spine

spine

1. anatomy of the spine

   • cervical vertebrae
   • thoracic
   • lumbar
   • ligaments of the spine
   • muscles
     • Iliocostalis
     • Longissimus
     • Spinalis

2. types of Disc Herniation

3. Physical examination of the spine

   • special tests
     • Schober's test “ Patient is Standing “
     • Straight leg raising “ Supine position “
     • Femoral stretch test “ Prone Position “
   • start with introduction, ask patient to expose chest completely, look, inspect and move
     • specific movements
       • neck
       • thoracic-lumbar

4. Degenerative Disc Diseases

   • an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain.
   • DDD will cause
     • lack of oxygen
     • lack of glucose
     • changes in PH levels
     • death of proteoglycans
       • IV discs are mainly made up of proteoglycans + collagen (both made by the chondrocytes)
     • changes in hydrostatic pressure
   • how does it happen?

5. X-ray imaging of the spine

   • they are the first line investigation to asses the bony anatomy of the spine and various conditions that might affect the spine
     • various conditions include : deformity, trauma, DDD, areas of instability
   • standard views
     • AP, lateral, oblique, flexion and extension views

6. lower back pain

   • Aggravating factors
     • Sitting for long hours with no breaks to move, Lack of physical activity, Wrong application of hot and cold therapy , Lifting objects incorrectly, Sitting with no back support
   • Alleviating factors
     • Using medications (OTC, injections, ointments), Certain yoga stretches, Sleeping and resting in a certain position, Heat and ice therapy
   • alternative treatments
     • spinal manipulation, biofeedback, messages, yoga, acupuncture, TENS

7. medications

   • muscle relaxants
     • Neuromuscular blockers
       • Depolarizing agents:
         • succinylcholine
       • Non-depolarizing agents
         • tubocurarine, mivacurium
     • Spasmolytics & Antispasmodic Drugs
       • diazepam, baclofen,

8. Scoliosis

   • Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty
     • Symptoms
       • uneven shoulders, one shoulder blade more prominent than the other, uneven waist, one hip side higher than the other
     • Causes
       • neuromuscular conditions, birth defects affecting bone development, injuries or infections to the spine
     • risk factors
       • age, sex, family history
     • Treatment
       • braces, surgery (spinal fusion)

9. Sciatica

   • risk factors
     • age, obesity, occupation, prolonged sitting, diabetes
   • pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. usually affects one side only
   • complications
     • loss of feeling and weakness in the affected leg, loss of bowel or bladder function
   • tests to diagnose
     • MRI and CT scans
     • special tests
       • passive straight leg raise and slump test
   • management
     • self care : hot and cold packs, stretching and OTC medication
     • specific medications : anti-inflammatories, muscle relaxants, anti-seizure medications
     • physical therapy
       • types
         • active
           • stretching, aerobic, strengthening exercises
         • manual
           • mobilisation and manipulation
     • alternative medicine like acupuncture, chiropractic therapy
     • steroid injections
     • last route : surgery
       • when should one go for spinal surgery in general ?
         • herinated or ruptured discs
         • spinal stenosis
         • vertebral fractures
         • degenerative disk disease (DDD)

10. spinal injection placement

    • epidural space
    • into and around the facet joint
    • Sacroiliac Joint Injections given around the SI joint

11. Visual analogue scale of pain

    • It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured like pain
    • helps the care provider or physician to asses the pain

12. drug adherence

    • refers to how closely you follow a prescribed treatment regimen
    • has to do with the patients ability and willingness to follow the treatment

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