Spine Red Flags

Functions of the Vertebral column

1. Movement

2. Protection: houses SC, nerve roots

3. Weight bearing/loading: head, trunk, limbs. Absorbs shock. Passes load to pelvis thru SI joint to lower extremity

What dictates movement of the spine?

Orientation of facets, vertebral bodies, IVD

What exits out of foramen?

Lower motor neurons

Central NS

Command centre

Brain, SC

Process info, make decisions, send commands

Peripheral NS

Neural network outside of brain + SC

Carries messages to/from limbs, skin, organs

C spine characteristics

When do lower motor neurons begin?

L1/L2

Past conus medullaris

Function of the NS

Motor: myotomes, RIMS, MMT

Sensation: Dermatomes, ULTT, neurodynamic tests

Reflexes: Deep tendon reflexes

Where does descending info originate/send?

Brain down SC to periphery

Where does ascending info originate/send?

Periphery to SC to brain

+ve Reflexe Tests means what?

Higher centres not in control

• Usually absent reflex

Stretch reflex occurs at what level?

Level of the nerve root, not higher.

Mm spindle > 1a afferent > SC > alpha motor neuron

Examples of dengerative pathologies

Spondylosis

• Degenerative disc disease

• Osteoarthritis [facets]

Stenosis

Stenosis

Encroachment into SC space or nerve root

Variable symptoms

Examples of Space Occupying Lesions

Disc bulge

Tumour

Fracture

• Anything taking up SC space

May not have clinical presentation; only when encroachment onto nerve root or SC when become symptomatic

Spinal Fractures

Compresses tracts

• Up-tick of reflexes bc can’t dampen pathological reflexes

• +ve reflexes

• Clumsy hands

• Ataxic gait: wide BOS

Signs of spinal red flags

BILAT or QUADrilat weakness OR paraesthesia

• Indicative of a central issue

• Nerve root affects 1 side

Ataxia

Change in bowel and bladder fxn: cauda equina

• Past conus medullaris (L1/2): is lower motor neuron

Fatigue-able weakness to MULTIPLE MYOTOMES

CLUSTER OF CLUES/findings

Special test for red flags?

Myotomes

Dermatomes

Reflexes

Hyper/hyporeflexia

Could be red flag: sign of upper centres NOT dampening [hyper]

• reflex loop compromised

Could also be just the individuality of the person

Cervical disc herniation/tumour is a red flag?

Alone, no.

• If doesn’t impinge on SC its fine.

• Normal with aging

T spine and disc herniations

T spine is more protective and narrow in space

Less space

Uncommon for things to go wrong

L spine disc herniation signs + symptoms

Numbness in saddle region

Bowel/bladder dysfxn

Bilateral symptoms

How many roots are compressed in radiculopathy

Compress 1 nerve root

Not emergent

Myelopathy

Spinal cord compression [tumour or disc bulge]

• Encroachment

Anatomical changes

Space occupying lesions have access to SC

Types of spinal fx

Compression

Burst

Seat belt type

Fx disloactions

Emergent spinal pathology?

Central issue

Vertebral fx

Does the artery move w/ c spine?

YES, side flex and rotation, vertebral artery moves with

• Vasculature can become stiff and compromised

• Runs thru neck and near facet joints

Each artery has its own pain distributions

• Vertebral artery: just L side of neck

• Internal carotid artery: base of skull down neck, side of head/forehead area

What supplies Cerebellum

Superior cerebellar artery

Functions of the Cerebellum + brainstem

Motor: eyes, face, speech, swallow (cranial nerves in brainstem)

Sensory: face, balance (vestibular)

Reflexes: balance (cerebellum), eye

Other causes of spinal pain

Visceral/non msk origins

Ex. Spleen, lung, liver