Blue Boxes 1: Deep Back Flashcards
What are the most common areas affected by Osteoporosis?
Vertebral bodies, neck of the femur, metacarpals, and the radius
What does a radiograph of vertebral bodies with osteoporosis look like?
In early stage the vertebral bodies will appear to have striations.
As it progresses the inner spongy bone of the bodies appears more translucent than normal due to demineralization.
Late osteoporosis results in what type of back shape deformity?
Kyphosis of the thoracic vertebra.
What is a Laminectomy?
Surgical excision of spinous processes and the adjacent supporting Laminae.
ie –> removing the vertebral arch by cutting the pedicles
What surgical procedure is often used to relieve pressure on the spinal cord or nerve roots cause by a tumor, herniated IV disc, or bony hypertrophy.
Laminectomy
Which type of vertebrae can be dislocated more easily than fractured?
Cervical
They may dislocate and then come back into place so its easy to miss soft tissue damage, without an MRI
What specific vertabrae is easily fractured by vertical forces to the neck? like a diving accident
atlas C1
What is a Jefferson’s or burst fracture?
Fracture of the atlas anterior and/or posterior arches
A traumatic spondylolysis of C2 usually occurs as a result of what injury? What part of the bone usually fractures?
Hyperextension of the head on the neck
Pars Interarticularis
What is a nickname for a fracture of the pars interarticularis of C2?
Hangman’s fracture
What is a lumbar spinal stinosis?
Narrowing of the vertebral foramen in one or more lumbar vertebrae
What is thoracic outlet syndrome and what is a common cause?
It is a narrowing of the superior thoracic aperture that is often caused by a cervical rib. This can put pressure on the subclavian artery or inferior truck of the brachial plexus.
Where would you place an epidural anesthetic?
Into the fat of the sacral canal that lies beneath the sacrococcygeal ligament. Acts on the nerves of the cauda equina
What are the bony landmarks for finding the location of the sacral hiatus to place and epidural?
Between the sacral cornua and inferior to the S$ spinous process.
Coccygodynia is a painful syndrome that results from trauma to what bone?
Coccyx
When L5 is sacralized, what often happens to the L4 - L5 level?
It degenerates, often producing painful symptoms
What happens to vertebrae as they age?
There is an overall decrease in bone density and strength, particularly centrally withing the vertebral body. The articular surfaces start to bow inward and look concave.
Why do osteophytes (bone spurs) commonly develop around the periphery margins of the vertebral body?
Because there is more pressure on the body periphery due to aging of the IV discs combined with the changing shape of the vertebrae.
What is spina bifida?
The neural arches of L5 and/or S1 fail to develop normally and fuse posterior to the vertebral canal.
What often indicates the location of spina bifida?
A patch of hair
What is a meningomyelocele?
Severe spina bifida associated with a meningeal cyst and/or a herniation of the spinal cord.
Severe forms of spina bifida result from what?
Neural tube defects during development
What happens to IV discs as they age?
The nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen. This causes them to lose their turgor, becoming stiffer and more resistant to deformation.
Why do people lose height as they age?
Bodies of vertebrae break down and become concave
Do IV discs increase or decrease in size as you age?
Increase
What does herniation mean?
Protrusion
What is the nuclei pulposi primarily comprised of?
Water 90%
A herniated IV disc is inappropriately called a _____ by some people?
Slipped disc
Where do herniations of the nucleus pulposus usually happen?
Extend posterolaterally where the anulus fibrosus is relatively thin and does not recieve support from either the posterior or anterior longitudinal ligaments.
What causes the referred pain of a herniated disc?
compression of the spinal nerves
What usually causes the localized pain of a herniated disc?
Pressure on the longitudinal ligaments
Where do about 95% of lumbar disc protrusions occur?
L4 - L5 or L5 - S1
What is sciatica?
Pain in the lower back and hip radiating down the back of the thigh into the leg.
Often caused by a herniated lumbar IV disc that compresses the L5 or S1 component of the sciatic nerve
Why is sciatica so common?
Because the lumbar nerves increase in size while the lumbar foramina decrease in size.
When a Lumbar IV disc protrudes, what nerve root does it normally compress?
The one numbered one inferior to the herniated disc.
L4-L5 herniation would likely compress the L5 nerve
How could you fracture a cervical IV disc?
Hyperflexion of the cervical region.
Head-on collisions or illegal head blocking in football
When a cervical IV disc protrudes, what nerve root does it normally compress?
The one exiting at the same level, however the numerical relationship is the same because cervical spinal nerves exit superior to the vertebra of the same number.
What are the most commonly ruptured cervical discs?
C5 - C6 and C6 - C7
Why are fractures of the Dens often unstable (do not reunite)?
The transverse ligament of the atlas becomes interposed between fragments, and because the separated fragment no longer has a blood supply, resulting in avascular necrosis.
Why do fractures of the axis body heal more readily then fractures of the dens?
Because the fragments retain their blood supply.
What happens when the transverse ligament of the atlas ruptures?
THE dens of the axis is set free, resulting in atlanto-axial subluxation, an incomplete dislocation of the median atlanto-axial joint.
Which is more likely to cause spinal cord compression, a transverse ligament rupture or fracture of the dens?
Transverse ligament rupture, it causes atlanto-axial subluxation, slideing of the atlas forward. When the dens fractures it moves with the atlas because the transverse ligament holds it in place.
What is Steele’s Rule of Thirds?
Approximately one third of the atlas ring is occupied by the dens, one third by the spinal cord, and the remaining third by the fluid-filled space and tissues surrounding the cord.
What can be torn during whiplash injuries of the neck? (hyperextension)
Anterior longitudinal ligament
What are the most commonly fractured non-cervical vertebrae?
T11 and especially T12
Why is dislocation much more common in the cervical region than the others?
Thoracic and lumbar vertabrae have an interlocking of their articular processes.
Look at the scottie dog on pg 479
Look
Spondylolysis?
fracture of the pars interarticularis
What does the scottie dog look like with spondylolysis?
It has a broken neck
What is a dislocation between adjacent vertebrae called?
spondylolysis
Why are zygapophysial joints of clinical interest?
Because they are close to the IV foramina through which the spinal nerves emerge from the vertebral canal.
In back pain, pain from nervous tissue is usually what kind of pain?
Referred pain, associated with the dermatome of the affected nerve
Localized lower back pain is generally caused by what?
muscular, joint, or fibroskeletal
What is kyphosis?
humpback
What is Dowager’s hump?
Excessive thoracic kyphosis in older women resulting from osteoporosis.
What is lordosis?
Hollow back or sway back. Characterized by an anterior tilting of the pelvis
What type of spine deformity develops in pregnant women?
temporary lumbar lordosis
What is a back sprain?
An injury in which only ligamentous tissue, or the attachment of ligament to bone is involved without dislocation or fracture
What do back strains result from?
Overly strong muscular contractions, often sports injuries
What muscles are usually involved in a back sprain?
Erector spinae
How can you minimize back strains when lifting?
By crouching and holding the back as straight as possible. Use the muscles of the buttocks and lower limbs to assist
What is a spasm?
A sudden involuntary contraction of one or more muscle groups. Often occur after an injury or i response to ligament inflammation
What is arteriosclerosis?
A hardening of arteries due to a loss of elasticity, blood flow to a region is reduced.
What circulatory system problem can occur from a prolonged turning of the head, as occurs when backing up a motor vehicle?
Lack of blood supply to the brainstem, light-headedness, dizziness.
Which spinal level has the thickest nerve roots and the narrowest IV foramina?
L5
What is the clinical name for bone spur?
osteophyte
What is the name for a radiopaque contrast procedure that allows visualization of the spinal cord and spinal nerve roots?
Myelography
CSF is withdrawn by lumbar puncture and replaced with a contrast material injected into the spinal subarachnoid space.
What two layers of the spinal cord form the leptomeninges?
Pia mater and arachnoid mater
They develop from a single layer of mesenchyme surrounding the embryonic spinal cord
What connects the arachnoid mater to the pia mater?
arachnoid trabeculae
What is a lumbar puncture used for?
To withdraw CSF from the lumbar cistern
Used as a tool to diagnose CNS disorders
Why are lumbar punctures performed with the patient lying on the side with back and hips flexed?
Flexion of the vertebral column facilitiates insertion of the needle by spreading apart the vertebral laminae and spinous processes, stretching the ligamenta flava
Between what two spinous processes would you do a lumbar puncture for spinal anesthesia?
For epidural anesthesia?
L3 - L4
L4 - L5
When would a lumbar puncture not be performed?
In the presence of increased intracranial pressure
Spinal anesthesia usually occurs within one minute when injected into the subarachnoid space. Why might someone get a headache following this?
Leakage of CSF through the lumbar puncture
Where are the two places an epidural can be placed?
Sacral hiatus
Lumbar spinal puncture
What does the great anterior segmental medullary artery of Adamkiewicz do?
Reinforces the circulation to two thirds of the spinal cord, including the lumbosacral enlargement. It is on the left side in about 65% of people
What is paraplegia?
Impairment of the sensory and motor functions of the lower extremities
Cross clamping the aorta or the great anterior segmental medullary artery during surgery can lead to what?
Ischemia of the Spinal Cord
Where is the vertebral canal the narrowest?
In the cervical region
What happens is the spinal cord is transected at C1 - C3?
No function below head level, ventilator is required to maintain respiration.
