DSA Thoracic and Lumbar Spinal Mechanics

Question 1

What are the junctions that are present in the spine?

Answer 1

Craniocervical Cervicothoracic Thoracolumbar Lumbosacral

Question 2

What are the points of the gravitational line?

Answer 2

External Auditory canal Head of the humerus L3 Anterior 1/3 of sacrum Lateral malleolus

Question 3

What are the two parts of the back that are in lordosis? Kyphosis?

Answer 3

Lordosis: Cervical and lumbar Kyphosis: Sacral and thoracic

Question 4

Describe the thoracic vertebrae in terms of 1. body 2. spinous process

Answer 4

1, medium sized, heart shaped, costal facets present 2. long, slope poster-inferiorly

Question 5

Describe the lumbar vertebrae in terms of 1. body 2. spinous process

Answer 5

1. large sized and kidney shaped 2. short and broad

Question 6

Define a vertebral unit

Answer 6

Two adjacent vertebrae associated intervertebral disc

Question 7

Describe the spinous processes of T1-T3, T12

Answer 7

Located at the level of the corresponding transverse process

Question 8

Describe the spinous processes that are located at T4-T6, T11

Answer 8

Spinous processes are 1/3 of a segment below the corresponding transverse process

Question 9

Describe the spinous processes that are located at T7-T9, T10

Answer 9

Spinous process located at the level of the spinous process as the one below

Question 10

What is the superior fact orientation of the cervical vertebrae?

Answer 10

Backwards Upwards Medial

Question 11

What is the superior fact orientation of the thoracic vertebrae?

Answer 11

Backwards Upwards Lateral

Question 12

What is the superior fact orientation of the lumbar vertebrae?

Answer 12

Backwards Medial

Question 13

Describe the anterior longitudinal ligament

Answer 13

strong, broad fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and IV discs Limits extension

Question 14

Describe the posterior longitudinal ligament

Answer 14

narrower, weaker band that runs within the vertebral canal along the posterior aspect of the vertebral bodies resists hyper flexion prevents posterior herniation of nucleus pulposus

Question 15

Describe the ligamentous flava

Answer 15

Connects the lamina of the adjacent vertebrae

Question 16

Describe the interspinous ligaments

Answer 16

Connects the adjoining spinous processes

Question 17

Describe the inter transverse ligaments

Answer 17

connects the adjacent transverse processes

Question 18

What are the transversespinalis muscles?

Answer 18

Rotatores (longus and brevis) Multifidus Semispinalis (semispinalis capitis, semispinalis cervicis, semispinalis thoracis)

Question 19

Define coupled motion

Answer 19

consistent association of a motion along or about one motion with another motion occurring along a second axis The principle motion could not be produced without the associated motion happening as well

Question 20

Who is Harrison Fryette?

Answer 20

A DO that described the physiologic motion of the spine published in 1918 developed 2 principles of spinal motion

Question 21

______ ______ developed the third Fryette principle in 1948

Answer 21

C.R. Nelson

Question 22

What is the first Fryette principle? (type 1 mechanics)

Answer 22

In the neutral range, side bending and rotation are coupled in opposite directions ***rotates towards the convexity (tends to be a group of vertebra)

Question 23

What is the second Fryette principle? (type 2 mechanics)

Answer 23

Flexion or extension, and side bending and rotation are coupled in the same direction *** rotates toward the concavity (tends to be a single vertebrae)

Question 24

What is Fryettes third principle?

Answer 24

Initating movement of a vertebral segment in any place will modify the movement of that segment in other planes of motion If motion is restricted in one motion it will be restricted in the other, and same with improvement

Question 25

What is scoliosis? What is it named towards?

Answer 25

Lateral curvature of the spine named toward the convexity -levo(left-obscures the heart) -dextro(right-frames the heart)

Question 26

What are possible physical exam findings of a patient that has scoliosis?

Answer 26

asymmetry of the sacral base or periscapular area rib cage prominence leg length discrepancies Cobb angle (high) forward bending test (see if there is a deformity)

Question 27

Describe the treatment of scoliosis based on varying Cobb angles 1. less than 25 degrees 2. 25-45 degrees 3. greater than 50 degrees

Answer 27

1. conservative; monitor with frequent X-rays 2. non-operative, bracing 3. surgical fusion, prevents progression

Question 28

What are the concerns of curves of the spine that are 1. above 50 degrees 2. above 75 degrees?

Answer 28

1. respiratory compromise 2. cardiac compromise

Question 29

What are 3 reasons of mechanical low back pain with radiation below the knee?

Answer 29

1. herniated nucleus pulposus 2. spinal stenosis 3. cauda equina

Question 30

What are the clinical features of herniated lumbar nucleus pulposus (L4-L5 disc herniation)

Answer 30

1. Pain in the sacroiliac joint, hip, lateral thigh, and leg 2. numbness in the lateral leg and the first three toes 3. weakness with dorsiflexion of the great toe and foot; difficulty walking on the heel 4. minor atrophy 5. diminished reflexes, specifically in the internal hamstring reflex

Question 31

Describe a disc herniation at the L5-S1 level

Answer 31

1. sacroiliac joint, hip, posterolateral thigh, leg to heel pain 2. numbness to the back of the calf, lateral heel, and foot to the toe 3. weakness in plantar flexion of the foot and the great toe with difficulty walking on the toes 4. atrophy of the gastrocnemius and soles 5. ankle jerk is diminished or absent

Question 32

Describe spinal stenosis

Answer 32

bilateral lower limb pain with possible impaired neurologic function chronic and needs an MRI work up

Question 33

Describe radiculopathy

Answer 33

pain along the dermatomal distribution may have neurologic dysfunction acute and can become chronic MRI work up

Question 34

Describe spina bifida 1. spina bifida oculta 2. meningocele 3. myelomenginocele

Answer 34

group of congenital anomalies where the neural tube failed to completely close 1. failure of the neural tube to close without herniation 2. failure of the neural tube to close with protrusions of the meninges through the defect 3. failure of the neural tube to close with protrusion of the meninges and spinal cord through the defect

Question 35

What are the things that you should look for when assessing a radiologic study of the back?

Answer 35

Vertebral bodies Lines (anterior, posterior lumbar regions as well as the spinous processes) Intervertebral discs

Question 36

Describe sacralization

Answer 36

one or both TPs of L5 are long and articulate with the sacrum

Question 37

Describe lumbarization

Answer 37

Failure of S1 to fuse with the rest of the sacrum

Question 38

What is pictured?

Answer 38

Spondylosis

Question 39

What is pictured?

Answer 39

Spondylosis

Question 40

What is pictured?

Answer 40

Spondylolithesis: one vertebrae slipping on another vertebrae

Question 41

List the sympathetic levels for all of the major body systems

1. Head/Neck
2. Heart
3. Lungs
4. Upper GI
5. Small intestine
6. Ascending and transverse colon
7. Descending and sigmoid colon
8. Adrenal
9. Genitourinary tract
10. Ureter
11. Extremities (upper and lower)

Answer 41

Head/Neck (includes upper esophagus)

T1-T5

Heart

T1-T6

Lungs

T1-T7

Upper GI (includes lower esophagus)

T5-T10

Small Intestine/Ascending Colon

T9-T11

Ascending and Transverse Colon

T10-L2

Descending and Sigmoid Colon/Rectum

T12-L2

Adrenal

T5-T10

Genitourinary tract (includes bladder)

T10-L2

Ureter – Upper/Lower

T10-T11/T12-L2

Extremities – Upper/Lower

T2-T7/T11-L2