Clinical Anatomy: Vertebral Column and Pelvis Flashcards
What is the mechanostat theory about?
Increases are seen in bone mass when the load is increased to the bone.
Opposite is also true for astronauts.
What is the effect of immobilization on bone?
According to Wolff’s law immobilization leads to atrophy which leads to poorer mechanical properties in bone.
What causes loss of bone that occurs in later life?
Many factors none act independently:
Lack of calcium in diet
Lack of oestrogen/testosterone (post-menopausal women, anorexia nervosa, amenorrhoeic athletes and dancers)
Lack of exercise and weight bearing
What are the segments of the intervertebral discs?
The annulus fibrosus (rings of collagen around the nucleus pulposus)
The nucleus pulposus contains glycosaminoglycans and collagen fibrils
How do intervertebral discs receive their nutrition?
Originally they have a direct blood supply but with maturation the disc end plates calcify and become ischaemic
What is Scheuermann’s disease?
Considered to be a form of juvenile onset osteochondrosis of the spine but the aetiology is debatable.
These people cannot consciously control their posture and the apex of their posture is located in the thoracic vertebrae. However, it causes both neck and lower back pain.
How can Scheuermann’s disease be treated?
With surgical procedures which include spinal fusion and hardware instrumentation.
What is scoliosis?
Abnormal spine curvature which causes rotation and lateral deviation of the spine
How can scoliosis be treated?
Using a brace. However, this will not reverse or cure scoliosis, instead it will prevent further scholiosis.
Another method that isn’t as restrictive is electrical stimulation of the deep paraspinal muscles.
What actions provide the worst stresses on intervertebral discs?
Combined movements:
Compression + Shear or torsion
What other causes of back pain can arise from the spine?
Facet joint pain/syndrome
How can facet joint pain/syndrome be treated?
Using NSAIDs or direct injections with steroids
What is spondylolisthesis?
Slipping of a vertebra out of position. Causes vary, some people are born with defective vertebra, others experience injury or repeated sub-threshold trauma.
When is surgery indicated for spondylolisthesis?
When pain is extreme or there is severe spinal damage.
What is a wedge fracture?
Wedge fractures occur to the vertebral bodies and are often the result of a forced flexion trauma (fall from height, car accident, very heavy lifting)
How are wedge fractures treated?
Conservative treatments are possible but for extreme cases stabilisation and fusion surgeries can be done.
What is intervertebral disc degradation?
Degradation of the nucleus over time which causes:
Narrowing of the intervertebral space
Stenosis of the intervertebral foramen and nerve root compression
Reactive changes in facet joints with inflammation
Increased loading on the annulus leading to mechanical limitations on the vertebral column
What is piriformis syndrome?
Sciatic nerve passes below or between fibers of piriformis muscle causing mechanical entrapment of the nerve.
What are the symptoms of piriformis syndrome?
Radiation of pain down the thigh in a way that is similar to nerve root entrapment without obvious pathology. Tenderness is felt under the buttock region.
How is piriformis syndrome treated?
Stretching in mild cases and corticosteroid injection and local anaesthetics in severe cases
