Clinical Anatomy of the Spine Flashcards
Mr P Davies
how many vertebrae do we have?
33
how many sections spine are there? name them.
5 section
7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccygeal (fused)
how many curves are in a healthy spine?
4 curves
name the 2 atypical vertebra. what do they allow?
atlas
axis
allow head rotation
what level is vertebra prominens? and what does this lack?
C7
No foramena transeverse process (veretbral artery)
what is the other name given to the intervertebral fibrocartilaginous joints
intervertebral disc
the intervertebral disc consists of 2 parts. name them.
anulus fibrosus
nucleus pulposus
outline the degree of movement in the cervical and lumbar spine
cervical - greatest movements as horizontal facet joints
lumbar is least as more vertically orientated
what do intervertebral discs lose with ageing?
water
pain is worse with _________ of the spine
extension
what can help spondylosis and osteoarthritis under fluoroscopy?
facet joint injections
OA in one or two motion segments of the spine can be treated with…
localised fusion
degeneration with age and the loss of H2O content occurs most frequently in what levels of the spine?
L4/5 and L5/S1
what test is not diagnostic of conditions in the spine?
MRI
acute disc prolapse in the spine most commonly at levels…
L4/5 or L5/S1
annulus tear can be a result of _______ _____ _______
lifting heavy objects
motor neurones originate __________ and the bodies are located in the anterior ____ ____ wheres sensory neurones originate ________ and their bodies are in the ______ ____ ________.
motor neurones originate ANTERIORLY and the bodies are located in the anterior GREY HORN wheres sensory neurones originate DORSALLY and their bodies are in the DORSAL ROOT GANGLION.
the spinal cord/cauda equine runs down the what?
spinal canal
what is the spinal canal formed by?
the vertebral foramina
where do the anterior and posterior dorsal roots from mixed spinal nerves exit via in the vertebrae?
intervertebral foramen
what is the cauda equine susceptible to?
compression
what level does the spinal cord end?
L1
what does the exiting nerve root pass under?
the pedicle of the corresponding vertebra (ie L4 root passes under L4 pedicle)
what is the exiting nerve root outside of?
the thecal sac
what does the transverse nerve root remain in?
the thecal sac
where is the traversing nerve root positioned?
anteriorly (in an area known as the lateral recess) in preparation to penetrate the thecal sac and become the next exiting nerve root more distally
where is the weak point on the disc?
posterior
With disc prolapse it is commonly what nerve root which is compressed?
the traversing nerve root
i.e. L5 root for L4/5 prolapse and S1 root for L5/S1 prolapse
what does Nerve root compression cause?
a radiculopathy
what does a radiculopathy result in?
pain down the sensory distribution of the nerve root (dermatome), which in the lower leg is known as Sciatica
what nerve roots contribute to the sciatic nerve?
L4, L5 & S1 nerve roots contribute to Sciatic nerve (along with S2 & S3)
common fibular and tibial nerve make up the sciatic nerve
define spinal stenosis
Nerve roots compressed by osteophytes and hypertrophied ligaments in OA
what does spinal stenosis result in?
radiculopathy or burning leg pain on walking = neurogenic claudication
walking down hill is difficult in someone with spinal stenosis
true or false?
true
Compression from thickening and arthritis – nerve roots don’t have adequate blood supply
what can spinal cord compression like a tumour or disc prolapse result in?
Myelopathy & upper motor neuron signs
cauda equina syndrome is caused by _______ on all ___________ nerve roots at level of lesion including sacral nerve roots for _______ ___ _____ control
cauda equina syndrome is caused by PRESSURE on all LUMBOSACRAL nerve roots at level of lesion including sacral nerve roots for BOWEL AND BLADDER control
what does cauda equine syndrome result in?
bilateral lower motor neuron signs
bladder and bowel dysfunction
saddle anaesthesia
loss of anal tone
name the 3 important muscles of the spine
Iliocostalis
Longissimus thoracis
Spinalis thoracis
a fractured vertebral body with disruption posterior ligaments with or without fracture of posterior elements is known as what?
chance fracture - very unstable
where do you want to avoid and where are you aiming gin a lumbar puncture?
avoid spinal cord
aim for equina area
