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MSK > Clinical Anatomy: Spine > Flashcards

Clinical Anatomy: Spine Flashcards

1
Q

how many vertebrae

A

33

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2
Q

what are the sections of the vertebral column

A 
7 cervical 
12 thoracic 
5 lumbar
5 sacral (fused)
4 coccygeal (fused)
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3
Q

what are the normal 4 curves of the spine

A

cervical (lordosis)
thoracic (kyphosis)
lumbar (lordosis)
sacral (kyphosis)

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4
Q

when do kids develop secondary spine curves

A

at about 1 year- when start walking develop a lordosis in the lumbar spine

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5
Q

what is atypical about vertebra prominens (C7)

A

no foramena transeverse process (does not transmit the vertebral artery)

has long spinous process that is non bifid (rounded tubercle)

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6
Q

what are the components of the intervertebral discs

A

annulus fibrosus surrounding inner gelatinous nucleus pulposus

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7
Q

what movements happen at the spine joints

A

flexion, extension and lateral flexion at facet joints and intervertebral discs- cumulative effect

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8
Q

why is there less flexion/ extension in the thoracic spine

A

constraint of the ribs

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9
Q

why is lumbar rotation less than thoracic rotation

A

more vertically orientated facet joints

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10
Q

what part of spine allows the greatest movement, why?

A

cervical spine, more horizontal facet joints

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11
Q

what happens to water content in the intervertebral discs over time- what does the lead to

A

decreases- overload facet joints, second degree OA

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12
Q

in what position is OA pain the worst

A

when spine extended- standing up straight

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13
Q

is OA usually multilevel or in one area of the spine

A

multilevel

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14
Q

what is a role of the annulus pulposus

A

distribute stress and weight load

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15
Q

where is degeneration with age most commonly seen in the spine

A

L4/5 and L5/S1

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16
Q

why is MRI not diagnostic for intervertebral disc age degeneration

A

as asymptomatic people will have e.g. bulging discs, disc extrusion, nerve root compression

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17
Q

where are you most likely to get acute disc prolapse

A

L4/5 or L5/S1

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18
Q

what causes an acute disc prolapse

A

lifting heavy object- annulus tear- may/ may not feel twang- nerve symptoms

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19
Q

what is an acute disc prolapse

A

when nucleus pops out of annulus fibrosis

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20
Q

what are the symptoms of an acute disc prolapse

A

pain on coughing

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21
Q

what is the treatment of an acute disc prolapse

A

most settle within 3 months with physio and conservative therapy

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22
Q

why is surgery avoided in acute disc prolapses

A

due to proximity to spinal chord

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23
Q

where do motor neurones originate from

A

anteriorly- bodies in anterior grey horn

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24
Q

where do sensory neurones originate from

A

dorsally- bodies in dorsal root ganglion

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25
Q

where does the spinal chord run

A

in spinal canal formed by the vertebral foramina

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26
Q

where is the cauda equina found

A

cauda equina can be found in the bottom third of the spinal canal and from the T12/L1 vertebrae to the coccyx, beyond the conus medullaris into the lumbar region

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27
Q

how do spinal nerves (formed form anterior and posterior (dorsal) roots) exit the spinal canal

A

via the intervertebral foramen

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28
Q

where does the spinal chord end

A

conus medullaris (tip of spinal chord) at L1

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29
Q

what symptoms does compression of cauda equina produce (cauda equina syndrome)

A

bowel and/or bladder dysfunction

lower back pain and sensory/ motor defects

lower limb weakness and sensory defects

sexual dysfunction

bilateral lower motor neurone signs

saddle anaethesia

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30
Q

what forms mixed spinal nerves

A

anterior and posterior (dorsal) nerve roots

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31
Q

describe the nerve roots in the lumbar spine

A

(cauda equina) sensory and motor nerve roots run together with 2 pairs at each level susceptible to compression

32
Q

what do upper motor neurones cause when compressed

A

weakness, spasticity, increased tone, hyperreflexia

33
Q

what do lower motor neurones (connect stem to muscle cells) cause when compressed

A

weakness, flaccidity, loss of reflexes

34
Q

what nerve would a far lateral disc prolapse affect

A

the exiting nerve root

35
Q

what nerve would a central compression affect in the spinal chord

A

thecal sac and traversing root (going to lower level)

36
Q

what is the path of the exiting nerve root

A

outside the thecal sac, passes under the pedicle of the corresponding vertebra (e.g. L4 root passes under L4 pedicle)

37
Q

what is the path of the traversing nerve root

A

in thecal sac, positioned anteriorly in lateral recess (in prep to penetrate the thecal sac and becoming next exiting nerve root)

38
Q

is if the exiting or traversing root that is commonly affected in a disc prolapse

A

traversing (so L5 root affected in L4/5 prolapse, S1 compressed in L5/s1 prolapse)

39
Q

what does nerve compression result in

A

a radiculopathy resulting in pain down the sensory distribution of the nerve root (dermatome)

weakness in any muscle supplied- myotome

reduced/ abscent reflexes (LMN signs)

40
Q

what is sciatica

A

radiating pain down sensory distribution of sciatic nerve root (dermatome) in the lower limb

41
Q

what myotome allows hip flexion

A

L2,3

42
Q

what myotome allows hip extension

A

L5,S1

43
Q

what myotome allows knee extension

A

L3,4

44
Q

what myotome allows knee flexion

A

L5,S1

45
Q

what myotome allows dorsifelxion

A

L4,5

46
Q

what myotome allows plantar flexion

A

S1,2

47
Q

what myotome allows foot inversion

A

L4,5

48
Q

what myotome allows foot eversion

A

L5, S1

49
Q

what nerve roots contribute to sciatica

A

L4,5 and S1 (plus S2,3)

50
Q

what is spinal stenosis

A

when nerve roots are compressed by osteophytes in osteoarthitis and hypertrophied ligaments in OA

51
Q

what are the feature of neurogenic claudication

A

radiculopathy or burning leg pain on walking (seen in spinal stenosis)

52
Q

what is myelopathy

A

an injury to the spinal cord due to severe compression that may result from trauma, congenital stenosis, degenerative disease or disc herniation

53
Q

what is cauda equina syndrome caused by

A

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

54
Q

what exam must you do if you suspect cauda equina syndrome

A

PR

55
Q

what are the msucles of the erector spinae

A

iliocostalis
longissium thoracis
spinalis thoracis

56
Q

what do the muscles of the erector spinae allow

A

flexion and extension

57
Q

what ligaments contribute to spinal stability

A 
anterior longitudinal lig
posterior longitundinal lig 
ligamentum flavum
supraspinous lig
interspinous lig
58
Q

what happens when bones are in tact but ligaments torn (chance fracture)

A

spine very unstable, creates gibbus deformity (kink in spine), may need surgical stabilisation

59
Q

where should you try to do lumbar puncture and spinal anaesthesia

A

posterior iliac crest L4 to avoid the spinal chord

PSIS S2

60
Q

what are the bone causes of back pain

A

fracture (trauma, osteoporosis)
spondylolistesis
tumour
infection

61
Q

what are the joint causes of back pain

A

spondylosis and OA

spinal stenosis

62
Q

what are the muscle and ligament causes of back pain

A

sprains and strains

63
Q

what are the disc causes of back pain

A

discogenic back pain
sciatic
cauda equina syndrome

64
Q

what is the most common cause of back pain- describe it

A

mechanical- related to joints, ligaments and muscles no red flag features

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

65
Q

what might mechanical back pain be related to

A

obesity, poor posture, poor lifting technique

66
Q

what is the treatment for mechanical back pain

A

analgesia, physio, chiropractor, pain clinic

NO SURGERY

67
Q

what are back pain red flags

A

history of cancer, weight loss, night sweats, bladder/bowel problems

68
Q

what causes of back pain can be helped by surgery

A

discectomy or decompression good fro sciatica/ leg pain which doesn’t settle with 3 months conservative management

69
Q

how can you tell radiating mechanical back pain from sciatica

A

sciatica shouldn’t go past knee

70
Q

what is the special features of C1

A

facet for articulation with occipital bone

71
Q

what movement does the atlanto-occipital joint do

A

nodding head

72
Q

what is the special feature of C2

A

ondontoid process (dens)

73
Q

what type of joints are facet joints

A

synovial

74
Q

what type of joints between the vertebral bodies

A

cartilaginous joints

75
Q

what are the ligaments of the vertebral column

A 
posterior longitudinal ligament 
anterior longitudinal ligament 
ligament between flavum (between laminae)
supraspinatus ligament 
interspinous ligament
76
Q

what spinal nerves form plexuses

A

anterior rami of spinal nerves

77
Q

what are the three layers of meninges covering the spinal cord

A

pia matar
arachnoid mater
dura matar

MSK (71 decks)

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