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MSK > 4 Lumbar Spine > Flashcards

4 Lumbar Spine Flashcards

1
Q

How many vertebrae are there?

A

33

7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal

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2
Q

Are the lumbar, sacral and coccygeal sections mobile?

A

Lumbar region is mobile

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3
Q

What is the sacrum?

A

Fusion of 5 vertebrae

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4
Q

What is the coccyx?

A

Fusion of 4 vertebrae

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5
Q

What are the functions of the lumbar spine?

A

Support
Protection
Movement
Haemopoeisis

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6
Q

What does the anterior region of the lumbar vertebra have?

A

Vertebral body

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7
Q

What does the posterior region of the lumbar vertebra have?

A

Vertebral arch

Vertebral foramen

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8
Q

What are the end plates covered in?

A

Superiorly and inferiorly covered with hyaline cartilage

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9
Q

What kind of bone is the anterior region made up of?

A

10% cortical bone

90% cancellous bone

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10
Q

Why does the size of vertebral body increase from superior to inferior?

A

Lower vertebrae take more weight, spreads load more if bigger

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11
Q

What does the vertebral foramen contain?

A

Conus medullaris
Cauda equina and meninges
Epidural veins
Spinal arteries

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12
Q

What are the structures in the posterior region?

A

2 pedicles
2 lamina
7 processes: 1 spinous, 2 superior articular, 2 inferior articular, 2 transverse

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13
Q

What is the role of the transverse processes?

A

Provide attachments for muscles

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14
Q

What is the facet joint?

A

Joins the inferior articular processes of one vertebra to the superior articular processes of the vertebra below
Paired
Also called zyagpophyseal joints

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15
Q

What is the role of facet joints?

A

Interlocking design
Prevents anterior displacement of vertebrae
Orientation determines amount of flexion and rotation permitted

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16
Q

What is the orientation of lumbar facet joints?

A

At 45 degrees to coronal plane therefore flexion and extension are possible
Perpendicular to axial plane

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17
Q

What are the types of joints in the lumbar spine?

A

Fibrous: non-mobile
Secondary cartilaginous: partially mobile
Synovial: highly mobile

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18
Q

Give an example of a fibrous joint

A

Sacroiliac

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19
Q

Give an example of a secondary cartilaginous joint

A

Intervertebral disc

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20
Q

Give an example of a synovial joint

A

Facet joint

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21
Q

What is the make up of intervertebral discs?

A

70% water
20% collagen
10% proteoglycans

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22
Q

What are the 2 regions of intervertebral discs?

A

Nucleus pulposus

Annulus fibrosus

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23
Q

What is the annulus fibrosus?

A

Mae from lamellae of annular bands in varying orientations
Type 1 collagen
Avascular and aneural (uses diffusion from vertebrae)
Surrounds nucleus pulposus

24
Q

What is the nucleus pulposus?

A

Remnant of notochord
Gelatinous, type 2 collagen
High oncotic pressure
Located more posteriorly in adult

25
Q

What is the role of intervertebral discs?

A

Major shock absorber
Keep the vertebrae separate
Highly resilient under compression

26
Q

Are anterior or posterior ligaments in the vertebral column stronger?

A

Anterior

27
Q

What are the 2 anterior ligaments?

A

Anterior longitudinal ligament

Posterior longitudinal ligament (limits flexion)

28
Q

Describe the anterior longitudinal ligament

A 
Anterior to vertebral body
Slightly wider than PLL
Blends with periosteum of vertebral bodies
Mobile over intervertebral discs
Prevents hyper extension
29
Q

Describe the posterior longitudinal ligament

A

Throughout lumbar spine
Weaker than anterior longitudinal ligament
Prevents hyperflexion
Reinforces annulus centrally leading to paracentral disc prolapses

30
Q

What ligaments are in the posterior region?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum

31
Q

Describe the supraspinous ligaments

A

Tips of adjacent spinous processes
Strong bands of white fibrous tissue
Lax in extension
Tight in flexion

32
Q

Describe the interspinous ligaments

A

Weak sheet of fibrous tissue
Unite spinous processes along adjacent borders
Well developed only in lumbar region

33
Q

Describe the ligamentum flavum

A

Yellow in colour: elastin
Between laminae of adjacent vertebrae
Stretched during flexion of spine

34
Q

Where do spinal nerves exit the spinal canal in the sacrum?

A

Via the sacral foramina and sacral hiatus

35
Q

What is the shape of the vertebral column in the fetus?

A

C-shaped
Concave anteriorly = kyphosis
Curvature known as primary curvature
Primary curvature retained in life in thoracic, sacral and coccygeal regions

36
Q

What is the evolution in 18 months of the spine?

A

Primary curvature is remodelled to add 2 secondary curvatures
Cervical spine develops first posterior concavity (cervical lordosis) when young child beings lifting its head
Lumbar spine loses its primary kyphosis during crawling
When child begins to stand up and walk, lumbar lordosis develops

37
Q

What are the features of the vertebral column in adults?

A

4 distinct curvatures
2 kyphoses - thoracic and sacrococcygeal
2 lordoses - cervical and lumbar

38
Q

What happens to the vertebral column in old age?

A

Secondary curvatures start to disappear
Loss of disc height and osteoporotic fractures
Continuous primary curvature is reestablished

39
Q

Where does the mechanical axis pass through the vertebral column?

A

C1 and C2
C7 and T1
T12 and L1
L5 and S1

40
Q

What is mechanical back pain?

A

Pain when spine is loaded
- sitting
- standing
Worse with exercise, relieved by rest

41
Q

What is the natural history of mechanical back pain?

A

Intermittent
Often triggered by innocuous activity
Predisposition overweight, unhealthy lifestyle deconditioned core muscles

42
Q

What is the ageing physiology of the spine?

A 
Bottom disc ages first
Nucleus pulposus dehydrates with age
Loss of disc height - disc bulge
Increased load stresses (syndesmophytes)
Increased load stress on the facet joints (osteoarthritis)
43
Q

What is a prolapse?

A

Protrusion of the nucleus pulposus with slight impingement into the spinal canal

44
Q

What is an extrusion?

A

Nucleus pulposus breaks through annulus fibrosus, but remains within the disc space

45
Q

What is a sequestration?

A

Nucleus pulposus breaks through annulus fibrosus and separates from the main body of the disc in the spinal canal

46
Q

Where do prolapsed intervertebral discs usually occur?

A

L4/5 or L5/S1

Usually herniated paracentrally, causing compression of spinal nerve roots

47
Q

What is sciatica?

A

Pain caused by irritation or compression of one or more of the nerve roots which contribute to the sciatic nerve (L4, L5, S1, S2, S3)

48
Q

Where does L4 sciatica cause pain?

A

Lumbar spine
Anterior thigh
Anterior knee
Medial leg

49
Q

Where does L5 sciatica cause pain?

A

Lumbar spine
Lateral thigh
Lateral leg
Dorsum of foot

50
Q

Where does S1 sciatica cause pain?

A 
Lumbar spine
Posterior thigh
Posterior leg
Heel
Lateral border and sole of foot
51
Q

What is cauda equina syndrome?

A

Canal-filling disc compressing the lumbar and sacral nerve roots (cauda equina)

52
Q

What are the symptoms of cauda equina syndrome?

A 
Bilateral sciatica 
Perianal numbness
Painless retention of urine
Urinary/faecal incontinence
Erectile dysfunction
Surgical emergency
53
Q

What is claudication?

A

Pain in legs whilst walking

54
Q

What is neurogenic claudication?

A

Compression of nerve roots
Venous engorgement of nerve roots during exercise
Reduced arterial inflow
Pain and paraesthesia

55
Q

What is spondylolisthesis?

A

Caused by disconnection of vertebral body from vertebral arch
Usually a forward displacement

MSK (4 decks)

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