clinical anatomy of the vertebral column Flashcards
What does the vertebral column consist of
33 vertebrae in total, 23 cartilaginous disks between them.
What are the functions of the vertebral column?
Upright position, assists with balance, shock absorbent and facilitates movement e.g. flexion and extension. Protects vertebral canal housing spinal cord.
How are the curves of the vertebral column seen?
sagittal plane
What type of joint is an intervertebral disc?
Fibrocartilaginous joint
What is the structure of the intervertebral disc?
Consists of an outer annulus fibrosus and inner nucleus pulposus
What keeps the intervertebral discs in place?
Anterior and posterior longitudinal ligaments form boundaries and provide stability. Anterior stronger. Anterior prevents hyperextension, posterior prevents hyperflexion.
Why do we “shrink” in height we get old?
Joint space narrowing, loss of muscle mass and tone, reduced volume of intravertebral disc
Why do the intervertebral discs not heal properly after injury?
Avascular and low cell density
what are the articulation points?
what are articular surfaces covered in?
Superior articular facets articulate with vertebrae above. Inferior with vertebrae below. Indirectly articulate via intervertebral discs.
Articular surfaces covered in hyaline cartilage.
important ligaments and what are they between?
: Ligamentum flavum – between lamina. Interspinous and supraspinous – spinous processes.
how to insert a lumbar puncture?
what are the layers the needle goes through?
causes of back pain
sinrim
why is back pain important?
Estimated that between 60 – 80% of the population have back pain at some point in their lives.
Very common presentation in both GP and ED.
Some presentations are chronic, some are medical emergencies.
HERNIATED INTERVERTEBRAL DISK
-> degenerative changes
-> age related changes
causes
most likely location
what is sciatica and how to test for it
->Gelatinous NP replaced with fibrous tissue
Unable to bear compressive forces.
Weight transferred to AF causing fissures over time.
Once fissure reaches peripheries of the IV disc, risk of NP herniation.
=> Annular tears occur when the water content declines with age, reducing tension in the AF.
Flexion of the spine (Bending over)
Jobs involving heavy lifting
Contact sport injuries
Trauma to the vertebral column
Mostly occur in lumbar region (L4-L5 or L5-S1 level)
Compress L5 or S1 part of sciatic nerve sciatica
Useful test: straight leg raise
Lower back pain (dull ache, worse with flexion)
Sciatica – pain or paraesthesia in the dermatomal distribution of sciatic nerve (nerve roots L4-S3) and weakness of those myotomes
Usually postero-lateral IV disc herniation, impinging on spinal nerve root
what type of herniation is often an emergency and why
Posterior herniation of IV disc is often an emergency: cauda equine syndrome or spinal cord compression (if above L1/L2
Patient is admitted with severe lower back pain, which came on all of a sudden. The pain is radiating down both legs and she is having difficulty walking.
How will you assess this patient systematically?
History vs neurological exam
which imaging technique?
History
PQRST: Pain at rest.
Low back pain, dull in nature.
Radiates down both buttocks, thighs and lower legs (radicular pain).
Acute onset (hours-days)
Urinary incontinence (S2-4)? Are you aware when your bladder feels full (urinary retention)?
Bowel incontinence (S2-4)?
Numbness around perianal region + buttocks? (saddle anaesthesia - S2-4)
Neurological Examination
Local tenderness? (lumbar spine)
Loss of sensation? (touch, pain, temperature) in dermatomes supplied by lumbar + sacral nerve roots.
Lower limb muscle weakness? (unilateral or paraplegia)
Loss of knee and ankle reflex (L3-4 and S1)
Saddle anaesthesia? (loss of sensation)
Loss of anal sphincter tone? (on PR exam) – S2-4
which imaging technique?
what is CAUDA EQUINA SYNDROME?
causes:
-degenrative
-traumatic
-infective
-malignant
symptoms
SPINE
Summary of Cauda Equina Syndrome (CES)
Definition:
Cauda Equina Syndrome is caused by severe compression of the lumbar and sacral nerve roots in the lumbar cistern, leading to serious neurological symptoms.
Key Risks:
- Permanent incontinence
- Sexual dysfunction
- Paraplegia
Importance:
Prompt diagnosis and surgical decompression are crucial to prevent lasting damage.
Causes (Aetiology):
1. Degenerative:
- Lumbar disc herniation (most common)
- Spondylolisthesis
2. Traumatic:
- Vertebral fracture or dislocation
- Epidural hematoma (trauma or post-surgery)
3. Infective:
- Epidural abscess
- Tuberculosis
4. Malignant:
- Metastases
- Primary CNS malignancies
what is this?
cause
ODONTOID PEG FRACTURE (C2).
Odontoid (peg) view plain film.
Lateral CT.
Caused by sudden severe flexion.
what is this?
cause
JEFFERSON FRACTURE (C1).
Caused by axial loading i.e. falling on head.
Atlas compressed between occiput and C2 with fracture of the lamina and pedicles.
what is this and what is it associated with?
FACET JOINT DISLOCATION (Example C4-C5)
These are rotational injuries, rarely occurring in isolation.
Associated with significant ligament injury, therefore unstable.
what is this?
what was it historically caused by/ how about now?
HANGMANS FRACTURE (C2)
Hyperextension leading to pedicle fracture.
Historically caused by hanging. In modern times seen in patient’s who have struck their head on the steering wheel during an RTC.
whiplash injury - what does it tear?
