BACK AND SPINAL CORD FINAL Flashcards
L5-S1
-spina bifida occult- fusion -> tuft of hair
-spondylolisthesis -> L5 displaced anteriorly to sacrum -> compresses cauda equina -> lower back and limb pain
-sciatica- herniated IV disc or osteophyte compresses sciatic nerve
L1-L2
-spinal cord ends
S2-S3
-dural sac ends
L3/L4 or L4/5
-lumbar puncture into subarachnoid space
-epidural -> this can also be done in sacral canal via sacral hiatus OR trans-sacral space via posterior sacral foramina
localized back pain
-longitudinal ligament compression
-anulus fibrosus compression
-inflammation due to chemicals released from ruptured nucleus pulposus
chronic back pain
-posterolateral herniation
-increased ossification of IV foramina (older pts)
-nerve compression!
fracture/dislocation of atlas
-rupture of transverse ligament -> dens set free
-atlantoaxial subluxation- partial dislocation
-complete dislocation:
-upper cervical region of spinal cord -> quadreplegia
-medulla/brain stem -> death
sprain vs strain
-sprain -> ligament damage without dislocation or fracture (can be caused by strong contraction)
-strain -> muscles (erector spinae) damaged via improper form
laseque test
-traction on sciatic nerve
Adamkiewicz artery
-segmental medullary artery
-supplies anterior spinal artery -> lower thoracic, lumbar, and sacral spine
-sustained decreased BP, obstructive arterial disease, clamping during surgery -> ischemia
-muscle weakness and paralysis
-supplies inferior 2/3rd of spinal cord
-vertebral arteries and segmental medullary arteries supply
vertebral venous plexus
-drains pelvis and abdomen to SVC if IVC is obstructed
-if abdominal or pelvic metastasis -> spreads to vertebrae and brain
-no valves
back pain sources
-1. fibroskeleton- periosteum, ligaments, annuli fibrosi of IV discs
-2. meninges
-3. zygapophysial joints
-4. muscles (intrinsic)
-5. spinal nerves
spinal nerves
-8 cranial (7 vertebrae)
-12 thoracic
-5 lumbar
-5 sacral
-1 coccygeus (4 vetebrae)
triangle of auscultation
-allows for optimal auscultating lung sounds
-laterally- medial border of the scapula
-medially- ascending fibers of trapezius
-inferiorly- superior border of the latissimus dorsi
-intercostal space 6 about
superficial (extrinsic/false) back muscles
-connect the axial skeleton (vertebral column) with the appendicular skeleton (pectoral girdle and humerus
-support and move the upper limb
-nerve supply- ventral rami
-trapezius
-latissimus dorsi
-rhomboid major
-rhomboid minor
-levator scapulae
-serratus posterior superior and inferior
back dimples
-sacroiliac joint
atlanto-occipital joint and atlanto-axial joint
-atlanto-occipital joint- between superior articular facets of C1 and occipital condyles
-atlanto-axial joint- inferior facets of C1 and superior facets of C2 ALSO synovial pivot joint with dens -> axis of pivot
lumbar triangle
-medially- latissimus dorsi
-laterally- external oblique muscle laterally
-inferiorly- iliac crest inferiorly
-site of lumbar hernia
supracrista plane
-L4
-umbilical region too!
disc herniation and nerve impinged
-posterolateral MC bc of strength of centrally located posterior longitudinal ligament
-cervical- nerve impinged = lower vertebra (C5 is impinged at C4-C5) -> bc cervical nerves exit superiorly
-thoracic- nerve impinged = upper vertebrae (T3 is impinged at T3-T4)
-lumbar- nerve impinged = lower vertebrae
spinal nerve exits
-thoracic and lumbar nerves exit inferiorly to vertebrae
-cervical nerves exit superiorly
-ex. C1 nerve exits between skull and C1, C2 nerve exits between C1-C2, C8 nerve exits between C7 and T1
how many spinal nerves are there
31
denticulate ligaments
-21
-from pia matter (traverse arachnoid mater) and attach to dura mater
cranial nerves
-1 and 2 exit from cerebrum
-3-12 exit from brain stem
parasympathetic innervation
-CN 3, 7, 9, 10
-S2-S4
L5 stress fracture case study
-continuous hyperextension / compressive forces of vertebral column -> stress fractures.
-interarticular parts of lamina involved
-spondylolysis -> anterior movement of L5
-diving, gymnastics, wrestling, overhead lifting, repetitive activities, and weightlifting are especially vulnerable
severe pain while extending vertebrae lifting heavy weights case study
-severe back spasm
-intermediate and deep layers of intrinsic
(deep) muscles
-constant, dull ache in the lower back
-limited range of motion of vertebral
column
-large areas of palpable tenderness.
-poor posture / improper lifting mechanics -> advise to lift with the lower limbs instead of the
back
spina bifida occulta
-failure of vertebral arch (laminae) to fuse
-spina bifida cystica- arch (laminae) is not there
severed cervical spinal cord
-superior to C5 -> quadriplegia
-superior to C4 -> respiratory arrest / possible death -> phrenic nerve derived from C3, C4, C5 -> innervate diaphragm
spondylolisthesis vs spondylosis
-spondylosis- FRACTURE of pars interarticularis
-Spondylolisthesis- FORWARD DISPLACEMENT of vertebrae
-Can occur secondary to spondylolysis
-Often occurs in L5 vertebral body relative to sacrum
-Can possibly cause pressure in cauda equina
