Blue Boxes Back Flashcards
1
Q
Vertebral Body Osteoporosis
A
- Common metabolic bone disease
- Osteoporosis: demineralization of bones from disruption of calcium balance
- Most common in thoracic vertebrae & post-menopausal females
2
Q
Laminectomy
A
- Def: Surgically removing the spinous process + adjacent laminae in vertebral column
- Posterior exposure of spinal cord
- Preformed to relieve pressure from tumor, herniated IV disc, or bony hypertrophy (excess growth)
3
Q
Dislocation of Cervical Vertebrae
A
- Cervical vertebrae have horizontal articular facets, so they arent locked together as tight, making dislocation easy in neck
- Since the cervical vertebral canals are large you can dislocate them w/out damaging the spinal cord
- If no “facet jumping” occurs (locking of displaced facets) the problem usually resolves itself, have to get an MRI to see if there is spinal cord soft tissue damage
4
Q
Fracture and Dislocation of Atlas
A
- Rupture of transverse ligament –> Jefferson/Burst Fracture –> spinal cord damage
- You can get hit on top of the head (dive into pool headfirst) and it usually doesn’t hurt the spinal cord becuase the bony ring actually gets bigger
5
Q
Fracture and Dislocation of Atlas
A
- Fractures of the vertebral arch of the axis = most common cervical vertebrae injury
1. Traumatic/Cervical Spondylolysis of C2 or Hangman’s Fracture –> hyperextension of head
2. Whiplash –> Combined hyperextension of head and neck
3. Quadripelegia –> Incomplete dislocation of Axis
4. Fractures of the Dens –> Horizontal blow to head
5. Osteopenia –> Loss of bone mass
6
Q
Lumbar Spinal Stenosis
A
- Def: Stenotic (narrowing) of vertebral foramen in lumbar vertebrae.
- Compresses nerves becuase they get bigger as you go down, more vulnerable to IV disc bulging
7
Q
Cervical Rib
A
- C7 transverse process = enlarged
- The supernumerary rib can place pressure on subclavian artery or inferior trunk of brachial plexus and can cause thoracic outlet syndrome
8
Q
Caudal Epidural Anesthesia
A
- Anesthetic agents are injected into the fat of the sacral canal that surrounds the sacral nerves
- You can do this through the sacral hiatus cause it will act on the S2-Co1 cauda equina spinal nerves and block all inferior to those
- Or if you go in through the posterior sacral foramina this is called transsacral epidural anesthesia
9
Q
Injury of Coccyx
A
- Caused by an abrupt fall onto the butt
- Fracture of coccyx = dislocation of sacrococcygeal joint
- Sometimes you have to surgically remove the bone to help relieve pain
- Coccygodynia = pain after coccygeal trauma (from difficult childbirth)
10
Q
Abnormal Fusion of Vertebrae (5%)
A
- Hemisacralization* –> L5 partly w/ sacrum
- Sacralization of L5 veretbrae* –> L5 fully w/ sacrum
- Lumbarization of S1 Vertebrae* –> S1 separated w/ sacrum and fused with L5, painful cause other lumbar veretbrae start to degenerate (they dont have as strong of connections)
11
Q
Effect of Aging on Vertebrae
A
- Bone loss and the slight change in shape of veretbraes may account for the loss of height that occurs w/ aging
- IV discs + vertebrae age –> causes compressive forces –> Osteophytes (bony spurs) develop –> called spondylosis –> normal w/ aging
- Spondylosis = vertebral discs
- Osteoarthrosis = zygapophysial joints
12
Q
Anomalies of Vertebrae
A
- Spina bifida occulta:* L5 and/or S1 vertebral arches fail to develop normally & fuse to vertebral canal
- Minor form = Small dimple w/ tuft of hair in lower back (back problems in infants)
- Severe types:
- Spina bifida cystica:* veretebral arches fail to develop completely and the meninges herniate
(meningocele = spina bifida w/ meningeal cyst)
(Meningomyelocele = Neruo symptoms like paralysis, from neural tube closure defect)
13
Q
Aging of Intervertebral Discs
A
- W/ advanced age nuclei pulposi dehydrate –> Discs become stiffer
- Annulos fibrosis gets all the vertical load and gets squished! Making the discs wider (increase in size w/ age)
- Degenerative disc disease = disc narrowing = not normal aging
14
Q
Back Pain
A
Five sources of the very common “back pain”
-
Fibroskeletal structures: periosteum, ligaments, anuli fibrosi of IV discs
- Sharp pain of fracture is from periosteal (membrane covering the bone)
- Pain from dislocations = ligaments (Ex. Disc herniation is from anulus fibrosis pinning the posterior longitudinal ligament) - Meninges: coverings of the spinal cord (rare)
-
Synovial Joints: capsules of the zygapophysial joints
- Aging (osteoarthrosis) or disease (rheumatoid arthritis) of joints -
Muscles: Intrinsic muscles of the back
- Reflexive cramping (spasms) producing ischemia (local loss of blood supply), often as a result of guarding (contraction in anticipation of pain) -
Nervous tissue: Spinal nerves/roots exiting the IV foramina
- Referred pain from subcutaneous (dermatome)
- Localized Lower Back Pain = Muscular, Joint, or Fibroskeletal in Orgin
15
Q
Herniation of Nucleus Pulposus (Herniation of IV Disc)
A
IV discs are so strong (90% water) in young people that sometimes you will fracture a vertebrae before the discs ruptures.
What causes a disc rupture/fracture adjacent vertebral bodies? –> Violent hyperflexion + sports with downward/twisting pressure on back & neck
- nucleus pulposis ruptures through annulus fibrosis posteriorlaterally (usually)
- Acute localized back pain: from pressure on ligaments + inflammation
- Chronic Back Pain is usually referred radiating pain, percieved as coming from the area (dermatome) supplied by that nerve
- Except for cervical, when the IV disc protrudes it compresses the spinal nerves one vertebrae below it
- 95% of lumbar @ L4/5 or L5/S1 level (IV space narrows)
- Sciatica: Pain radiating from lower back down to posterior/laterall thigh = L5/S1 sciatic nerve compression
16
Q
Spinal Fusion & Intervertebral Disc Replacement
A
- Degenerative Disc Disease:* Results from a big decrease in IV disc space –> produces spinal stenosis (narrowing of vertebral canal)
- Treated w/ Laminectomy to relieve pressure on nerves, sometimes they use spinal fusion (arthrodesis) to eliminate back movement, use rods and artificial discs
