back and spine

What is a vertebrae?

series of small bones forming the backbone

What goes through the hole in the vertebrae?

The spinal cord

How many vertebrae are there?

33

How many cervical vertebrae are there?

7

How many thoracic vertebrae are there?

12

How many lumbar vertebrae are there?

5

How many sacral vertebrae are there?

5 fused

How many coccygeal vertebrae are there?

4

What is an intervertebral disc?

cushion-like pad

What does an intervertebral disc do?

-acts as a shock absorbers during running, walking, and jumping.

-allow spine to flex and extend and to a lesser extent bend laterally from side to side

What happens to intervertebral discs over time?

they lose flexibility and compressibility with age

What are intervertebral discs composed of?

nucleus pulposus and anulus fibrosus

What is the nucleus pulposus?

inner semifluid which gives the disc its elasticity and compressibility

What is the annulus fibrosis?

strong outer ring of fibrocartilage which contains the nucleus pulposus and limits its expansion

What are spinal nerves?

exit through the intervertebral foramen which is the space between two discs

What do spinal nerves do?

control various functions in the body such as muscle strength and sensations

What are dermatomes?

area on the surface of body innervated by afferent fibers from one spinal root

What do dermatomes do?

transmit nerve impulses from periphery toward the central nervous system

What dermatome is affected when you cannot toe walk?

S1

What dermatome is affected when you cannot stand on heels?

L5

When you push on someone's bones and they hurt what is the cause?

Fracture (which is secondary to osteoporosis), osteomyelitis, and cancer (multiple myeloma)

What is osteomyelitis?

infection of the bone

What two kinds of cancers are we worried about with bone pain?

Primary and secondary carcinoma

What is primary carcinoma?

where the cancer started

What is secondary carcinoma?

Cancer that has metastasized from where it started to another place

What is the mnemonic for tumors that like to metastasize?

PB KTL

What does PB KTL stand for?

Prostate, Breast, Kidney, Thyroid, Lung

What test is good for seeing the back?

MRI

Complications with MRI

expensive and often have to deal with the insurance company

What does an MRI evaluate for?

disc for herniation and nerve impingement

Who is an MRI reserved for?

patients in whom it would change therapy for

What is modality of choice for cervical HNP?

MRI

What modality is normally not used for back assessments?

X-rays

Why are x-rays not used for back assessments?

cannot see muscles, tendons, tissues, ligament, or intervertebral discs

risk is not worthwhile because of radiation

Within normal limits how many curves of the spine are there?

four

What are the four kinds of curvatures?

Cervical-concave

Thoracic-convex

Lumbar-concave

Pelvic-convex

Which curvature is the least pronounced?

cervical

What are the two abnormal curvatures of the spine?

Lordosis and kyphosis

What is lordosis?

accentuated lumbar curvature

Who tends to have lordosis?

Infants and people who need to counterbalance a protuberant abdomen (pregnant and obese people)

What is kyphosis?

accentuated thoracic curvature

What is another name for kyphosis?

hunchback

Kyphosis is common in who?

elderly women

What is the first most common reason for seeking medical attention from a primary care provider?

upper respiratory infection

What is the second most common reason for seeking medical attention from a primary care provider?

lower back pain

What are the ages and percentages of people who will experience lower back pain?

age 20-50 and 60-80%

What is the most common reason for disability and lost productivity in adults younger than 45?

lower back pain

Regardless of treatment how many people will recover from lower back pain in 6 weeks?

60-70%

Regardless of treatment how many people will recover from lower back pain in 12 weeks?

80%

What is the primary care provider's responsibility?

differentiate between life-threatening and non-life-threatening diseases

What are other disease that present as back pain but are life threatening?

aortic aneurysm, spinal infection, cauda equina syndrome, kidney stones, and ectopic pregnany

What is the most common cause of back pain?

muscle strain

What is the pathophysiology of a muscle strain?

paraspinal muscle is strained

What causes muscle strains?

often poor muscle tone leads to muscle fatigue and discomfort with use, repeated movements.

Often occurs with the simplest of movements

What are the signs and symptoms of a muscle strain?

-pain with movement and relieved with rest

-pain located in the back (lumbar spine)

-pain does not go past the knee

-pain sometimes down buttocks and leg

-no neurological complaints

What are the physical exam findings of a muscle strain?

-pain on the muscles, not the bone

-decreased range of motion

-can walk on the heels and toes

-worse discomfort with extension

-muscle spasms

What tests are done for a muscle strain?

usually none or MRI if absolutely necessary

What is the treatment for a muscle strain?

Education, RICE, and physical therapy

What is included in education for treatment of a muscle strain?

proper back posture and back exercises to strengthen muscles, protect back, proper lifting

How long would bed rest last for a muscle strain?

No longer than 2 days

How long should ice last for a muscle strain?

20 minutes then deep massage

What does RICE stand for?

Rest, Ice, Compression, and Elevation

What is another way to say physical therapy?

Back to school- used for acute simple back pain

good for home exercise program for long term stabilization of spine and prevention of reoccurances.

What do elements of physical therapy for muscle strains include?

abdominal and paraspinal muscle strengthening, spinal and hamstring strengthening, awareness of posture, and lifting techniques

What is the pharmacological treatment for muscle strains?

NSAIDS and tylenol

What is a NSAID?

non-steriodal anti-inflammatory drug

What are examples of NSAIDS

aspirin-bayer, ibuprofeun-motrin, naproxen-aleve

What is the generic name for tylenol?

acetaminophen

Taking too much of what causes liver problems?

tylenol

Taking too much of what causes kidney problems?

NSAIDs also causes ulcers and digestive problems

What medication is safe to take during pregnany?

Tylenol

NSAIDS increase risk of miscarriage, birth defects, and other complications

What is the pathophysiology of a herniated disc?

Nucleus pulposus protrudes into the annulus fibrosus and thus impinges on a spinal nerve exiting the spinal column

What is the prevalence of a herniated disc?

2-5% and most spontaneously resolve within 6 weeks

Where do herniated discs occur?

Lumbar

95% L4-L5 or L5-S1

When do herniated discs occur?

as we age because of degenerative changes of the discs

What are the symptoms of a herniated disc?

sharp, electric, and burning pain that radiates down the leg. The pain tends to be worse in the leg than back. Symptoms are along the spinal nerve and motor involvement is muscle weakness

What are the physical exam findings for a herniated disc?

Positive neurological findings that are dermatomal, muscle weakness, change in sensation, and decreased reflexes and strength

When the L5 dermatome is affected...

can't stand on heel and the pain is through the big toe

When the S1 dermatome is affected...

can't toe walk and the pain is through pinky toe

What is the treatment for herniated disc?

NSAIDS, decreased activity x1-2 days, narcotic medications (no longer than 7 days), most improve in 3-4 weeks, and epidural steroid injections

What are examples of narcotics?

Morphine, oxycontin, vicodin, codeine, methadone, fentanyl

What are the side effects of narcotics?

can't drive, constipated, and respiratory issues

What is an example of epidural steroid injections?

prednisone

What are prednisone dosages?

5 mg and 60 mg tablets

1 to 25 mg liquid

1 mg or 1 mg in everly 1 mL

What is cauda equina?

formed by nerve roots caudal to the level of spinal cord termination

What is cauda equina syndrome?

a serious condition which results from a sudden reduction in the volume of the lumbar spinal canal that causes compression of multiple nerve roots and leads to muscle paralysis

What are particularly vulnerable in cauda equina syndrome?

the sacral roots that control bladder and anal sphincter function (s2 to s4) are midline and vulnerable

General information of cauda equina

prevalence- rare 0.2-2% of disc herniation and potentially devastating consequences

Pathophysiology of cauda equina

nucleus pulposus presses directly on the spinal cord

What are the classic presentations of cauda equina?

The triad

-saddle anesthesia

-bowel or bladder dysfunction

-bilateral lower extremity weakness

Patients with pre existing back condition that suddenly becomes excruciating is associated with

-severe bilateral radicular leg pain

-bilateral symmetric lower extremity weakness and sensory loss

-loss of sensation in the anal, perianal, and genital region (Do you feel different when you wipe)

-bladder retention or overflow incontinence

When do pts have a lax anal sphincter tone?

Cauda equina syndrome

What is the treatment for cauda equina syndrome?

immediate surgical referral, One of the few reasons for emergent spinal surgery, Delay in decompression can lead to permanent loss of bowel and bladder control, impotence, sensory abnormalities, etc

Scoliosis is from the greek word

crookedness

Scoliosis is the curvature of the spine that is ______ degrees

>10

When is the onset of scoliosis

infancy, early childhood, and adolescence

What does idiopathic mean?

unknown etiology

Adolescent idiopathic scoliosis is how much of scoliosis?

85%

Adolescent idiopathic scoliosis is more common in ?

females

What are the structural change of scoliosis?

-vertebral bodies rotate towards convexity

-spinous processes rotate towards concavity