the pars interarticularis, with no displacement. Leads to osteophyte development
    • Spondylolisthesis: Bilateral defect in the pars interarticularis resulting in displacement of one vertebrae on another.
    • Baastrup’s disease – rare
    • Vertebral stress fracture
  • Palpation Structures:
    • Spinous processes
    • Transverse processes
    • Facet joints
    • Lumbosacral junction
    • Sacrum
    • Erector spinae
    • Gluteals
    • Hamstrings
  • Differential Diagnoses (D/D):
    • Facet joint pathology
    • Muscle strain
    • Disc pathology
    • Stenosis
    • SI (sacroiliac) joint pathology
    • Piriformis syndrome
    • Adverse neurodynamics
    • Hip joint pathology
    • Myelopathy (upper motor neuron lesion)
    • Neoplasm
  • Crucial Action for Spondylopathies: Referral.

Osteoporosis

  • Progressive deterioration of bone tissue, leading to low bone density and increased porosity.

Sprains and Strains

  • Graded Injury:
    • Grade 1: Slight damage, little loss of function, full/almost-full strength, mild-moderate pain, minimal swelling.
    • Grade 2: Moderate damage, painful loss of function, decreased strength, moderate-substantial pain, possible swelling (strains).
    • Grade 3: Complete damage, substantial loss of function, decreased strength, no pain at injury site.
  • Description: Acute soft-tissue injury, often involving musculature & ligaments.
  • Whiplash: Concurrent injury to contractile and inert tissues in the cervical spine from high-velocity trauma.
  • Acute/Acquired Torticollis: Often associated with whiplash and/or cervical strains.
  • Whiplash Associated Disorder (WAD) Classification:
    • Grade 0: No neck pain or physical signs
    • Grade 1: Neck pain, stiffness, or tenderness, no physical signs
    • Grade 2: Neck pain, stiffness, tenderness, musculoskeletal signs (e.g., decreased ROM, point tenderness).
    • Grade 3: Neck pain, stiffness, tenderness, neurological signs (decreased or absent DTR, muscle weakness, sensory deficits).
    • Grade 4: Neck pain, accompanied by fracture or dislocation.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Description

Test your knowledge on bony conditions affecting the spine, including types of fractures and their common locations. Delve into the specifics of acute and insidious fractures and the structures involved. This quiz is essential for understanding spinal health and injuries.

More Like This

Use Quizgecko on...
Browser
Open
Browser
Browser