Back Flashcards
Dr. wilson
What are the reasons for adult visits to office-based physicians?
- Hypertension 2. pregnancy care 3. check-ups 4. colds 5. low-back pain 6. depression/anxiety 7. diabetes
What are the functions of the vertebral column?
weight support, erect posture, bipedal locomotion, enclose and protects the spinal cord & nerves
The spinal cord and nerves is housed and protected by what?
The vertebral column
What is paraplegia?
Damage of the spinal cord below the origin of the brachial plexus (C5-T1) and above (spinal level) S4
Damage of the spinal cord between C5-T1 (the origin of the brachial plexus) results in what?
quadreplegia
Damage of the spinal cord at or above the origin of the phrenic nerve (C3-5) results in ?
asphyxiation and death (without medical intervention)
Changes in the vertebral foramen may result in ?
compression of the spinal cord/nerve
How intervetrabal foramen formed?
by 2 intervetral notches
stenosis of the interverteberal foramen will cause what?
Compression of the spinal nerve
This is their point of exit
What are the 5 regions of the vertebral column?
cervical (7 vertebrae) thoracic (12 vertebrae) lumbar (5 vertebrae) sacral (5 fused vertebrae) coccygeal ( 5 vertebrae)
What are distinct characteristics of the cervical vertebrae?
bifed spine
transverse foramen
What are distinct characteristics of the thoracic vertebrae?
articular facets for ribs
oblique spine
What are distinct characteristics of the lumbar vertebrae?
large size
horizontal spines
what can you see on the dorsal side of the sacrum?
posterior sacral foramen
spinous process
sacral hiatus cornua
What does the depth of anesthesia depend on?
amount injected
position of patient
what are the two type of epidural anesthesia that can be given
Caudal epidural anesthesia (through sacral hiatus) transsacral epidural anesthesia (between posterior sacral foramen)
How do you know where to place the epidural?
You have to palpate and look for the cornea and spinous process
For the caudal (epidural) anesthesia where is the injection made into?
epidural space
From a lateral view, the spine is seen to have?
two secondary curvatures in the cervical & lumbar regions two primary curvatures in the thoracic & sacral regions
Where do most back problems occur?
where secondary curvatures become primary Lower cervical and lower lumbar - common locations for herniated disc
At this time the spine has a single, primary curvature, that is convexed posteriorly
At birth
Why is the baby not stable enough when standing bipedially
the center of gravity is too anterior
When does the secondary curvature in the cervical region begin?
begins to develop at 3 months when the baby begins to raise his/her head to look around
At 1 years of age when the baby begins to stand and walk what happens?
secondary lumbar curvature develops
What is a kyphosis
exaggerated 1’ curvature in the thoracic spine (anterior curvature to the spine) (hunchback, dowager’s hump)
What are different causes of kyphosis?
congenital
occupational
TB
degenerating discs
osteoporosis
fractures (compression fractures)
An Exaggerated secondary curvature in the lumbar region is known as?
Lordosis
What can cause lordosis?
Pregnancy and obesity
Scoliosis is known as?
Lateral curvature of the spine
What are the causes of scoliosis
In many cases, the cause of scoliosis is idiopathic (unknown). Some possible cases hemi-vertebra a short leg polio, stroke, herniated disc
A straight spine is supported by what?
by a level pelvis
patient comes in complaining of back pain.. You realize that her right leg is shorter than her left leg so her left hip is elevated 5 degrees. What do you suspect is the reason for her back pain
Scoliosis
Why does the spine bend laterally when the pelvis is not leveled?
to compensate this keeps the body wight centered
How do back muscles help keep the spine straight?
antagonistic back muscle maintain muscular tone
Unopposed, true back muscles results in what?
one side bend the vertebral column laterally like a bow -> scoliosis
What can cause Unilateral paralysis/ paresis of back muscles that can lead to lateral curvature of the spine?
stroke, polio, or disease
Decrease in in size of thoracic cage affects what?
Cardiopulmonary systemic,
This ligament runs posteriorly along the body of the vertebra (i.e in the vertebral canal)?
Posterior longitudinal ligament
These ligaments both run the length of the spine, attaching to adjacent centrums.
anterior and posterior longitudinal ligaments
what is the function of the anterior and posterior longitudinal ligaments?
These ligaments maintain vertebral alignment. Malalignment may compromise these ligaments
What are the 3 column of trauma?
anterior - ALL, anterior 2/3rd of body
middle - post 1/3 of body, PLL
posterior - all structures posterior to PLL - Same as Holdsworth ligament flavum - posterior injury not sufficient to cause instability
What is the legamentum falvum?
It is very yellow
VERY ELASTIC, HELPS TO RETURN COLUMN TO AN ERECT POSTURE AFTER FLEXION. ELASTIC FIBERS KEEPS LIGAMENT FROM BULGING INTO CANAL
Which spinal injuries are stable and which are not?
One column - stable
Two column - unstable
three column - invariably unstable
What is Flexion/distraction (Chance) fracture caused by?
often by seat belts in cars (upper body thrown forward while pelvis is stable)
With this fracture all three columns of the vertebral body can fail and there may be injury to bone, ligaments, and disc
This type of fracture is unstable and requires immediate stabilization of the body and medical attention?
Flexion/distraction (Chance) fracture
hyperextension (whiplash) injuries of the cervical spine results in what?
tearing of the anterior longitudinal ligament
The vertebral ligaments are so strong that dislocation of vertebrae usually results in ?
avulsion or vertebral fracture
tearing of anterior longitudinal ligament causes a piece of the vertebra to come off with it
What is spondylolisthesis?
When the vertebra slips forward on the bone below it
What are the two type of joints associated with the spine?
Zygapophyseal (synovial, call facet joint by radiologists) Intervertebral disc (symphysis)
Movement between adjacent vertebrae is very limited but when multiplied by a continuous column of 24 moveable vertebrae, the spine is capable of a wide range of movements. What are these movement?
Extension & flexion latereal bending Rotation of head and neck Rotation of upper trunk, neck, and head
Where does the greatest mobility of the spine occur?
where secondary curvatures become primary Lower cervical and lower lumbar
This joint is planar and synovial, between articular processes of two adjacent vertebrae
zygapophyseal joint
this joint is between the bodies of adjacent vertebra
Interertebral disc (symphysis) touch the end plates of the body of the vertebrae
What accounts for 25% oft the length of the vertebral column?
intervertebral disc
What is a schmori node?
upward and downward protrusion (pushing into) of a spinal disk’s soft tissue into the bony tissue of the adjacent vertebrae.
The intervetrabal disc consist of?
Annulus fibrous (most outer part)
nucleus pulpous (inner part)
This structure is semi-gelatinous (fibrous pulp) and derived from the notochord
nucleus pulposus
In the youth stage, the fibrogelatinous pulp is mainly made of?
water (88%) as we age loses water and turgidity -> becomes more stiff -> height of disc decreases
How does Stenosis of the intervertebral forman affect the nucleus pulposus?
Reduces its size
During locomotion the n. pulpous functions as?
Shock absorber
This herniates dorsolaterally through the thinnest part of the anulus fibrosus
n. pulposus
What can a herniated disc cause?
compression of spinal rootlets and nerves
What typically prevents the disc from herniating dorsally?
posterior longitudinal ligament
Herniation of C7 disc compresses which nerve?
C8 nerve roots
Prolapsed disc often occur where?
at lower cervical and lumbar regions
What is the progression of intervertebral disc?
healthy -> loss of height; loosening of ligament -> disc protrusion -> disc degeneration; osteophyte formation
This plexus is valveless and connects with veins of thorax, abdomen, and pelvis?
Internal vertebral plexus
Provides a route by which cancer cells can metastasize to the spine and skull
The first 3 anatomical layers of the back muscles are derived from what? Innervated by?
derived from hypomere (part of myotome) and are thus innervated by ventral primary rami
The 4th layer of the back muscles are derived from what? Innervated by what?
derived from epimere (part of myotome) and are thus innervated by dorsal primary rami “true back muscle”
The trapezius and the latissimus dorsi make up what?
The first layer of the muscles of the upper limb innervated by ventral primary rami
The triangle of Auscultation is betwen which two structures?
Trapezius and medial border of scapula
The lumbar triangle is generated by which muscles?
Latissimus dorsi
how do you physically examine muscles
In testing nerve function, the clinician always notes sensory/ motor asymmetries, thus using the patient has his/her own control. Muscles are tested against resistance to unmask weakness. The bulk of the muscle is also palpated
What muscles can mask paralysis of trapezius?
Levator scapula
latissimus dorsi
Rhomboids
The second layer of muscles in the upper limb include?
levator scapulae
rhomboid minor
rhomboid major
innervated by the ventral primary rami
The serattus posterior superior and serratus posterior inferior make up what?
3rd layer of the back muscles also known as the respiratory muscles innervated by the ventral rami
What are the true back muscles?
Splenius (cervical; most superficial)
Erector Spinae Transversospinalis – run oblique to vertebral column
Where is the vertebral prominence?
C7, longest spine
The inferior angle of the scapular is at the level of?
T7
At which level would you perform a spinal tap?
Between L4 and L5 i.e summit of iliac crest
The posterior superior iliac spine is located where?
At the level of of S2 bilaterally (dimples on lower back)
The natal cleft is where?
At the level of S4 between gluteus maximus and minims. Here you will find the sacral hiatus
