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MSK Revision > 5 - The Lumbar Spine and Associated Disorders > Flashcards

5 - The Lumbar Spine and Associated Disorders Flashcards

1
Q

How many of each of the 5 types of vertebrae are there?

A
  • Cervical - 7
  • Thoracic - 12
  • Lumbar - 5
  • Sacral - 5 (fused)
  • Coccygeal - 4 (fused)
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2
Q

What type of curvature is seen in the thoracic and sacral regions of the spine?

A

Primary kyphotic curvature (concave anteriorly)

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3
Q

What type of curvature is seen in the cervical and lumbar regions of the spine?

A

Secondary lordotic curvatures (concave posteriorly)

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4
Q

What are the functions of the vertebral column?

A
  • Supports the weight of the body
  • Protects the spinal cord and cauda equina
  • Posture and locomotion
  • Haematopoeisis in the bone marrow
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5
Q

What type of joint is a facet joint between vertebrae? What type of cartilage lines the articular surfaces?

A
  • Synovial joint
  • Hyaline cartilage
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6
Q

What movements can be performed by the cervical vertebrae?

A
  • Flexion
  • Extension
  • Lateral flexion
  • Rotation
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7
Q

What movements can be performed by the thoracic vertebrae?

A
  • Lateral flexion
  • Rotation
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8
Q

What movements can be performed by the lumbar vertebrae?

A
  • Flexion
  • Extension
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9
Q

What are the two parts of an intervertebral disc and where are they found?

A
  • Annulus fibrosus
  • Nucleus pulposus
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10
Q

What is significant about the annulus fibrosus in terms of its neurovascular supply?

A

It is both avascular and aneural

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11
Q

The nucleus pulposus is a remnant of what embryonic structure?

A

The notochord

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12
Q

When an intervertebral disc prolapses, what direction is it most likely to prolapse in?

A
  • Posterior and paracentrically (lateral to the posterior longitudinal ligament)
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13
Q

What is the name of the joints between the sacrum and the ilium of the pelvis?

A

Sacroiliac joints

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14
Q

The central canal of the vertebral column ends at the level of ……. at the ……….. ………..

A
  • S4
  • Sacral hiatus
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15
Q

Which nerve roots form the cauda equina?

A

L2 and below

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16
Q

The 5 sacral vertebrae are incompletely fused. The sacral nerve fibres leave the central canal through the ………. ……… …………

A

Posterior sacral foramina

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17
Q

There is a continuation of the pia mater of the conus medullaris of the spinal cord that attaches to the first segment of the coccyx. What is this called and what is it’s function?

A
  • Filum terminale
  • Gives longitudinal support to the spinal cord (holds it in place within the canal)
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18
Q

In the foetus, the vertebral column is ……-shaped. This concavity is known as a ………….

A
  • C-shaped
  • Kyphosis
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19
Q

In infancy, the cervical spine develops a posterior concavity. What is this called and what causes it’s development?

A
  • Cervical lordosis
  • Develops as the infant begins to lift its head and the intervertebral discs become more wedge-shaped
20
Q

In infancy, the lumbar spine develops a posterior concavity. What is this called and what causes it’s development?

A
  • Lumbar lordosis
  • Develops as an infant begins to stand up and walk, the intervertebral discs become more wedge-shaped
21
Q

What happens to the normal lumbar lordosis during pregnancy?

A

The additional abdominal mass leads to an exaggeration of the lumbar lordosis

22
Q

What affect does age have on the spinal curvature?

A
  • The annulus fibrosus degenerates and the nucleus pulposus becomes dehydrated (disc atrophy)
  • Some patients experience osteoporotic compression fractures
  • Secondary curvatures start to disappear - senile kyphosis
23
Q

The centre of gravity of the body passes centrally through the curvatures of the spine. Which 4 sites of the spine does the centre of gravity pass through?

A

The top of the spine and boundaries between the types of vertebrae:

  • C1/2
  • C7/T1
  • T12/L1
  • L5/S1
24
Q

What condition is narrowing of the spinal canal?

A

Spinal stenosis

25
Q

How does mechanical back pain usually present?

A
  • Pain when the spine is loaded, that worsens with exercise and is relieved by rest
  • Tends to be intermittent and triggered by day-to-day activities
26
Q

What are some risk factors of mechanical back pain?

A
  • Obesity
  • Poor posture
  • Sedentary lifestyle (deoconditioning of paraspinal muscles)
  • Poorly-designed seating
  • Incorrect manual handling
27
Q

Describe the process of intervertebral disc degeneration with age.

A
  • The nucleus pulposus dehydrates with age
  • Leads to decreased disc height and disc bulging
  • Osteophytes (bone spurs) develop next to the end plates of the discs - marginal osteophytosis
  • Osteoarthritic changes occur in the facet joints due to increased stress
  • Intervertebral foramina decrease in size, compressing spinal nerves
28
Q

What are the four stages of a disc herneation (slipped disc) and what occurs in each stage?

A
  1. Degeneration - discs dehydrate and bulge with age
  2. Prolapse - protrusion of the nucleus pulposus into the spinal canal, still contained under a thin rim of annulus fibrosus
  3. Extrusion - nucleus pulposus breaks through annulus fibrosus but is still within the disc space
  4. Sequestration - The nucleus pulposus separates from the body of the disc and enters the spinal canal
29
Q

Which sites are the most common for a slipped disc?

A
30
Q

Describe the most common type of intervertebral disc prolapse.

A
  • Nucleus pulposus herniates posterolaterally (lateral to PLL)
  • Paracentral prolapse
31
Q

What are the two possible ways a spinal nerve root can be affected by a disc prolapse?

A
  • Effect on the exiting nerve root - root emerging at the level of the disc (usually far-lateral herneations)
  • Effect on the traversing nerve root - root emerging at the level below the disc (paracentral herneations)
32
Q

What causes sciatica?

A
  • Irritation or compression of one or more of the nerve roots that form the sciatic nerve (L4 - S3)
  • Often due to marginal osteophytosis, slipped disc etc.
33
Q

In sciatica, where is the pain experiecnced?

A
  • Pain radiates from the back/buttock to the dermatome that is supplied by the affected nerve root
  • L4 - anterior thigh, anterior knee, medial leg
  • L5 - lateral thigh, lateral leg, dorsum of foot
  • S1 - posterior thigh, posterior leg, heel, sole of foot
34
Q

In sciatica, where may paraesthesia be experiecnced?

A
  • Experienced only in the nerve root’s associated dermatome (not the full path from the lumbar spine to the skin)
35
Q

What are some common causes of cauda equina syndrome?

A
  • Canal-filling disc prolapse
  • Tumours (of vertebrae or meninges)
  • Spinal infection/abscess
  • Spinal stenosis (due to arthritis)
  • Vertebral fracture
  • Spinal haemmorhage
  • Late-stage ankylosing spondylitis
36
Q

What are the red flag symptoms of cauda equina syndrome?

A
  • Bilateral sciatica
  • Perianal numbness
  • Painless urine retention
  • Urinary/faecal incontinence
  • Erectile dysfunction
37
Q

How is cauda equina syndrome treated? What is the prognosis if this diagnosis is missed?

A
  • Needs surgical decompression within 48 hours
  • Otherwise serious consequences:
    • Chronic pain
    • Impotence
    • Need intermittent self-catheterisation to pass urine
    • Faecal incontinence
    • Loss of sensation
    • Lower limb weakness requiring a wheelchair
38
Q

What is spinal canal stenosis?

A

Abnormal narrowing of the spinal canal that compresses the spinal cord or nerve roots

39
Q

What are the most common causes of spinal canal stenosis?

A

Most common causes:

  • Disc bulging
  • Facet joint osteoarthritis
  • Ligamentum flavum hypertrophy

Other causes include:

  • Compression fractures of vertebrae
  • Spondylolisthesis
  • Trauma
40
Q

What are the symptoms of spinal canal stenosis?

A
  • Discomfort when standing
  • Pain in the shoulder, arm or hand (cervical) or lower limb (lumbar)
  • Bilateral symptoms
  • Numbness below the level of stenosis
  • Weakness below the level of stenosis
  • Neurogenic claudication
41
Q

What is neurogenic claudication and what causes this to occur?

A
  • Pain/paraesthesia on prolonged standing and walking, radiating like sciatica
  • Compression of spinal nerves as they emerge from the lumbosacral cord (stenosis)
    • Venous engorgement of the nerve roots during exercise leads to transient arterial ischaemia
  • Relieved by rest and flexion of the spine (as the canal is enlarged)
42
Q

What is spondylolisthesis?

A

Anterior displacement of the vertebrae above relative to the vertebrae below

43
Q

What are some of the common causes of spondylolisthesis?

A
  • Congenital instability of facet joints
  • Defect in the pars interarticularis (i.e. stress fracture between the articular processes)
  • Trauma
  • Infection or malignancy
  • Caused by surgical intervention
44
Q

What is the difference between sponylolysis and spondylolisthesis?

A
  • Sponylolysis - complete pars interarticularis fracture without displacement
  • Spondylolisthesis - anterior displacement of the vertebrae
45
Q

Describe how a lumbar puncture is performed?

A
  • Patient lies on their side with back and hips flexed, spreads the spinous processes and stretches the ligamentum flavum
  • Needle is inserted between L3 and L4 (or L4 and L5) - found at the plane between the superior iliac crests
  • Needle must pass through the ligamentum flavum, dura and arachnoid and withdraw CSF from subarachnoid space

MSK Revision (6 decks)

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