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Year 1: OS Exam 1 > 2.1 Thoracic and Lumbar spinal mechanics > Flashcards

2.1 Thoracic and Lumbar spinal mechanics Flashcards

1
Q

Which areas of the spine have lordosis or kyphosis?

A

lordosis - cervical and lumbar

kyphosis - thoracic and sacral

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2
Q

Describe thoracic vertebra

A

body: medium size, heart shape, costal facets

spinous process: long, slope postero-inferiorly

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3
Q

Describe lumbar vertebra

A

body: large and kidney shaped

spinous process: short, broad

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4
Q

What is a vertebral unit?

A

two adjacent vertebrae and associated intervertebral disc

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5
Q

Where is the pedicle?

A

between body and transverse process

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6
Q

Where is the lamina?

A

between transverse process and spinous process

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7
Q

What does the rule of 3 describe?

A

The location of the spinous process in relation to the transverse process in the thoracic spine

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8
Q

What is the rule of 3?

A

T1-T3, T12 spinous process located at the level of the transverse process
T4-T6, T11 spinous process is located 1/2 a segment below the corresponding transverse process
T7-T9, T10 spinous process is at the level of the transverse process of the vertebrae one below

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9
Q

What is the superior facet orientation for the cervical, thoracic, and lumbar regions?

A

cervical: backward, upward, medial (BUM)
thoracic: backward, upward, lateral (BUL)
lumbar: backward, medial (BM)

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10
Q

What are the ligaments of the spine?

A 
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flava
Interspinous ligaments
Intertransverse ligaments
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11
Q

What is the anterior longitudinal ligament?

A

Strong, broad fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and IV discs
Limits extension

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12
Q

What is the posterior longitudinal ligament?

A

narrower, somewhat weaker band that runs within the vertebral canal along the posterior aspect of the vertebral bodies
resists hyperflexion
prevents posterior herniation of nucleus pulposus

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13
Q

What is the ligamentum flava?

A

connects adjoining spinous processes

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14
Q

What are the interspinous ligaments?

A

connects adjoining spinous processes

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15
Q

What are the intertransverse ligaments?

A

connects adjoining transverse processes

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16
Q

What does the iliolumbar ligament connect?

A

ilium to the lumbar vertebrae

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17
Q

What are the transversospinalis muscles?

A

rotatores, multifidus, and semispinalis

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18
Q

Rotatores breves: origin and insertion, innervation, and action

A

T1-T12 between transverse and spinous processes of adjacent vertebrae
posterior rami
bilateral: extend thoracic spine
unilateral: rotates thoracic spine to opposite side

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19
Q

Rotatores longi: origin and insertion, innervation, and action

A

T1-T12 between transverse and spinous processes, skipping one vertebra
posterior rami
bilateral: extend thoracic spine
unilateral: rotates thoracic spine to opposite side

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20
Q

Multifidus: origin and insertion, innervation, and action

A

sacrum, ilium, mamillary processes of L1-L5, transverse and articular processes of T1-T4, C4-C7
superomedially to spinous processes, skipping 2 to 4 vertebrae
posterior rami
bilateral: extends spine
unilateral: flexes spine to same side, rotates to opposite side

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21
Q

semispinalis capitis: origin and insertion, innervation, and action

A

C4-T7 transverse and articular processes
Occipital bone between superior and inferior nuchal lines
posterior rami
bilateral: extends thoracic and cervical spines and head (stabilizes craniovertebral joints)
unilateral: bends head, cervical, and thoracic spines to same side, rotates to opposite side

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22
Q

semispinalis cervicis: origin and insertion, innervation, and action

A

T1-T6 transverse processes
C2-C5 spinous processes
posterior rami
bilateral: extends thoracic and cervical spines and head (stabilizes craniovertebral joints)
unilateral: bends head, cervical, and thoracic spines to same side, rotates to opposite side

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23
Q

semispinalis thoracis: origin and insertion, innervation, and action

A

T6-T12 transverse processes
C6-T4 spinous processes
posterior rami
bilateral: extends thoracic and cervical spines and head (stabilizes craniovertebral joints)
unilateral: bends head, cervical, and thoracic spines to same side, rotates to opposite side

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24
Q

Degrees for flexion, extension, sidebending, and rotation for entire spine

A

flexion: 40-90
extension: 20-45
sidebending: 15-30
rotation: 3-8

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25
Q

What is coupled motion?

A

consistent association of a motion along or about one axis with another motion about or along a second axis. One motion cannot be isolated without the other.

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26
Q

What is linkage?

A

relationship of joint mechanics with surrounding structures to increase ROM

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27
Q

What are outcomes of restrictions of ROM in the spine?

A

reduce efficiency
impair flow of fluids
alter nerve function
create structural imbalance

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28
Q

What are type one fryette mechanics?

A

Neutral range, sidebending and rotation are coupled in opposite directions. tends to be a group.
TONGO

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29
Q

What are type two fryette mechanics?

A

in sufficient flexion or extension, sidebending and rotation are coupled in the same direction. tends to be a single vertebra. TypeTwoSingleSegment

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30
Q

What did Harrison Fryette DO do?

A

described physiologic motion of the spine in two principles in 1918

31
Q

What is Fryette Third Principle?

A

initiating movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion.

32
Q

Who developed Fryette’s third prinicple? When?

A

CR Nelson DO in 1948

33
Q

What parts of the spine do Fryette’s third principle apply to?

A

Thoracic and lumbar spine

34
Q

What spinous process and transverse process is at the spine of the scapula?

A

T3

35
Q

What spinous process and transverse process at the inferior angle of the scapula?

A

spinous process of T7

transverse process of T8

36
Q

What level is the iliac crest?

A

L4

37
Q

What is scoliosis? How do you name the curves?

A

lateral curvature of the spine
levo - left
dextro - right

38
Q

What percent of the population has scoliosis?

A

2% of the population, more common in females

39
Q

What is the physical exam for scoliosis?

A 
asymmetry of the waist, shoulders
may have rib cage prominence
leg length discrepancies
cobb angle
Forward Bending test
scoliometer (inclinometer)
40
Q

What is the management of scoliosis?

A

OMT
based on Cobb angle:
<25 degrees conservative - monitor with frequent radiographs
25-45 degrees - non operative, bracing
>45 degrees - surgical fusion prevents progression

41
Q

What are complications of scoliosis?

A

respiratory compromise >50 degrees

cardiac compromise >75 degrees

42
Q

What are some types of low back pain with radiation below the knee?

A

radiculopathy, spinal stenosis, cauda equina syndrome

43
Q

What is radiculopathy?

A
  • pain with dermatomal distribution
  • neurological function may be impaired: lower extremity weakness and diminished reflexes
  • typically acute, may become chronic
44
Q

How is radiculopathy diagnosed?

A

MRI

+straight leg test

45
Q

L4-5 disc herniation

A
  • level of 5th lumbar nerve root
  • pain over SI joint, hip, lateral thigh and leg
  • numbness lateral leg and first 3 toes
  • weakness of dorsiflexion of great toe and foot, difficulty walking on heels, foot drop may occur
  • atrophy: minor
  • reflexes: changes uncommon in knee and ankle jerks, but internal hamstring reflex diminished or absent
46
Q

L5-S1 disc herniation

A
  • level of 1st sacral nerve root
  • pain over SI joint, hip, posterolateral thigh and leg to heel
  • numbness over back of calf, lateral heel, foot to toe
  • weakness of plantar flexion of foot and great toe may be affected, difficulty walking on toes
  • atrophy of gastrocnemius and soleus
  • ankle jerk diminished or absent
47
Q

What is the straight leg raise test?

A

raise the leg with knee extended, nonspecific test
+ is pain
indicates pain from 15-30 degrees with lumbar disc etiology

48
Q

What is spinal stenosis?

A
  • narrowing of spinal canal
  • bilateral lower limb pain
  • neurologic claudation
  • neurological function may be impaired: lower extremity weakness, diminished reflexes
  • typically chronic
49
Q

How is spinal stenosis diagnosed?

A

MRI

+ straight leg raise

50
Q

What is cauda equina syndrome?

A
  • herniated disc into the spinal canal
  • impaired neurological function: saddle anesthesia, lower extremity weakness, diminished reflexes, urinary retention
  • EMERGENCY
  • usually traumatic
51
Q

How is cauda equina syndrome diagnosed?

A

MRI

52
Q

What is spina bifida occulta?

A

failure of the neural tube to close without herniation

53
Q

What is meningocele?

A

failure of the neural tube to close with protrusions of the meninges through the defect

54
Q

What is myelomenginocele?

A

failure of the neural tube to close with protrusion of the meninges and spinal cord through the defect

55
Q

What is sacralization?

A

one or both TP’s of L5 are long and articulate with the sacrum (DJD)

56
Q

What is lumbarization?

A

failure of S1 to fuse with the rest of the sacrum (not common)

57
Q

What causes spina bifida?

A

defect in the closure of the lamina

58
Q

What is spondylosis?

A

bony spurs

59
Q

What is spondylolesthesis?

A

slipping of one vertebra on another

60
Q

What are the viscerosomatic reflex levels of head and neck?

A

sympathetic: T1-T4
parasympathetic: vagus N

61
Q

What are the viscerosomatic reflex levels of heart?

A

sympathetic: T1-T5
parasympathetic: vagus N

62
Q

What are the viscerosomatic reflex levels of lungs?

A

sympathetic: T2-T7
parasympathetic: vagus N

63
Q

What are the viscerosomatic reflex levels of esophagus/UE?

A

sympathetic: T2-T8
parasympathetic: vagus N

64
Q

What are the viscerosomatic reflex levels of adrenal medulla?

A

sympathetic T10

parasympathetic: vagus N

65
Q

What are the viscerosomatic reflex levels of upper genitourinary?

A

sympathetic T10-T11

parasympathetic vagus N

66
Q

What are the viscerosomatic reflex levels of upper GI?

A

sympathetic: T5-T9

parasympathetic vagus N

67
Q

What are the viscerosomatic reflex levels of middle GI?

A

sympathetic: T10-T11
parasympathetic: vagus N

68
Q

What are the viscerosomatic reflex levels of appendix?

A

sympathetic T12

parasympathetic vagus N

69
Q

What are the viscerosomatic reflex levels of lower genitourinary?

A

sympathetic: T12-L2

parasympathetic pelvic splanchnic N

70
Q

What are the viscerosomatic reflex levels of bladder?

A

sympathetic: T11-L2
parasympathetic: pelvic splanchnic N

71
Q

What are the viscerosomatic reflex levels of lower GI?

A

sympathetic T12-L2

parasympathetic pelvic splanchnic N

72
Q

What are the viscerosomatic reflex levels of uterus and cervix?

A

sympathetic T10-L2

parasympathetic pelvic splanchnic N

73
Q

What are the viscerosomatic reflex levels of LE, urethra, and erectile tissue?

A

sympathetic: T11-L2
parasympathetic: pelvic splanchnic N

74
Q

What are the viscerosomatic reflex levels of prostate?

A

sympathetic: T12-L2
parasympathetic: pelvic splanchnic N

Year 1: OS Exam 1 (39 decks)

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