clinical anatomy of the back (week 11) Flashcards
what are the three As used to interpret a C-spine injury?
Adequacy, Alignment and Asymmetry
what does each A stand for?
Adequacy - can you see all 7 vertebrae and top of T1?
Alignment - draw 3 vertical parallel lines along the anterior and posterior border of the 7 vertebral bodies and a 3rd line through the base of each spinous process; Asymmetry - look for abnormal asymmetry between the 7 cervical vertebrae
what is a hangman’s fracture?
caused by overextension of the neck; fracture through C2 lamina/pedicle; patient complains of pain and stiffness in neck often following a high velocity injury (a CT scan should be done to assess for degree of instability and/or vertebral artery damage as its close to the foramen transversarium
how do you get an Xray of the C1 vertebrae?
by doing an open mouth Xray
what is the transverse ligament?
the ligament which holds the odontoid process in place and allows rotation of the atlanto-axial joint
what is Jefferson’s fracture?
a burst fracture of C1. Usually resulting from a blunt force hitting directly from crown of head. C1 bursts 4 ways around the odontoid process
what is the owls eyes and beak?
used to help assess a thoracic back Xray from anterior/posterior view. Owls eyes = pedicles; owls beak= spinous process.
what does a winking owl suggest?
a single or bilateral pedicle disruption. suggests possible fracture
what does a wedge shaped vertebral body indicate on a lateral Xray of the spine?
a compression fracture. Common in osteoporosis after bone has become brittle.
what are the PQRST questions asked about back pain?
Provocative and palliative factors; Quality of pain; radiation; severity and systemic symptoms; timing
what are zygapophysial joints?
facet joints
what do zygapophysial joints prevent in terms of movement?
excess rotation or lateral flexion of the vertebrae, with support from the ligamentum flavum
what is spondylosis?
osteoarthritis in the synovial joints of the vertebrae (the zygapophysial joints). Common in cervical and lumbar regions. The joint becomes weak.
what is facet joint syndrome?
common cause of back pain. Can be due to degenerative changes in the zygapophysial joint or the ligamentum flavum
what is spondylolisthesis?
anterior slip of a vertebrae on the lower segment due to weakness of ligametum flavum or fracture of pedicle. (commonly L4/L5 or L5/S1) There may be impingement of the spinal nerve as it exits through the IV foramen.
what is cauda equina syndrome?
SURGICAL EMERGENCY: a collection of symptoms and signs which result from severe compression of the descending lumbar and sacral nerve roots within the lumbar cistern.
what is the acronym for recognition of symptoms of Cauda equine syndrome?
S - saddle anaesthesia P - pain in back and/or down both legs I - Incontinence (bladder or bowel movements) N - numbness in leg(s) E - emergency
what are some degenerative conditions which can result in cauda equine syndrome?
lumbar disc herniation; spondylolisthesis
what are some traumatic causes of cauda equine syndrome?
vertebral fracture or dislocation; epidural haematoma
what are some infective causes of cauda equina syndrome?
epidural abscess; tuberculosis
what are some malignant causes of cauda equine syndrome?
metastases and primary CNS malignancies
what are the disease mechanisms involved with degenerative changes to the intervertebral disc causing disc herniation?
gelatinous NP replaced with fibrous tissue, unable to bear compressive forces. weight transferred to AF causing fissures to develop. If fissure reached IV disc peripheries there is a risk of NP herniation
what are the disease mechanisms involved with age related changes to the intervertebral disc causing disc herniation?
annular tears occur when the water content of IV disc declines with age, reducing tension in the AF.
what are some other causes of lumbar IV disc herniation?
jobs involving heavy lifting, contact sport injuries, following trauma to the vertebral column
