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Musculoskeletal > Clinical Anatomy of the Spine > Flashcards

Clinical Anatomy of the Spine Flashcards

1
Q

What are some features of the osteology of the spine?

A

33 vertebrae = 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), 4 coccygeal (fused)
4 curves of the spine = help maintain posture

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2
Q

What are the atypical vertebrae of the spine?

A

C1 and C2 (axis and atlas) = allow head movement

C7 (vertebral prominence) = no formena transverse process

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3
Q

What kind of joint are the intervertebral discs?

A

Intervertebral fibrocartilaginous joints

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4
Q

What kind of joints are zygapophysial joints?

A

Facet joints (synovial joints)

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5
Q

What movements do the facet joints and intervertebral discs allow?

A

Flexion, extension and lateral flexion = cumulative effect

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6
Q

Why is there less flexion and extension in the thoracic spine?

A

Ribs cause constraint

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7
Q

Why is lumbar rotation less than thoracic rotation?

A

Due to more vertically orientated facet joints

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8
Q

Why does the cervical spine allow the greatest movement?

A

Due to more horizontal facet joints

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9
Q

What happens to intervertebral discs with aging?

A

Lose water content = overload of facet joints and second degree osteoarthritis

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10
Q

What makes the pain of osteoarthritis and spondylosis worse?

A

Worse with extension of spine = facet joint injections with fluoroscopy can help

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11
Q

How can osteoarthritis in one or two motion segments be treated?

A

Localised fusion

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12
Q

What are some changes that can occur in intervertebral discs?

A

Outer annulus fibrosis and inner gelatinous nucleus pulposus

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13
Q

Where does degeneration of the intervertebral discs most commonly occur?

A

l4/5 and L5/S1 = also most common sites of slipped disc

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14
Q

What occurs in acute disc prolapse?

A

Lifting heavy object causes annulus tear, rich innervation to outer annulus, pain on coughing, most settle by three months

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15
Q

What do 60% of asymptomatic people over >45 show on an MRI?

A

Bulging disc = 10% have disc extrusion, 5% have asymptomatic nerve root compression

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16
Q

Where do motor nerves originate?

A

Anteriorly = bodies in anterior grey horn, (sensory neurons originate dorsally)

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17
Q

Where does the spinal cord run through?

A

Spinal canal = formed by vertebral column

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18
Q

What is formed from the anterior and posterior roots?

A

Mixed spinal nerve = exits via intervertebral column

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19
Q

How are sensory and motor nerve roots arranged in the lumbar spine?

A

Run together with two pairs at each level (susceptible to compression)

20
Q

Where does the spinal cord end?

A

L1

21
Q

What are some features of cauda equina syndrome?

A

Junctional upper motor neuron = weakness, spasticity, increased tone, hyperreflexia
Lower motor neuron = weakness, flaccidity, loss of reflexes

22
Q

Where does the exiting nerve root outside the thecal sac pass?

A

Under pedicle of corresponding vertebra

23
Q

Where are the transversing nerve roots located?

A

Pair whilst remaining in the thecal sac positioned anteriorly (in the lateral recess) in preparation to penetrate

24
Q

What nerve is commonly compressed in disc prolapse?

A

Transversing nerve root commonly

25
Q

What is compressed in a far lateral disc prolapse?

A

Exiting nerve root

26
Q

What does nerve root compression cause?

A

Radiculopathy resulting in pain down sensory distribution of nerve root (dermatome) = called sciatica when in lower leg
Also weakness in any muscle supplied (myotome) and reduced/absent reflexes

27
Q

What nerve roots contribute to the sciatic nerve?

A

L4, L5 and S1

Also S2 and S3

28
Q

What is sciatica?

A

Radiation of nerve pain along sensory distribution of sciatic nerve

29
Q

What can spinal stenosis cause?

A

Compression of nerve roots = usually by osteophytes and hypertrophied ligaments in osteoarthritis

30
Q

What is the pain of spinal stenosis like?

A

Radiculopathy or burning leg on walking = neurogenic claudication
Some cases benefit from surgical decompression

31
Q

What are some features of myelopathy?

A

Spinal cord compression (e.g tumour, disc prolapse)

Upper motor neuron signs

32
Q

What causes cauda equina syndrome?

A

Caused by pressure (usually prolapsed disc) on all lumbosacral nerve roots at level of lesion (including sacral nerve roots for bladder/bowel control)

33
Q

What are some symptoms of cauda equina syndrome?

A

Bilateral lower motor neuron signs, bladder and bowel dysfunction, saddle anaesthesia and loss of anal tone

34
Q

What are the erector spinae muscles?

A

Iliocostalis, longissimus thoracis, spinalis thoracis = source of sprains and strains

35
Q

What do the ligaments of the spine contribute to?

A

Stability

36
Q

What is a chance fracture?

A

Very unstable = fractured vertebral body with disruption to posterior ligaments with/without fracture of posterior elements

37
Q

How can a chance fracture be treated?

A

Surgical stabilisation

38
Q

What are the landmarks for lumbar puncture and spinal anaesthesia?

A

Posterior iliac crest (L4), PSIS (S2)

39
Q

What are some bone and joint causes of back pain?

A 
Bone = fracture, tumour, infection
Joint = spondylosis, osteoarthritis, spinal stenosis
40
Q

What are some muscular and disc causes of back pain?

A

Muscles and ligaments = sprains and strains

Disc = degenerative back pain, sciatica, cauda equina syndrome

41
Q

What does mechanical back pain relate to?

A

Joints, ligaments, and muscles = no red flag features

42
Q

What are some features of mechanical back pain?

A

Worse with activity, relieved by rest, tends to be long course relapsing and remitting

43
Q

What are some risk factors for mechanical back pain?

A

Obesity, poor posture, poor lifting technique

44
Q

How can mechanical back pain be treated?

A

Nothing can be done surgically = analgesia, physio, pain clinic, chiropractor

45
Q

What are some surgical treatments for back pain and what are they good for?

A

Discectomy/decompression, good for sciatica/leg pain which doesn’t settle with 3 months conservative management

46
Q

How are some negatives of doing an MRI of the spine?

A

False positives, middle aged (about age 45) asymptomatic patients will have signs so not specific, less specific in ageing patients

Musculoskeletal (57 decks)

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