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BMB Test 1 > B7.006 Spine and Back > Flashcards

B7.006 Spine and Back Flashcards

1
Q

structure of vertebra

A

body - anterior to spinal cord, become larger from C2 to L5
arch - creates a cranial/caudal opening that protects the spinal cord
4 articular processes
2 transverse processes
1 spinous process

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2
Q

components of vertebral arch

A

2 pedicles

2 laminae

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3
Q

vertebral foramen

A

helps form the vertebral canal containing the spinal cord

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4
Q

intervertebral foramen

A

formed by inferior and superior vertebral notches

contains dorsal root ganglion and spinal nerves

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5
Q

spinous processes

A

extend posteriorly and inferiorly
connected by:
interspinous ligaments
supraspinous ligament

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6
Q

transverse process

A

originate from the junction of the pedicles and laminae

serve as site of muscle attachment

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7
Q

articular facets

A

at oblique angles which vary significantly up and down the spinal column
limit rotation and flexion of adjacent vertebral bodies
add stability to column

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8
Q

pars interarticularis

A

portion between the superior and inferior articular facet on each vertebra
often defective in spondylolisthesis

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9
Q

key difference in cervical vertebrae

A

have a transverse foramen for the vertebral artery in C1-C6

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10
Q

bump you feel on the back of your neck

A

C7 has an extra long spinous process (vertebral prominence)

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11
Q

atlas

A

C1 vertebrae

has no body or spinous process, but has a posterior arch and posterior tubercle

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12
Q

axis

A

C2 vertebrae

has a body and spinous process, two large superior articular facets, and one large dens process

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13
Q

dens process

A

formed during embryonic development from body of the first cervical vertebra

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14
Q

stabilization of atlas and axis to the skull

A

alar ligaments

cruciform ligaments

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15
Q

thoracic vertebrae (12)

A

very stable
articulate with ribs
have at least one or sometimes two facets for the heads of ribs on each side of the body
long thin spinous process points inferiorly

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16
Q

lumbar vertebrae (5)

A

large, kidney shaped vertebral bodies
no facets for ribs
articular processes project superior and inferior and limit rotation while permitting flexion and extension
contain an additional process of muscle attachment - mammillary process
spinout process is thicker and shorter than in the thoracic region

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17
Q

function of facet joints

A

limit movement between adjacent vertebrae

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18
Q

sacrum

A

5 fused vertebrae
support vertebral column
forms the posterior of bony pelvis

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19
Q

intervertebral discs

A

shock absorbers in between each vertebrae
make up 1/4 height of column
allow for flexion of the vertebral bodies between each other

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20
Q

intervertebral discs as a symphysis

A

fibrocartilaginous articulation between hyaline cartilage on the “end” of the bodies of vertebrae

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21
Q

2 parts of the intervertebral disc

A

annulus fibrosus- concentric layers of oblique fibers

nucleus pulposus - avascular gelatinous mass, derived from notochord

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22
Q

height variation throughout the day

A

1/4 of the length of the vertebral column is due to the intervertebral disks which are hydrated structures
in the morning, you are the tallest
most adults are 1 cm short by the end of the day

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23
Q

location of dorsal root ganglia

A

sits in the intervertebral foramen

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24
Q

how does an intervertebral disk respond to increased load?

A

bulges into intervertebral foramen, can impinge on exiting and entering spinal nerves when this occurs

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25
Q

at what positions is your body putting the most load on your 3rd lumbar disc

A

bending over
sitting
this is why standing desks are good

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26
Q

ligamentum flavum

A

extends from lamina to lamina
forms the:
1. posterior boundary of the intervertebral foramen
2. posterior wall of the spinal canal

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27
Q

result of hypertrophy of ligamentum flavum

A

spinal cord stenosis

most frequently in lumbar and cervical regions

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28
Q

anterior longitudinal ligament

A

strong, broad fibrous band running anterior to the vertebral bodies and discs from base of skull to sacrum
limit hyperextension

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29
Q

posterior longitudinal ligament

A

weaker than anterior
runs within the vertebral canal, just anterior to the spinal cord
helps stabilize vertebral bodies
called tectorial membrane when it reaches the base of the skull

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30
Q

causes of vertebral body (compression) fracture

A

osteoporosis
cancer
trauma

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31
Q

where do compression fractures occur

A

weight of body is largely anterior to the spinal column so compression fractures occur first within the anterior portion of the vertebral body

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32
Q

burst fractures

A

more severe

can put bone fragments into the spinal canal

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33
Q

effect of compression fractures

A

trap spinal nerves as they pass out in the intervertebral foramen
leads to radicular pain or loss of function

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34
Q

spondylolysis

A

defect in pars interarticularis (in between superior and inferior facets)
bone breaks, most common at L5 inferior facets, can lead to pain and instability of the vertebra
may be unilateral or bilateral

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35
Q

who gets spondylolysis

A

adolescent athletes

prevalence of LBP in 11-17 year old athletes is 30.4%

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36
Q

diagnosis of spondylolysis

A

breakage most frequent at the pars interarticularis or isthmus (neck)
may not be visible on plain films, but typically seen on MRI of thin slices and high resolution

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37
Q

spondylolisthesis

A

slipping (subluxation) of vertebra in relation to the adjacent inferior vertebra or sacrum
often secondary to spondylolysis of the L5 vertebra, allowing the vertebral column to slide forward on top of the sacrum

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38
Q

result of spondylolisthesis

A

dislocation/ subluxation of the vertebral body, typically anteriorly
compression of sacral spinal nerves and thus, leg pain

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39
Q

classification of spondylolisthesis

A

by degree of slippage, measured as percentage of the width of the vertebral body

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40
Q

when is surgery required in spondylolisthesis

A

generally 50-100% slippage

grade 3-4

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41
Q

primary curvature of spine

A

develops in utero

concave (anterior) curve

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42
Q

secondary curvature of the spine

A

occurs in cervical and lumbar regions as we learn to look around and walk
saves energy

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43
Q

kyphosis

A

anterior concave curvature of the vertebral column
most frequently in thoracic region
when severe, can limit lung function and cause digestive problems
>3 mil per year in US

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44
Q

lordosis

A

anterior convex curvature of the vertebral column
200,000 per year in US
most frequently occurs w pregnancy

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45
Q

scoliosis

A

lateral and/or rotational curvature of the vertebral column
most frequently initiates during adolescence and involves both thoracic and lumbar regions
3 mil per year in US

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46
Q

screening for scoliosis

A

having patient bend forwards looking at the height of the left and right shoulder lades

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47
Q

types of curves in scoliosis

A

thoracic - 90% on right side
thoracolumbar - 80% on right side
lumbar - 70% on left side
double major - right thoracic and left lumbar curves are equal in size

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48
Q

embryonic spinal cord in vertebral canal

A

at 8 weeks, the spinal cord fills the vertebral spinal canal and the spinal levels match the vertebral level

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49
Q

differential growth of the spinal cord

A

eventually, spinal cord slows its growth and the bones and ligaments continue to grow rapidly
in a full term newborn, cord terminates at L3

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50
Q

where does the cord terminate in adults

A

most around L1

99% by inferior end of L2

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51
Q

what is the spinal cord

A

cylindrical structure beginning in the medulla, exiting from the foramen magnum and ending at L1-2

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52
Q

how many spinal nerves

A

31

made up of ventral motor roots and dorsal sensory roots

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53
Q

corresponding nerves and vertebra

A

in cervical level, nerve exits above corresponding vertebra (C8 exits below C7)
for thorax, lumbar, and sacral levels, nerve exits below the corresponding vertebra

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54
Q

cervical enlargement

A

accommodating spinal segments C4-T1 for the brachial plexus

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55
Q

lumbosacral enlargement

A

L1-S3 spinal segments (T11-L2 vertebral segments)

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56
Q

tethered spinal cord syndrome

A

neuro disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column
usually in children

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57
Q

symptoms of tethered spinal cord in children

A

back pain
shooting pain in the legs
weakness, numbness, or problems with muscle function in the legs
tremors or spasms in the leg muscles
changes in the way the feet look, like high arches or curled toes
loss of bladder or bowel control that gets worse
scoliosis or abnormal curve of the spine that changes or gets worse
repeated bladder infections

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58
Q

symptoms of tethered spinal cord in adolescents

A

bending slightly
buddha sitting with legs crossed
baby holding (or equivalent weight) at the waist level

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59
Q

diagnosis and treatment of tethered spinal cord

A

diagnosed by MRI

treated surgically

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60
Q

meninges of the spinal cord

A

dura matter
arachnoid matter
pia matter

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61
Q

dura mater

A

tough, fibroelastic connective tissue sheath, free within the vertebral canal
ends at S2ish

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62
Q

what is located outside of the dura mater

A

fat, arteries, veins, and periosteum

between dura mater and periosteum = extradural / epidural space which is filled with fat and venous blood vessels

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63
Q

sacral hiatus

A

opening at end of spinal canal
located 1.5-2 in above the top of the coccyx
allows access to epidural space

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64
Q

inside the dura mater

A

arachnoid mater

denticulate ligament

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65
Q

denticulate ligament

A

formed of pia mater
ribbon-like structure extending laterally from the midline from each side of the spinal cord to attach to the inner surface of the dura in 21 tooth like projections
stabilizes spinal cord within the dura mater

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66
Q

arachnoid mater

A

separates pia from the dura by a fluid filled space, the subarachnoid space
applied directly to the inner surface of the dura, and sends arachnoid trabeculae through the subarachnoid space to the pia
contains CSF

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67
Q

pia mater

A

2 fused layers of loos connective tissue

encloses network of blood vessels which supply the cord

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68
Q

subdural space

A

potential space (pathologic) between dura and arachnoid mater

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69
Q

end of the spinal cord

A

ends in the conus medullaris at L1-2
dura mater and subarachnoid space end at S2
from L2-S2 is the lumbar cisterna

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70
Q

cauda equina

A

within the lumbar cisterna

spinal nerves distal to the conus medullaris

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71
Q

filum terminale internus

A

strand of connective tissue from the end of L2 to S2
attaches to the periosteum of the coccyx below the dural sac
upon flexion, pulls the spinal cord anteriorly

72
Q

function of CSF

A

serves as mechanical and protective support for the brain

serves as an ion sink

73
Q

volume of CSF

A

120-150 mL
95 mL within brain, 35-55 mL around spinal cord
450-500 mL produced every day

74
Q

composition of CSF

A

clear fluid w SG = 1.007

pressure 70-180 mm

75
Q

spinal tap / lumbar puncture procedure

A

cerebral spinal fluid is most commonly taken from the lumbar cisterna by inserting a spinal tap needle between L3/L4 or L4/L5

76
Q

how to find L4

A

horizontal line across superior iliac crests generally falls between L3 and L4 (or on the L4 spinous process)

77
Q

superficial back muscles

A 
trapezius
levator scapulae
rhomboid minor
rhomboid major
latissimus dorsi
serratus posterior superior
serratus posterior inferior
serratus anterior
78
Q

trapezius origin

A

superior nuchal line on back of head down to the T12 spinous process

79
Q

trapezius insertion

A

spine of scapula
acromion
lateral 1/3 of clavicle

80
Q

innervation of trapezius

A

CN XI

C3, C4

81
Q

action of trapezius

A

adduct, elevates, depresses, and rotates scapula

82
Q

levator scapulae origin

A

transverse processes of C1-C4

83
Q

levator scapulae insertion

A

medial border of scapula

84
Q

levator scapula innervation

A

dorsal scapular nerve

C3,C4

85
Q

rhomboid minor origin

A

spines of C7-T1

86
Q

rhomboid minor insertion

A

root of spine of scapula

87
Q

rhomboid minor innervation

A

dorsal scapular nerve

C5

88
Q

levator scapulae function

A

elevates scapula

89
Q

rhomboid minor function

A

adducts scapula

90
Q

rhomboid major origin

A

spines of T2-T5

91
Q

rhomboid major insertion

A

medial border of scapula

92
Q

rhomboid major innervation

A

dorsal scapular nerve

C5

93
Q

rhomboid major action

A

adducts scapula

94
Q

latissimus dorsi origin

A

spines of T5-T12
thoracolumbar fascia
iliac crest
ribs 9-12

95
Q

latissimus dorsi insertion

A

floor of bicipital groove of humerus

96
Q

latissimus dorsi innervation

A

thoracodorsal nerve

97
Q

latissimus dorsi action

A

adducts, extends, and rotates arm medially

98
Q

serratus posterior superior origin

A

ligamentum nuchae
supraspinous ligament
spines of C7-T3

99
Q

serratus posterior superior insertion

A

upper border of ribs 2-5

100
Q

serratus posterior superior innervation

A

first 4 intercostal nerves

101
Q

serratus posterior superior action

A

elevates ribs

102
Q

serratus posterior inferior origin

A

supraspinous ligament

T-11-L3

103
Q

serratus posterior inferior insertion

A

lower border of and spines of ribs 9-12

104
Q

serratus posterior inferior innervation

A

last 4 intercostal nerves

105
Q

serratus posterior inferior action

A

depresses ribs

106
Q

serratus anterior origin

A

outer surface of ribs 1-8

107
Q

serratus anterior insertion

A

medial border of scapula

108
Q

serratus anterior innervation

A

long thoracic nerve

109
Q

serratus anterior action

A

abducts and protracts scapula

110
Q

triangle of auscultation

A

by the trapezius, lat dorsi, and medial border of the scapula

111
Q

ddx of back pain

A 
intervertebral disc rupture / herniation
nerve inflammation or compression
degenerative changes in the vertebral facet joints
metabolic bone disease
abdominal aortic aneurysm
metastatic cancer
myofascial disorders
back strain and sprain
112
Q

characterize the intermediate layer of deep back muscles

A

called the erector spinae group

contained within a common connective tissue sheath (thoracolumbar fascia)

113
Q

what muscles are included in the intermediate layer of deep back muscles

A

iliocostalis (most lateral)
longissimus
spinalis (most medial)
I love spaghetti (lateral > medial)

114
Q

deep layer of back muscles

A

collectively called transversospinalis
semispinalis
multifidus
rotatores

115
Q

semispinalis

A

most superficial of deep back muscles
runs next to spinalis portion of erector spinae
arise from transverse processes of C4-T12 and insert onto spinous processes 4-6 segments superiorly

116
Q

multifidus

A

deeper than semispinalis
arise from sacrum and ilium inferiorly or transverse processes more cranially
insert into spinous processes 2-4 segments superiorly

117
Q

rotatores

A

deepest and smallest of the deep back muscles

arise from transverse processes and insert into spinous process 1 or 2 segments superiorly

118
Q

back sprain

A

damage to back ligaments which connect vertebrae

less common than back strain

119
Q

back strain

A

muscular problem
microscopic tears to the muscle fibers, typically due to overuse
“weekend warrior”

120
Q

symptoms of back strain/sprain

A

may cause protective reflex tonic muscle contraction (tight back) to guard and protect the back from excessive movement and further damage

121
Q

muscle guarding

A

protective response in muscle that results from pain or fear of movement
semi-contracted or stimulate state which may produce muscle pain and fatigue

122
Q

treatment of muscle guarding

A

induced relaxation by using biofeedback to reduce EMG activity

123
Q

injuries that can produce muscle guarding

A

damage to vertebrae or ligaments that connect vertebrae

damage to back muscle

124
Q

muscles surrounding spine at L4 level

A

psoas
transversospinalis group
erector spinae group
this is why do you do sit ups to strengthen your back as well as back muscle exercises

125
Q

blood supply to the spinal cord

A

medullary arteries reach the anterior or posterior spinal arteries of the spinal cord
radicular arteries supply non-spinal cord structures (vertebrae)

126
Q

artery of Adamkiewicz

A

great medullar artery which provides major blood supply to the lumbar and sacral cord

127
Q

origin of artery of Adamkiewicz

A

in 75% of people, the left side of the aorta between the T8 and L1 vertebral segments

128
Q

damage to the artery of Adamkiewicz

A

can result in anterior spinal artery syndrome, with urinary and fecal/anal incontinence and impaired motor function of the legs
sensory function is often preserved to a degree

129
Q

importance of identifying artery of Adamkiewicz

A

when surgically treating an AAA to prevent damage which would result in insufficient blood to the spinal cord

130
Q

Batson’s venous plexus

A

network of valve-less veins that connect from deep pelvic veins, thoracic veins, and head and neck veins to the internal vertebral venous plexus
epidural veins
thought to allow the spread of some metastatic cancers to the vertebral column and brain

131
Q

communications of batson’s venous plexus

A

scalp, skull, and face
thoracoabdominal wall
azygous, pulmonary, and caval venous systems
pelvic, prostatic, and sacral veins

132
Q

lifetime risk of disc herniation

A

2-4%

more common in males

133
Q

epidemiology of disc herniation

A

most frequently occurs during middle ages

  • younger individuals may not be strong enough to lift weight sufficient to cause herniation
  • as individuals age the nucleus pulposus tends to dry out and herniate less frequently
134
Q

what spinal nerves are at risk during herniation

A

spinal nerve BELOW level of herniation

disk herniation usually occurs in either cervical or lumbar regions

135
Q

L4 herniation symptoms

A

rare

pain: lower back, hip, posterolateral thigh, anterior leg
numbness: anteromedial thigh, knee
weakness: quad
atrophy: quad
reflexes: knee jerk

136
Q

L5 herniation symptoms

A

pain: SI joint, lateral thigh and leg
numbness: lateral leg, web of great toe
weakness: dorsiflexion
atrophy: minor
reflexes: none

137
Q

S1 herniation symptoms

A

common

pain: SI joint, hip, posterolateral thigh and leg to heel
numbness: back of calf, lateral heel, foot and toe
weakness: plantarflexion
atrophy: gastroc and soleus
reflexes: ankle jerk

138
Q

function of sacral hiatus

A

used to gain access to caudal epidural space
injection of steroid into the fat and venous blood within the sacral canal
used for birthing pain relief

139
Q

C5

A

lat deltoid

140
Q

C6

A

thumb

141
Q

C7

A

middle finger

142
Q

C8

A

little finger

143
Q

L1

A

inguinal ligament

144
Q

L4

A

knee cap (patella)
medial malleolus
side of big toe

145
Q

L5

A

lateral knee

top and sole of foot

146
Q

S1

A

lateral malleolus

back of thigh

147
Q

S2,3,4

A

external genitalia and perineum

148
Q

C2-3

A

upper neck

149
Q

C5

A

clavicle

150
Q

T4

A

nipple

151
Q

T7

A

xiphoid

152
Q

T10

A

umbilicus

153
Q

hip movement

A

flexion: L2,3
extension: L4,5

154
Q

knee movement

A

extension: L3,4
flexion: L5,S1

155
Q

ankle flex/extend movement

A

dorsiflexion: L4,5
plantarflexion: S1,2

156
Q

ankle inversion/eversion movement

A

inversion: L4
eversion: L5,S1

157
Q

3 most common nerve roots damages in disc herniation

A

C7
L5
S1

158
Q

myotome of C7

A

tricep

extension of forearm

159
Q

myotome of L5

A

extensor hallicus longus

dorsiflexion of great toe

160
Q

myotome of S1

A

gastrocnemius

plantarflexion

161
Q

ankylosing spondylitis

A

chronic inflammatory disease of the axial skeleton
manifested by back pain and progressive stiffness of the spine
inflammation around the enthesis (site of ligament insertion onto bone)

162
Q

epidemiology of ankylosing spondylitis

A

peak onset in 20s
prevalence 0-1.4% depending upon ethnic group
HL-B27 association

163
Q

ankylosis

A

fibrous or bony bridging of oint

164
Q

other sponyloarthropathies

A

reactive arthritis
psoriatic arthritis
juvenile spondyloarthropathy
IBD associated arthropathy

165
Q

diagnosis of ankylosing spondylitis

A

suggestive clinical features and evidence of sacroiliitis by radiological imaging

166
Q

characteristics of identifying inflammatory back pain

A 
onset before 40
insidious
persistence for 3 months
morning stiffness
improvement with exercise
167
Q

chest expansion

A

measured at 4th intercostal space
should be >5cm
less than 2.5 cm is abnormal

168
Q

causes of cauda equina syndrome

A

severe / massive ruptured disc in the lumbar area (most common)
narrowing of spinal canal
spinal lesion or tumor
spinal infection, inflammation, hemorrhage, or fracture
complication from a severe lumbar spine injury
AV malformation

169
Q

symptoms of cauda equina syndrome

A 
occur suddenly
severe low back pain
pain, numbness, or weakness in legs that causes stumbling or trouble arising from a chair
loss of or altered sensation in legs, butt, inner thighs, external genitalia, back of legs, feet
bladder/bowel dysfunction
sexual dysfunction
absent Achilles reflex
absent anal reflex
170
Q

diagnosis of cauda equina syndrome

A

MRI or CT

171
Q

treatment of cauda equina syndrome

A

usually surgical

often laminectomy

172
Q

epidemiology of spinal canal stenosis

A

common, gradual onset
8% of people
occurs in people > 50
males and females equally

173
Q

symptoms of spinal canal stenosis

A

pain, numbness, weakness in the legs and arms
gradual in onset
improve with bending forwards

174
Q

classification of spinal canal stenosis

A

cervical, thoracic, lumbar

lumbar most common followed by cervical

175
Q

causes of spinal canal stenosis

A 
ligamentum flavum hypertrophy
facet joint hypertrophy
disk bulging
posterior longitudinal ligament thickening
RA
spinal tumors
trauma
Paget's
scoliosis
spondylolisthesis
achondroplasia

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