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Spinal compression fracture
- collapsing of bone secondary to osteoporosis
- thoracic level or thoracolumbar jx
- usually in postmenopausal women, elderly men, long-term corticosteriods, trauma
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Spondylolysis
- fracture of pars interarticularis (L5/S1) - scottie dog w/collar
- 5% of pop, athletes who hyperextend their spines
- spondylolisthesis (vertebal body slip) occurs secondary to this in younger adults - can be stable or unstable
- in older adults, spondylolisthesis occurs secondary to degenerative disk disease
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Spondylolysis symptoms
- pain causes antalgic gait, reactive muscle spasm
- ROM: limited back extension
- pain over L5 on palpation
- usually does not require surgical intervention
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Lumbar degenerative disk disease: pathophysiology
- decline in concentration of proteoglycans, increase in collagen in nucleus pulposus
- excessive pressure on vertebral endplate
- tears form in annulus fibrosis
- articular cartilage degenerates -> osteoarthritis of joints, bridging osteophytes
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Lumbar degenerative disk disease: clinical presentation and treatment
- loss of lumbar lordosis (due to paraspinal muscle spasm)
- normal/limited ROM, pain worse w/extension
- pain is not reproducible, except in the spasmed paraspinal muscles
- weight loss can help stress on spine, strengthening of paraspinal muscles, possible surgical fusion
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lumbar disk herniation pathophysiology
- tears in annulus fibrosis
- inflammatory response affecting surrounding soft tissues
- nucleus pulposus protudes posteriorly b/c the posterior longitudinal ligament is thinner in the lumbar spine
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lumbar disk herniation clinical presentation
- local low back pain, paraspinal muscles, worse w/movement
- nerve root compression - radiculopathy, sharp shooting, tingling, numbness, aching
- thecal sac compression - bowel, bladder incontinence, weakness, leg symptoms
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Dens (C2) Fracture
- Most common upper spine fracture, car accidents, falls
- posterior displacement of dens toward spinal cord
- spinal cord injury in 15% cases
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Hyperflexion Teardrop Fracture
- Hyperflexion Teardrop Fracture
- Anterior longitudinal ligament pulls on anterior vert. body, while the rest of the vet. body is distracted posteriorly
- Most serious cervical spine injury
- Fracture is unstable with little change of neurological improvement
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Extension Teardrop Fracture
- Osteoporosis
- Avulsion fracture. Same as hyperflexion fracture but not from severe flexion force
- Fracture tends to be stable and doesn’t usually cause spinal cord injury
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Vertebral Axial Load Burst
- VB compressed both anteriorly and posterioly. Often caused by fall from height
- Pieces of vertebra displace into surrounding tissues and can go into the spinal cord , on CT.
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Jefferson Axial Load Burst
- VB compressed both anteriorly and posterioly
- Involves C1 vet (atlas) at the weakest points in C1 –where lateral masses connect to the ant/post lateral arches
- Same as Vertebral Axial load burst except that it occurs in the atlas (C1)
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Cervical DDD (OA)
- Normal aging process, losing flexibility and shock absorbing function
- Nucleus pulposus loses [proteoglycans] that bind water and it deteriotes. Also increase [Collagen], so it becomes white and firm. Shortening of disk height and changes alignemnet -> lots of pressure on vertebral endpates. Vetebral endplates form osteophytes. Tears in annulus fibrosis. Facet joints disarticulate/don’t fit right
- Inspection: loss of normal cervical lordosis bc of paraspinal muscle spasm in response to pain
- Range of motion: normal to limited
- Treatment: NSAIDs, opiods
- Strengthen paraspinals, stretching
- If severe, surgical cervical spinal fusion
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Cervical Disk Herniation
- Normal aging as int. vet. Disk degenerates
- Microtears in annulus fibrosis allows nucleus pulposus to leak out and get inflammation
- Typical posterolateral pathway –nucleus pulposus pushes posteriorly bc of flexion.
- -can compress nerve roots (cervical radiculopathy) -directly compress spinal cord (cervical mypoathy)
- Spurling’s Test + for nerve root compression
- Prog: most resolve w/in 6 weeks. More complicatons if radicu or myopathy
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Cervical Muscle Strain
- Injury of muscle from incorrect exertion or overuse. Most common reason for neck pain
- Injury of muscle from incorrect exertion or overuse. Most common reason for neck pain
- loss of cervical lordosis bc of muscle spasm
- -ROM limited bc of pain/stiffness
- Palpation-reproducible w/ palpation of affected neck muscle,
- -Acute onset sharp aching throbbing pain locatlized to posterior neck,
- -Worse w/ neck movement
- -can migrate to head-> headaches
- -no CR needed
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Whiplash Syndrome
- Too much and too fast hyperflexion/hyperext, injures facet joints, ligaments, muscles
- Deep aching, sharp, throbbing neck pain, from base of skull to CT junc of spine
- sometimes pain in trapezius, SCM, or headaches
- Pain worse w/ movement and can get paraspinal muscle spasm
- Loss of normal lordosis, ROM limited cuz of pain
- Tender in paraspinals on spinous process
- CR in flexion/ext to rule out vertebral fractures and spinal instability
- 80% full recover 3 mo, 20% have pain cuz of chronic muscle spasm or ligamentous instability
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Atlantoaxial Instability
- Dens moves posteriorly and might compress spinal cord
- C1/C2 instability, abnormalities of transverse ligament (congenital laxity) –Down syndrome, RA (structural damage)
- CR –increased distance in predental space, normal 3mm
- Symptom: (asymptomatic or) subluxaton of dens, spinal cord compress, cervical myelopathy –weakness/sensory impairement in legs, can last mo-yrs, sometimes increase intensity over time, sudden spinal cord compression => death
- ROM limited to pain,
- Midline deep pain bc of paraspinals spsasm
- -Weakness, increased tone, hyperreflexia, ,sensation probs
- Treat w/ surgical fixation
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Cervical Radiculopathy
- C6 and C7 most commonly affected-inflammation usually bc of annulus fibrosis tears
- parasthesia in dermatome pattern
- motor deficit from nerve root
- cervical parapsinal muscle spasm, ROM limited as extension might cause more compression of nerve roots
- local tenderness over paraspinals but not in the extremity (pain not reproducible)
- Spurlings
- EMG-CR not always, but to rule out, MRI someimtes helpful
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Cervical Spine Stenosis
- Narrowing of the cervical spinal canal
- disk herniation, osteophyte on vertebral end plates, hematoma, tumor, foreign body
- Cervcial muscle spasms, loss of normal lordosis, abnormal gait if spinal cord compressed
- ROM limited bc of neck pain , neck extension painful- must avoid neck ext if this is suspected
- Spurlings, EMG
- Sensory/motor reflex testing-MRI
- NSAIDs, opiods, oral corticostroid for acute pain/weakness
- corticosteroid injection,
- excision of osteophytes/ herniated disk Prog:herniation good, others need treatment (aimed to prevent progression, not reverse deficits)
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