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Anatomy > Chapter 4: Back and Embryology > Flashcards

Chapter 4: Back and Embryology Flashcards

1
Q

What is the period of time called when all three germ layers are present?

A

gastrulation

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2
Q

What are the three primary germ layers?

A

ectoderm, endoderm, mesoderm

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3
Q

What are the two initial germ layers?

A

hypoblast: cells that develop in the first weekepiblast: cells that develop in the second week

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4
Q

Where do the head and brain eventually develop?

A

the primitive groove

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5
Q

What do neural crest cells develop into?

A

ganglia, medulla, facial bones

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6
Q

What do somites develop into?

A

vertebrae

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7
Q

What’s the importance of the notochord?

A

initiates neuralation (the development of neural tissue)

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8
Q

What germ layer does the spinal cord develop from?

A

ectoderm

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9
Q

What do the parietal and visceral mesoderm layers differentiate into?

A

layers surrounding the heart and lung

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10
Q

What serves as a rigid axis for the embryo?

A

notochord

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11
Q

In what week does the development of upper and lower limb buds occur?

A

4th week

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12
Q

The upper limb undergoes what rotation? Lower limb? Where are their extensors found?

A

upper = external rotation; extensors are posteriorlower = internal rotation: extensors are anterior

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13
Q

What exact germ layer are the somites formed from?

A

pariaxial mesoderm

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14
Q

What all do the somites form? Where are they found on an embryo?

A

skull, dermis, vertebral bodies, skeletal muscle; found on the dorsal surface of the embryo

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15
Q

At what week are all three germ layers present?

A

3rd week

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16
Q

What rises up to create the neural groove and later the neural tube?

A

ectoderm

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17
Q

How many somites are there for each portion of the body? (occipital, cervical, thoracic, etc.)

A

4 occipital8 cervical12 thoracic5 lumbar5 sacral8-10 coccygeal

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18
Q

Which areas of the somites fuse together?

A

sacrum, coccyx, and occipital bones all fuse respectively

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19
Q

The embryo is the size of the tip of an eraser at the end of which week?

A

week 3

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20
Q

Explain the differences between the superior half of the somite and the inferior half; which structures are formed in each?

A

superior: less dense, so spinal nerves and IVD developed hereinferior: more dense, so bony vertebrae are formed

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21
Q

When is the heart bulge first visable?

A

4th week

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22
Q

How do the disks form?

A

notochord pinches off, gets squeezed out and forms the nucleus puposis and anulus fibrosis.

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23
Q

T/F: The notochord is still present at birth.

A

true

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24
Q

What structure forms the IVD?

A

notochord

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25
Q

Why/how does the notochord get squeezed?

A

Because the somites are developing, so the notochord has is squeezed and becomes the IVD

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26
Q

What does the somitic mesenchyme consist of?

A

cranial, less dense portion (nerves and IVD)caudal, more dense portion (vertebrae)

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27
Q

T/F: You can tell what day of development the embryo is on by counting the number of somites.

A

true

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28
Q

In what week is the spine in place?

A

5th week

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29
Q

What happens in spinal stenosis? Why does this occur?

A

Both the vertebral foramen and the intervertebral foramen have the potential to narrow; happens naturally with age, but could also be genetics or poor posture

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30
Q

What causes spina bifida? Why does this range in severity?

A
  • the neural groove not fully closing to form the neural tube causes spina bifida- but this can range in severity: if only the bony structure is impaired the spinal cord/meninges are fine. If the tube is more deformed and the spinal cord/meninges are impaired, then you have lots of developmental delays and disabilities
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31
Q

The muscles of the trunk are formed from what germ layer?

A

paraxial mesoderm

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32
Q

All of the skeleton except for the skull is formed from what germ layer?

A

paraxial mesoderm

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33
Q

The urogenital system is formed from what germ layer?

A

intermediate mesoderm

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34
Q

What are the three primary centers of ossification?

A

one in each neural arch, and one in the centrum (body)

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35
Q

What is the direction of ossification throughout the vertebral column?

A

develop in cervical/thoracic first, then move more cervical, then go down to thoracic/lumbar

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36
Q

When do these primary ossification sites form on the vertebrae?

A

4th-12th week gestation

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37
Q

T/F: The improper lining up of the joints (ie. superior and articular facets) can be a source of back pain.

A

true

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38
Q

What parts of the body does the intermediate mesoderm form?

A

kidneys and relating ducts, reproductive organs

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39
Q

What are the two distinctions of lateral plate mesoderm?

A

1) somatic (parietal mesoderm)2) splanchnic (visceral mesoderm)

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40
Q

At what age do the primary centers of ossification unite and fuse?

A

by 3-5 years old

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41
Q

What does the paraxial mesoderm form?

A

somites, skeleton, muscles of the extremity and trunk, vertebral column, dermatomes, and dermis

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42
Q

Where are myotomes and dermatomes first formed?

A

on the somites

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43
Q

What germ layer forms the liver and pancreas? (GI tract)

A

endoderm

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44
Q

What germ layer forms appendicular skeleton?

A

mesoderm

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45
Q

What germ layer forms the neural tube?

A

ectoderm

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46
Q

What germ layer forms the hair, sebaceous glands, and sweat glands?

A

ectoderm

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47
Q

What germ layer forms the heart?

A

mesoderm

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48
Q

What germ layer forms the dermatomes?

A

mesoderm, because they’re from somites

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49
Q

What germ layer forms the spinal cord and brain?

A

ectoderm

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50
Q

What week does neuralation take place?

A

week 4

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51
Q

What week do somites start to form?

A

week 4

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52
Q

What are spinal ganglion?

A
  • clusters of dorsal sensory nerves, usually in the IVF- cell bodies of the dorsal roots
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53
Q

What are the 3 meninges?

A

pia, dura, arachnoid

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54
Q

What’s worse, a severed dermatome or peripheral nerve?

A

dermatome: lose input to all those regions

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55
Q

A patient reports severe whiplash coming in from an accident. Before treating, what should you make sure isn’t torn?

A

alar and transverse ligaments

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56
Q

What is the fine filament of connective tissue at the end of the conus medularis? What’s it for?

A

filum terminale, an extension of the pia that anchors the spinal cord to the coccyx

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57
Q

How far does the conus medularis extend to?

A

L1-L2

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58
Q

What does the notochord develop from?

A

The primitive node

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59
Q

What is the primitive streak?

A

indentation along the surface of the embryo; on caudal end is the primitive node

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60
Q

The vertebral artery becomes what artery when it goes up to the head?

A

basilar artery

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61
Q

What does the basilar artery supply?

A

the posterior half of the brain

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62
Q

Why is the proximal part of the vertebral artery prone to compression?

A

due to the longus colli and scalene muscles

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63
Q

Why do the transverse processes of C2-C6 cause the vertebral artery to be prone to compression?

A

compression from osteophytes and subluxed facet joints

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64
Q

What is an osteophyte?

A

a bone spur, indicating degeneration of the spine; common with age

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65
Q

Why is the suboccipital region prone to compression with the vertebral artery?

A

prone to compression from cervical rotation

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66
Q

What area of the vertebral artery trail is prone to plaque and stenosis build up?

A

intercranial portion

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67
Q

How many zygapophyseal joints are in the cervical spine?

A

14

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68
Q

How many uncovertebral joints are in the c-spine?

A

10

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69
Q

What is unique about the zygaphophyseal joint?

A
  • each dorsal rami innervates two adjacent joints, so each joint has two dorsal rami innervating it-It has dual innervation; one from the sinovertebral artery and one from the medial branch of dorsal rami. This gives the joint ability to be a spot of pain
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70
Q

Which muscles attach to the nuchal ligament?

A

rhomboid minor, trapezius, serratus posterior superior, splenious

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71
Q

What ligament limits flexion in the C-spine and assists in posture?

A

ligamentum nuchae

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72
Q

Which vertebrae has a “vertebrae prominens”

A

C7

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73
Q

Which area of the vertebral artery is prone to compression via bone spurs or subluxed facet joints?

A

transverse C2-C6 portion

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74
Q

Where are the facet joints most likely to dislocate?

A

In C-spine b/c they’re more horizontal; allows for greater range of motion but more likely for dislocation

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75
Q

What is unique about the joints of luschka? How do they form?

A
  • it’s “not a real joint” b/c it’s not present at birth- forms from the weight of the C-spine being distributed
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76
Q

Where can there be plaque build up and stenosis along the vertebral artery pathway?

A

intercranial portion

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77
Q

Which part of the vertebral artery is prone to compression via the surrounding muscles, like scalene and longus colli?

A

proximal portion

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78
Q

What joint allows rotation of C-spine?

A

atlantoaxial joint

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79
Q

T/F: There is no spinous process on C1.

A

true

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80
Q

What direction are the zygapophyseal joints facing in the C-spine?

A

anterior and inferior, vs posterior and superior like most other areas of the spine

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81
Q

What do articular pillars do?

A
  • help with stability of C-spine; they’re the column arrangements of the facet joints, junction of the pedicle and the lamina- this is what you palpate when you feel the C-spine usually
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82
Q

Do the uncinate joints have synovial membranes?

A

yes

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83
Q

What’s the role of the uncovertebral joint? (4)

A

1) limits lateral flexion of c-spine2) guides cervical flexion/extention3) prevents posterior translation of neighboring verts4) supports the IVD

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84
Q

Which portion of the spine forms the kyphotic curve?

A

thoracic spine

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85
Q

What forms the IVD?

A

notochord

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86
Q

What are the 5 secondary sites of ossification?

A
  • Two on the annular epiphysis (body), one anterior and one posterior- two on the tips of the transverse processes- one on the tip of the spinous process
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87
Q

What structure initiates the development of neural tissue?

A

Notochord

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88
Q

Where does the notochord develop?

A

In the primitive node

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89
Q

What are the primary curvatures of the spine?

A

thoracic and sacral; concave anterior

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90
Q

What are the secondary curvatures of the spine?

A

cervical and lumbar; concave posterior

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91
Q

What helps the spine to handle compressive forces?

A

the curvatures of the spine

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92
Q

Where does the transverse ligament of the atlas attach?

A

between the bodies of the lateral masses of C1

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93
Q

Where does the alar ligament attach?

A

From the sides of the dens to the foramen magnum

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94
Q

T/F: T-spine is pretty unstable because of all the rib attachments

A

false; very stable so not much herniation of disks

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95
Q

Does the spinal cord get larger or smaller as it travels to the lumbar region?

A

Larger

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96
Q

What movements do the lumbar vertebrae favor?

A

extension/flexion, very little rotation in this area

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97
Q

What movements are permitted in the zygapophyseal joints?

A

gliding

98
Q

What is the pars interarticularis?

A

collar on the dog; between the junction of the lamina and IAP

99
Q

What is spondylosis?

A

general wear and tear on the spine related to aging; can be a source of pain

100
Q

The zygapophyseal joint has what kind of receptors in it?

A

mechano and proprioceptors to tell it where it is in space, as well as pain receptors

101
Q

What are the vertebral endplates?

A

thin cartilage that lies above and below vertebrae; gives nutrition to the vertebral body

102
Q

T/F: Vertebral endplates are bone.

A

false; they’re permeable in the central portion where diffusion of blood and nutrients takes place

103
Q

Why are the vertebral endplates prone to injury?

A

Osteophytes build up; when the vertebral endplates break down, this decreases diffusion, causing the vertebra and the disk to break down as well

104
Q

What is the annulus fibrosis?

A

the collagen that wraps around the nucleus pulposa

105
Q

Why is the annulus fibrosis like an onion?

A

It has 12-15 outer rings of collagen, providing strong reinforcement for the nucleus pulposa

106
Q

What do the fibers of Sharpey do? (periosteal fibers)

A

attaches the outer ring of the annulus fibrosis to the vertebral body

107
Q

T/F: There are IVD’s throughout the entire spine.

A

False, there is no disk between C1 and C2, or btwn the sacrum and coccyx

108
Q

Where are the IVD’s the thickest?

A

In the cervical and lumbar portions of the spine

109
Q

T/F: The IVDs make up a third of the height of the spinal column

A

true

110
Q

What is likely the largest avascular structure in the body?

A

the intervertebral disk, especially in the middle

111
Q

As we age, what happens to the IVD?

A

loses the ability to take in water as well

112
Q

In what direction does disk herniation most usually occur?

A

posteriolaterally

113
Q

What nerves would a central nerve herniation affect if it was at L3?

A

All the nerves inferior to the herniation, including cauda equina and bowel/bladder nerves

114
Q

Which ligament limits hyperextension? From where to where does it run?

A

anterior longitudinal ligament; runs from sacrum to foramen magnum

115
Q

At what level does the techtorial membrane start?

A

C2, runs to foramen magnum

116
Q

T/F: The techtorial membrane supports the dens and axis.

A

true

117
Q

What is the primary action of the atlanto-axial joint? What structure allows this action to happen?

A

rotation because of the dens, mainly in the median atlanto-axial joint (pivot joint)

118
Q

What are the main motions of the atlanto-occipital joint?

A

flexion and extension, little side bending

119
Q

Why do disks tend to bulge out posteriolaterally?

A

the posterior longitudinal ligament is rather weak, allowing the disk to bulge out that way

120
Q

What ligament is an extension of the posterior longitudinal ligament?

A

techtorial membrane

121
Q

The vertebral artery can pass through a hole in which ligament?

A

posterior longitudinal ligament

122
Q

T/F: The atlanto-occipital joint has pain receptors, therefore can be a site of pain.

A

true

123
Q

Layer these ligaments from superficial to deep: alar, posterior longitudinal, cruciate.

A

Superficial to deep: posterior longitudinal -> cruciate -> alar

124
Q

What three ligaments make up the cruciate ligament?

A

superior longitudinal ligament, transverse ligament, inferior longitudinal ligament

125
Q

What ligament is also called the “check” ligament? Why is this?

A

alar; limits the amount of rotation occuring at C1-C2

126
Q

A patient presents with whiplash. What joint was probably most affected?

A

atlanto-occipital

127
Q

If one side of the head has more rotation than the other, what could this possibly tell you?

A

the alar ligament may have been comprimised

128
Q

What two populations are prone to having lax ligaments?

A

rheumatoid arthritis and down’s syndrome

129
Q

If the transverse ligament is lax, what could potentially happen?

A

The dens now has more range of motion, so it could move posteriorly and compress the spinal cord

130
Q

What are the “rules of three”?

A
  1. the dens takes up 1/3 of the space
  2. the chord takes up 1/3 of the space
  3. empty space takes up 1/3 of the space
131
Q

What is the hangman’s fracture?

A

disruption of the pars of C2, severe hyperextension

132
Q

What happens if the alar ligament is ruptured?

A

excessive head rotation

133
Q

Rupture of the transverse ligament results in what dislocation?

A

dislocation of the atlas from the axis

134
Q

What is a fracture of the atlas called?

A

Jefferson’s fracture (think diving injury)

135
Q

T/F: The posterior longitudinal ligament can become a source of pain.

A

true; innervated by the sinovertebral nerve which has pain receptors

136
Q

What ligament limits excessive flexion?

A

posterior longitudinal ligament

137
Q

The ligamentum flavum is made of what kind of tissue, (which is different than the other ligaments)?

A

elastin tissue makes up the ligamentum flavum, allowing it to move in almost any way, vs. collagen tissue for the other ligaments

138
Q

What two nerves make up the dual innervation of the ligamentum flavum?

A

sinuvertebral nerve and medial branch of dorsal rami (same as facet joint, which means it’s a site of pain)

139
Q

What ligament is important in counteracting the anterior translation of C1?

A

transverse ligament

140
Q

Which fracture, Jefferson’s or hangman’s, has the greater potential to injure the chord?

A

hangman’s

141
Q

T/F: The chord grows faster than the vertebrae at birth.

A

false, verts grow faster and chord ends at L2

142
Q

What is the cauda equina?

A

lumbar/sacral nerves going down to sacral foramina

143
Q

Name each portion for the three erector spinae muscles.

A

iliocostalis: lumbar, thoracic, cervical portions
longissimus: thoracic, cervical, capitus portions
spinalis: thoracic, cervical, capitus portions

144
Q

What’s the distal attachment for spinalis?

A

spinous processes of upper thoracic region to cranium

145
Q

Distal attachment for iliocostalis?

A

ribs and cervical transverse processes

146
Q

What muscles are in the transversospinalis group?

A

semispinalis, rotators, levatores costarum, interspinales, intertransversarii, multifidus

147
Q

What information do ventral roots carry?

A

motor, go away from the cord

148
Q

What information do dorsal rami carry?

A

both sensory and motor

149
Q

What info do dorsal roots carry?

A

sensory, go toward the cord

150
Q

Which muscle may play a role in chronic neck pain? And how?

A

semispinalis cervicis; may have fatty infiltration and become underutilized and atrophy
- not totally sure which comes first, the neck pain or the atrophy

151
Q

Why can the multifidus be a modulator for pain in the cervical area?

A

Because it inserts right near/on the facet joints (articular processes), so if the muscle is inflammed, the facet joint can be painful

152
Q

Which muscle is the first to react in cases of loud noise or horizontal acceleration?

A

multifidus; this means may be the first muscle reacting to whiplash

153
Q

What changes in anatomy occur with neck pain?

A
  • decreased CSA in both multifidus and semispinalis cervicis

- atrophy in deep muscles but more activity in superficial extensor muscles (this is bad, you need a balance)

154
Q

What are “slow twitch” muscles good for?

A

posture and proprioception, stabilization

155
Q

In which areas are there spinal cord enlargements?

A

cervical (C4-T1) and lumbar (L2-S3) , because there’s so many nerves needed to supply the upper and lower extremities

156
Q

The denticulate ligaments hold the pia mater to what?

A

the dura mater

157
Q

When a spinal nerve pierces through the dura and through the IVF, what is it now called?

A

dorsal/ventral rami

158
Q

What are the flattened extensions of the pia that anchor the cord to the dura?

A

denticulate ligaments

159
Q

What’s the lumbar cistern and what does it contain?

A

(aka dural sac) continuation of subarachnoid space where there’s no cord, just cauda equina, filum terminale, and CSF

160
Q

T/F: You can take CSF from the lumbar cistern.

A

true b/c it’s low enough that it won’t affect the cord

161
Q

At which level do spinal nerves begin to exit below the vertebrae?

A

C8, which exits below C7

162
Q

The muscles in the suboccipital region act on what joint?

A

atlantoaxial joint

163
Q

What are the two major joints of the neck/head?

A

atlantoaxial and atlantooccipital

164
Q

The back is mostly innervated by what nerves?

A

dorsal rami

165
Q

Shorter segment muscles are primarily used for what?

A

stabilization

166
Q

What portions of the occipital nerve are cutaneous?

A

greater and lesser occipital nerves; suboccipital does the triangle

167
Q

What is the function of the meninges?

A

protecting the cord

168
Q

What’s in the subarachnoid space?

A

CSF

169
Q

Where are cell bodies housed for the dorsal root system?

A

dorsal root ganglion

170
Q

Where are cell bodies housed for the ventral root system?

A

anterior horn

171
Q

What does the medial branch of the posterior ramus innervate?

A

the facet joint, ligamentum flavum, and other deep and medial spine muscles, like interspinalis, intertransversarii, multifidus

172
Q

T/F: The sinuvertebral nerve carries parasympathetic information.

A

false, sympathetic (responses to threat, fight or flight)

173
Q

The sinuvertebral nerve is a branch of what ramus?

A

anterior ramus

174
Q

The posterior longitudinal ligament is innervated by what?

A

anterior rami, specifically the sinuvertebral nerve

175
Q

Is the sinuvertebral nerve autonomic or somatic?

A

autonomic

176
Q

Which branch of the posterior ramus innervates the longissimus and spinalis muscles?

A

intermediate branch

177
Q

What does the lateral branch of the dorsal ramus innervate?

A

dermis and iliocostalis (ex.)

178
Q

What innervates the outer layer of the annulus fibrosis?

A

sinuvertebral nerve

179
Q

What are the three branches of the anterior ramus?

A

sinuvertebral nerve, skeletal branch, muscular branch

180
Q

What innervates the anterior longitudinal ligament?

A

skeletal branch of ventral rami

181
Q

What’s another same for the sinuvertebral nerve?

A

recurrent meningial; comes off of ventral rami and goes back to spinal cord to meninges

182
Q

What does the sinuvertebral nerve innervate?

A

IVD, posterior longitudinal ligament, parts of dura, annulus fibrosis

183
Q

What is the blood supply to the cord?

A
  • one anterior spinal artery and two posterior spinal arteries, which supply 2/3 of the way down
  • redicular arteries supply the remaining 1/3
184
Q

What the largest redicular artery?

A

great medullary artery

185
Q

Which artery, anterior spinal or posterior spinal, supplies more of the 2/3rds?

A

anterior

186
Q

T/F: The veins follow the arteries for the spine.

A

true

187
Q

How can viruses spread in the cord?

A

there are no valves that stop flow in venous drainage, so viruses can travel to the brain

188
Q

What is lumbarization?

A

6 lumbar vertebra instead of 5 (extra lumbar)

189
Q

What is sacralization?

A

4 lumbar instead of 5, one joins the sacrum

190
Q

What is hemivertebra?

A

half of vertebrae isn’t developed

191
Q

What is the Klippel-Feil anomaly?

A

vertebra (most times cervical) that are missing

192
Q

What is a fracture in the pars interarticularis called?

A

spondylolysis

193
Q

What is it called when there is a slippage of one vertebrae onto the one below?

A

spondylolistheses

194
Q

Describe the different grades of spondylolistheses.

A

grade 1: 25% slippage
grade 2: 50%
grade 3: 75%
grade 4: 100% (severest)

195
Q

What’s a schmorl node?

A

endplate degenerating and creating an invagination of bony tissue in the vertebral body

196
Q

What is the degeneration of bone due simply to aging called?

A

spondylosis

197
Q

If there is a posteriomedial disk herniation at L3, what nerve(s) are affected?

A

L3-4

198
Q

If there is a posteriolateral disk herniation at L5, which nerve(s) are affected?

A

L5 and one lower, so S1

199
Q

T/F: Intervertebral disks get thinner as you age.

A

False, they actually get thicker; thinning is a sign of pathology

200
Q

What gives the IVD a high fullness or turgor?

A

their water content in the nucleus puplosis; it’s around 90% in young individuals

201
Q

Why are IVD herniations mostly in the lumbar region?

A

Most flexion occurs here, and these are greater movements; IVD’s are also largest here, with more ability to impinge a spinal nerve

202
Q

An elderly patient comes in with an acute disk herniation. Why would you be skeptical of this diagnosis?

A

With aging, the nucleus becomes decreasingly dehydrated, even granular or solid. It’s more likely that the nerve roots are compressed by increased ossification of the IVF as they exit

203
Q

What differences in spinal anatomy occur with aging? (5)

A

1) Spondylosis, general wear and tear on the disk
2) osteophytes, bone spurs that indicate degeneration of the spine
3) nucleus pulposis can’t uptake H20 as well, leaving it fibrous or even granular
4) stenosis: narrowing of the foramens in the spine (IVF, VF) which can compress structures running through them
5) zygapophyseal joint pain

204
Q

At what level do 95% of lumbar herniations occur?

A

L4-L5 and L5-S1

205
Q

Acute middle and low back pain presenting with muscle spasms may indicate what injury?

A

posteriolateral herniation

206
Q

What is sciatica? What causes it?

A

sciatic is pain in the lower back and hip radiating down the back of the thigh, often caused by a herniated lumbar IV disk that compresses the L5/S1 component of the sciatic nerve

207
Q

Why is sciatica so common?

A

the increasing size of the lumbar nerves coupled with the decreasing size of the IVF

208
Q

How do you test to produce sciatic nerve pain?

A

flex the thigh with knee extended (straight leg raise test, stretches the sciatic nerve)

209
Q

What violent movements can produce disk damage?

A

violent hyperextension (like in a head-on collision) or violent rotation (like in a golf swing)

210
Q

Cervical IVD protrusions cause pain in what areas?

A

neck, shoulder, arm, and hand

211
Q

T/F: The dens of C2 is stronger than the transverse ligament that holds it down.

A

false, transverse ligament is stronger

212
Q

Why do we avoid movement in upper spinal cord injury patients?

A

If the antlantoaxial joint is subluxed or dislocated (from an injury or inflammation), sudden movements can cause posterior displacement of the dens or anterior movement of C1 and impinge the cord. You just may not know it yet because of the slight empty space between the dens and spinal cord

213
Q

A patient presents with greater cranial rotation to the right. On what side do you expect the alar ligament to be torn, and how much % greater rotation would you approximately find?

A

30% greater rotation on the left side

214
Q

A offensive lineman football player presents with a cervical injury. What injury could you suspect, given the motions he undergoes?

A

cervical flexion and rotation can rupture one or both alar ligaments, so check to make sure both are in place

215
Q

What are the five structures that can be sources of back pain?

A

1) fibroskeletal structures: periosteum, ligaments, and anuli fibrosi of IV discs
2) meninges (rare)
3) synovial joints: capsules of zygapophyseal joints
4) muscles: intrinsic muscles of back
5) nervous tissue: spinal nerves/roots exiting the IVF

216
Q

When someone has referred low back pain, what is usually the source?

A

compression/irritation of nerve roots, perceived as coming from the cutaneous/subcutaneous area; can be accompanied by low back pain

217
Q

What is usually the source of localized low back pain?

A

Perceived as coming from the low back, so it’s generally muscular, joint, or fibroskeletal pain

218
Q

Lordosis is often associated with what musculoskeletal issues?

A

weak trunk muscles, especially anteriolateral abdominals

219
Q

Why does kyphosis occur?

A

erosion of the anterior part of one or more vertebrae (osteoporosis)

220
Q

What can be done to prevent many back strains and sprains, which are causes of low back pain?

A

warming up, stretching, and exercising the anterolateral abdominal wall, especially the transverse abdominis

221
Q

A patient says he becomes dizzy when looking behind him when he’s backing up his car. What could be the problem?

A

The vertebral artery may be affected; blood flow isn’t getting to the head; think arteriosclerosis (hardening of arteries)

222
Q

Which area of the spinal cord is at highest risk for compression by bone spurs?

A

L5: largest nerve roots and smallest IVF; bone spurs will impact very quickly

223
Q

What does myelography allow you to see?

A

visualization of the spinal cord and nerve roots

224
Q

What are the most affected areas from osteoporosis?

A

neck of the femur, bodies of vertebrae (thoracic especially), metacarpals, and radius

225
Q

A surgeon needs to gain access to the spinal cord. What surgical procedure does she need to do?

A

laminectomy; also done to relieve pressure on the cord due to a tumor or herniated disk

226
Q

T/F: A Jefferson fracture alone doesn’t necessarily cause spinal cord injury.

A

true, more likely with the transverse ligament also torn

Jefferson fractures posterior and/or anterior arches of C1

227
Q

What is one of the most common injuries to C2?

A

fractures of the vertebral arch, caused from hyperextension of the head on the neck (vs. head and neck in whiplash)

228
Q

A patient presents with hyperextension of the head on the neck, what injury could you find?

A

a fracture of the vertebral arch of C2 in the pars interarticularis

229
Q

T/F: Fractures of the dens are common axis injuries.

A

true, 40-50%

230
Q

What can cause thoracic outlet syndrome?

A

the supernumerary rib elevating and putting pressure on the subclavian or inferior trunk of brachial plexus

231
Q

Where can you inject caudal epidural anesthesia?

A

in the sacral hiatus

232
Q

Why is there slight height loss that accompanies aging?

A

there’s a decrease in bone density, especially centrally in the body. So, the vertebral bodies become concave

233
Q

What’s the difference between back sprain and back strain?

A

both result from excessively strong contractions involving movements of the vertebral column
• SPRAIN is with only the ligaments are involved
• STRAIN is with the stretching/slight tearing of muscle fibers

234
Q

Lumbar punctures are performed with the patient in what position?

A

lying on the side with the back and hips flexed to stretch the ligamentum flavum

235
Q

With a spinal cord injury at C1-C3 level, what happens?

A

no function below head, ventilator needed for respiration

236
Q

SCI at C4-5, what’s the result?

A

quadriplegia

237
Q

SCI at T1-T9, what’s the result?

A

paraplegia, amount of trunk control varies with height of lesion

238
Q

Can you walk with an SCI at L2-L3?

A

yes, short leg braces may be required

239
Q

With an SCI at C4-C5, can the individual self feed?

A

no

240
Q

With an SCI at C6-C8, can the individual propel in a wheelchair?

A

potentially yes

241
Q

With an SCI at T1, will the individual be able to self propel in a wheelchair?

A

yes

Anatomy (9 decks)

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