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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
where does the spinal chord run
in spinal canal formed by the vertebral foramina
26
where is the cauda equina found
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
27
how do spinal nerves (formed form anterior and posterior (dorsal) roots) exit the spinal canal
via the intervertebral foramen
28
where does the spinal chord end
conus medullaris (tip of spinal chord) at L1
29
what symptoms does compression of cauda equina produce (cauda equina syndrome)
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
30
what forms mixed spinal nerves
anterior and posterior (dorsal) nerve roots
31
describe the nerve roots in the lumbar spine
(cauda equina) sensory and motor nerve roots run together with 2 pairs at each level susceptible to compression
32
what do upper motor neurones cause when compressed
weakness, spasticity, increased tone, hyperreflexia
33
what do lower motor neurones (connect stem to muscle cells) cause when compressed
weakness, flaccidity, loss of reflexes
34
what nerve would a far lateral disc prolapse affect
the exiting nerve root
35
what nerve would a central compression affect in the spinal chord
thecal sac and traversing root (going to lower level)
36
what is the path of the exiting nerve root
outside the thecal sac, passes under the pedicle of the corresponding vertebra (e.g. L4 root passes under L4 pedicle)
37
what is the path of the traversing nerve root
in thecal sac, positioned anteriorly in lateral recess (in prep to penetrate the thecal sac and becoming next exiting nerve root)
38
is if the exiting or traversing root that is commonly affected in a disc prolapse
traversing (so L5 root affected in L4/5 prolapse, S1 compressed in L5/s1 prolapse)
39
what does nerve compression result in
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
what is sciatica
radiating pain down sensory distribution of sciatic nerve root (dermatome) in the lower limb
41
what myotome allows hip flexion
L2,3
42
what myotome allows hip extension
L5,S1
43
what myotome allows knee extension
L3,4
44
what myotome allows knee flexion
L5,S1
45
what myotome allows dorsifelxion
L4,5
46
what myotome allows plantar flexion
S1,2
47
what myotome allows foot inversion
L4,5
48
what myotome allows foot eversion
L5, S1
49
what nerve roots contribute to sciatica
L4,5 and S1 (plus S2,3)
50
what is spinal stenosis
when nerve roots are compressed by osteophytes in osteoarthitis and hypertrophied ligaments in OA
51
what are the feature of neurogenic claudication
radiculopathy or burning leg pain on walking (seen in spinal stenosis)
52
what is myelopathy
an injury to the spinal cord due to severe compression that may result from trauma, congenital stenosis, degenerative disease or disc herniation
53
what is cauda equina syndrome caused by
pressure (usually prolapsed disc) on all lumbosacral nerve roots at level of lesion including sacral nerve roots for bladder and bowel control
54
what exam must you do if you suspect cauda equina syndrome
PR
55
what are the msucles of the erector spinae
iliocostalis longissium thoracis spinalis thoracis
56
what do the muscles of the erector spinae allow
flexion and extension
57
what ligaments contribute to spinal stability
``` anterior longitudinal lig posterior longitundinal lig ligamentum flavum supraspinous lig interspinous lig ```
58
what happens when bones are in tact but ligaments torn (chance fracture)
spine very unstable, creates gibbus deformity (kink in spine), may need surgical stabilisation
59
where should you try to do lumbar puncture and spinal anaesthesia
posterior iliac crest L4 to avoid the spinal chord | PSIS S2
60
what are the bone causes of back pain
fracture (trauma, osteoporosis) spondylolistesis tumour infection
61
what are the joint causes of back pain
spondylosis and OA | spinal stenosis
62
what are the muscle and ligament causes of back pain
sprains and strains
63
what are the disc causes of back pain
discogenic back pain sciatic cauda equina syndrome
64
what is the most common cause of back pain- describe it
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
what might mechanical back pain be related to
obesity, poor posture, poor lifting technique
66
what is the treatment for mechanical back pain
analgesia, physio, chiropractor, pain clinic NO SURGERY
67
what are back pain red flags
history of cancer, weight loss, night sweats, bladder/bowel problems
68
what causes of back pain can be helped by surgery
discectomy or decompression good fro sciatica/ leg pain which doesn't settle with 3 months conservative management
69
how can you tell radiating mechanical back pain from sciatica
sciatica shouldn't go past knee
70
what is the special features of C1
facet for articulation with occipital bone
71
what movement does the atlanto-occipital joint do
nodding head
72
what is the special feature of C2
ondontoid process (dens)
73
what type of joints are facet joints
synovial
74
what type of joints between the vertebral bodies
cartilaginous joints
75
what are the ligaments of the vertebral column
``` posterior longitudinal ligament anterior longitudinal ligament ligament between flavum (between laminae) supraspinatus ligament interspinous ligament ```
76
what spinal nerves form plexuses
anterior rami of spinal nerves
77
what are the three layers of meninges covering the spinal cord
pia matar arachnoid mater dura matar

MSK (71 decks)

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