Clinical anatomy of the spine Flashcards
What are common spine conditions?
Mechanical back pain and spondylosis
Facet joint arthritis
Multi-level degenerate back pain/ OA
Discogenic bacn pain
Disc prolapse, sciatica and radiculopathy
Spinal stenosis and bony root entrapement
Trauma and OA fracture
What are rare spine conditions?
Scoliosis Apondylolisthesis Ankylosing Spondylitis Beinign tumours - osteoid osteoma Malignant tumours - metastatic diseaes, multiple myeloma Discitis and osetomyelitis Cauda Equina Syndrome
What are the different sections of the spine?
C1-7 T1-12 L1-5 5 sacral fused 4 coccygeal fused
From what region will the vertebrae come from if they have a bifid process?
Cervical
What joints are in between the intervetebral joints?
Secondary cartilaginous joints - fibrocartilage joints
What does the facet joint connect in the spine?
Plane joints between the articular processes of two adjacent vertebrae
Each facet joint is innervated by the recurrent meningeal nerves
What movements can occur with a facet joint?
Flexion
Extension
Lateral flexion
How does OA occur in the spine?
IV discs lost water content from nucleous puloposa with aging leading to an oveload of weight on the facet joints
What type of movement will make spinal OA worse?
Extension
What is the structue of an IV disc?
Outer anulus fibrosis capsule to aid with weight bearing
An innter nucleus pulposus
Where are IV discs most likely to degenerate in the elderly?
L4/5 and L5/S1
How will an acute disc prolapse present?
Lifting of a heavy object can cause an annulus tear, feeling of a twang in back
The annulus tear means the nucelus pulposa can pop out and cause compression of the surrouding nerve roots
What type of nerve roots originate anteriorly?
Motor neurone roots
What type of nerve roots originate posteriorly (dorsal root ganglion)?
Sensory nerve roots
Where does the spinal cord run?
In the spinal canal formed by the vertebral foramina
Where do spinal nerves exit the spinal canal?
Intervertebral foamen
Where does the cauda equina start?
L1
Where does the exiting nerve root pass?
Outside the thecal sac, it will pass under the pedicel fo the corresponding vertebrae (L4 nerve root passes under L4 pedicle)
Where is the transversing nerve root in the spinal cord?
Remains in the thecal sac and is positioned anteriorly (lateral recess) to be able to penetrate the thecal sac and become the next extiting nerve root
What nerve is likely to be compressed in disc prolapse?
Transversing nerve root i.e. L5 root for L4/5 root prolapse and S1 root for L5/S1 prolapse
What symptoms will nerve root compression result in?
Radiculopathy resulting in pain down the sensory distribution of the dermatome (SCIATICA)
What clincal presentations will nerve root compression show?
Weakness in corresponding myotome
Reduced or absent reflexes
What nerve roots cause flexion of hip?
L2/3
What nerve roots cause extension of the hip?
L5/ S1
What nerve roots cause flexion of the knee?
L5/ S1
What nerve roots cause extension of the knee?
L3/4
What nerve roots cause dorsiflexion of the ankle?
L4/5
What nerve roots cause plantarflexion of the ankle?
S1/2
What nerve roots cause inversion of the foot?
L4/5
What nerve roots cause eversion of the foot?
L5/S1
Whta forms the the sciatic nerve?
L4-S3
Whta can cause spinal stenosis?
Nerve roots can be compressed by osteophytes and hypertrophied ligaments in OA
What symptoms will spinal stenosis cause?
Radiculopathy or burning of walking - neurogenic claudication
What will spinal cord compression cause?
Myelopathy and upper motor neuron signs
Babinski sign - fanning of toes on the extensor plantar response
What causes cauda equina syndrome?
Pressure (usually prolapsed disc) on all lumbrosacral nerve roots at level of lesion including sacral nerve roots for bladder and bowel control (S2,3,4)
What are the symptoms of cauda equina syndrome?
Bilateral lower motor neurone signs
Bladder and bowel dysfunction
Saddle anaesthesia
Loss of anal tone - ALWAYS PERFORM PR EXAM
What muscles make up the erector spinae muscles?
Iliocotalis
Longissimus thoracis
Spinallis thoracis
What are the ligaments of the spine?
Anterior and posterior longitudinal ligament
Ligamentum flavum
Supraspinout ligament
Interspinous ligament
What is a chance fracture?
Fracture of vertebral body with disruption of posteior ligmanets
This requires surgical stabilistaion
Where are lumbar punctures and spinal anaesthesia given?
Posterior iliac crest at L4
