Blue Boxes: Back Flashcards
Understanding disease/pathological states resulting from problems in back osteology, arthrology, angiology, neurology, or myology.
Vertebral Body Osteoporosis
Common metabolic bone disease that is often detected during routine radiographic studies
- characterized by vertical striations in vertebral body
- can lead to continued loss of trabecular bone (bone becomes less white)
- If osteoporosis becomes se ver, can lead to excessive thoracic kyphosis
What is a laminectomy?
Surgical excision of one or more spinous processes and adjacent supporting vertebral laminae
Often performed to relieve pressure on the spinal cord or nerve roots caused by a tumor, herniated IV disc, or bony hypertrophy (excess growth)
Dislocation of Cervical Vertebrae
- Cervical vertebrae are more likely to be dislocated due to more horizontally oriented articular facets
- However, large vertebral canal means less chance of damaging spinal cord
Jefferson Fracture
Fracture of both arches of the atlas
- Usually from a diving accident or large object falling onto the head
- Does not typically injure spinal cord (Larger vertebral foramen)
Hangman’s Fracture
Fracture of the vertebral arch of the axis
- Results from hyperextension of the head on the neck (not whiplash)
- One of the most common cervical vertebrae injuries
Fracture of Odontoid Process
Due to horizontal blow to the head
- Transverse ligament is stronger than the odontoid process.
- These breaks are typically harder to heal b/because of the lack of blood supply to the odontoid process (transverse ligament limits its blood supply)
- Can also results as a complication of ostopenia
Lumbar Spinal Stenosis
Narrowing of the Lumbar Vertebral Foramen
- Lumbar spinal nerves increase in size as the vertebral column descends, but paradoxically, the IV foramina decrease in size
- Compression of one or more spinal nerve roots occupying the inferior vertebral canal
- Complication: If IV Disc protrusion occurs along with stenosis, further compromises vertebral canal
(along w/ Arthritic Proliferation and Ligamentous Degeneration)
Cervical Ribs
Developmental costal element of C7 becomes abnormally enlarged, which can become a supernumerary (extra) rib
-Can place pressure on structures that emerge from superior thoracic aperture (notablly brachial plexus and sublcavian artery), which can thoracic outlet syndrome
Caudal Epidural Anesthesia
Anesthetic agents are injected into the fat of the sacral canal that surrounds the proximal portions of the sacral nerves
-accomplished via sacral hiatus or posterior sacral foramina
Coccygodynia
Painful bruisng or fracture of the coccyx (tailbone)
- hard to treat and pain relief is difficult
- dislocation common
- can happen as a result of difficult childbirth
Hemisacralization
Partial or complete incorporation of L5 into sacrum
-can produce painful symptoms
Lumbarization
Separation of S1 from sacrum and fusion with L5 vertebra
Effect of Aging on Vertebrae
Birth to Age 5: lumbar vertebra grows 3x in height
Age 5-13: lumbar vertebra grows 50% in height
Ages 13-25: Minimual longitiduinal growth until completion
Older Age: Overall decrease in bone density, causing changes in the shape of vertebral bodies (why there is slight height loss in aging)
-can see production of osteophytes (bony spurs) and osteoarthritis
Spina Bifida Occulta
Vertebral lamina fail to fuse and close off the vertebral canal
- Most common in L5-S1
- Possible to have tuft of hair over this area as well
Spina Bifida Cystica
One or more vertebral arches may fail to develop completely
-Associated with herniation of meninges (meningocele) or spinal cord (meningomyelocele)
Aging of Intervertebral Discs
Nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen, leading to IV discs becoming stiffer and more resistant to deformation
-Can lead to degenerative disc disease
Back Pain
Second most common reason to visit doctor (after cold)
Sources of Pain:
- Fibroskeletal structures: periosteum, ligaments, and anuli fibrosi of IV discs.
- Meninges: coverings of the spinal cord.
- Synovial joints: capsules of the zygapophysial joints.
- Muscles: intrinsic muscles of the back.
- Nervous tissue: spinal nerves or nerve roots exiting the IV foramina.
Herniation of Nucleus Pulposus
Protrusion of nucleus pulposis through the annular fibrosis
- Most common in L4/L5 and L5/S1
- Typically occurs posterolaterally where anterior and posterior longitudinal ligaments do not support the annular fibrosis
Sciatica
Pain radiating from lower back into buttock down the posterior or lateral aspect of thigh into leg
-often caused by herniated lumbar IV disc that compresses L5 or S1 component of sciatic nerve
Zygapophysial Joints
If they are injured or develop osteophytes (osteoarthritis), the spinal nerves are often affected
- Pain along the distribution patterns of the dermatomes and spasm in the muscles derived from the associated myotomes
- Myotome: consists of all muscles or parts of muscles receiving innervation from one spinal nerve*
Hyperextension/Whiplash
Overstretching of anterior longitudinal ligament (at front of vertebral body)
-most often in rear-end motor vehicle collisions
What do you do for a patient who has had a fracture of the vertebral column?
Keep them in hyperextension. Pull of the anterior longitudinal ligament.
Spondylosis
Calcification of edges of the vertebral bodies
-Causes joint pain and stiffness
Spondylolysis
Separation of vertebral arch from vertebral body
-Fracture of the column of bones connecting the superior and inferior articular processes (pars interarticularis)
Spondylolisthesis
Anterior displacement of vertebral body on inferior vertebral segment
Rupture of Alar Ligament
Alar ligaments of Axis are weaker than transverse ligaments
-Can cause increase of approximately 30% in the range of movement to the contralateral side
Primary Curvature of Spine
Cervical Lordosis
Thoracic Kyphosis
Lumbar Lordosis
Sacral Kyphosis
Excess Thoracic Kyphosis (Kyphosis)
Humpback of thoracic vertebrae
Excessive Lumbar Lordosis (Lordosis)
Swayback of lumbar vertebrae
Scoliosis
Lateral curvature in spine (cervical, thoracic, or lumbar)
What is the difference between back sprain, strain, and spasms?
Back Sprain: Injury to ligamentous tissue w/o dislocation or fracture
-Involves excessive stretching of fibers from overly strong muscle contraction
Back Strain: Common injury from overly strong musclar contraction
-Some degree of stretching or microscopic tearing of muscle fibers
Back Spasm: Protective mechanism after an injury or in response to inflammation
-Sudden involuntary contraction of one or more muscle groups
Reduced Blood Supply to Brainstem
Arteriosclerosis: Blood flow reduced due to hardening of arteries
-Affects vertebral arteries that go through transverse foramina of cervical vertebrae
Lumbar puncture
Peform at L3/L4 or L4/L5 to avoid puncturing spinal cord
- Pop occurs when needle passes through ligamentum flavum
- CSF drawn from the arachnoid space/lumbar cistern
Spinal cord injuries
- C1-C3: no function below head, respirator needed for life
- C4-C5: no function of ribs, can breath on their own (quadraplegia)
- C6-C8: Loss of function in hands and upper limbs)
- T1-9: Paralysis of both lower limbs
- T10-L1: Some thigh muscle function; walking with long leg braces
- L2-L3: most lower limb function present; can walk with short leg braces
Joint of Luschka
Joint between unicate process of inferior vertebra and the inferior surface of the superior vertebra
Second Number Rule
Cervical and lumbar regions: vertebral level at which the prolapse occurs will affect the spinal nerve with the second number designation
Example: Injury to L4/L5 will affect spinal nerve L5.
Example: Injury C5/6 will affect spinal nerve C6
