DSA Thoracic and Lumbar Spinal Mechanics Flashcards
What are the junctions that are present in the spine?
Craniocervical Cervicothoracic Thoracolumbar Lumbosacral
What are the points of the gravitational line?
External Auditory canal Head of the humerus L3 Anterior 1/3 of sacrum Lateral malleolus
What are the two parts of the back that are in lordosis? Kyphosis?
Lordosis: Cervical and lumbar Kyphosis: Sacral and thoracic
Describe the thoracic vertebrae in terms of 1. body 2. spinous process
1, medium sized, heart shaped, costal facets present 2. long, slope poster-inferiorly
Describe the lumbar vertebrae in terms of 1. body 2. spinous process
- large sized and kidney shaped 2. short and broad
Define a vertebral unit
Two adjacent vertebrae associated intervertebral disc
Describe the spinous processes of T1-T3, T12
Located at the level of the corresponding transverse process
Describe the spinous processes that are located at T4-T6, T11
Spinous processes are 1/3 of a segment below the corresponding transverse process
Describe the spinous processes that are located at T7-T9, T10
Spinous process located at the level of the spinous process as the one below
What is the superior fact orientation of the cervical vertebrae?
Backwards Upwards Medial
What is the superior fact orientation of the thoracic vertebrae?
Backwards Upwards Lateral
What is the superior fact orientation of the lumbar vertebrae?
Backwards Medial
Describe the anterior longitudinal ligament
strong, broad fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and IV discs Limits extension
Describe the posterior longitudinal ligament
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
Describe the ligamentous flava
Connects the lamina of the adjacent vertebrae
Describe the interspinous ligaments
Connects the adjoining spinous processes
Describe the inter transverse ligaments
connects the adjacent transverse processes
What are the transversespinalis muscles?
Rotatores (longus and brevis) Multifidus Semispinalis (semispinalis capitis, semispinalis cervicis, semispinalis thoracis)
Define coupled motion
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
Who is Harrison Fryette?
A DO that described the physiologic motion of the spine published in 1918 developed 2 principles of spinal motion
______ ______ developed the third Fryette principle in 1948
C.R. Nelson
What is the first Fryette principle? (type 1 mechanics)
In the neutral range, side bending and rotation are coupled in opposite directions ***rotates towards the convexity (tends to be a group of vertebra)
What is the second Fryette principle? (type 2 mechanics)
Flexion or extension, and side bending and rotation are coupled in the same direction *** rotates toward the concavity (tends to be a single vertebrae)
What is Fryettes third principle?
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
What is scoliosis? What is it named towards?
Lateral curvature of the spine named toward the convexity -levo(left-obscures the heart) -dextro(right-frames the heart)
What are possible physical exam findings of a patient that has scoliosis?
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)
Describe the treatment of scoliosis based on varying Cobb angles 1. less than 25 degrees 2. 25-45 degrees 3. greater than 50 degrees
- conservative; monitor with frequent X-rays 2. non-operative, bracing 3. surgical fusion, prevents progression
What are the concerns of curves of the spine that are 1. above 50 degrees 2. above 75 degrees?
- respiratory compromise 2. cardiac compromise
What are 3 reasons of mechanical low back pain with radiation below the knee?
- herniated nucleus pulposus 2. spinal stenosis 3. cauda equina
What are the clinical features of herniated lumbar nucleus pulposus (L4-L5 disc herniation)
- 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
Describe a disc herniation at the L5-S1 level
- 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
Describe spinal stenosis
bilateral lower limb pain with possible impaired neurologic function chronic and needs an MRI work up
Describe radiculopathy
pain along the dermatomal distribution may have neurologic dysfunction acute and can become chronic MRI work up
Describe spina bifida 1. spina bifida oculta 2. meningocele 3. myelomenginocele
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
What are the things that you should look for when assessing a radiologic study of the back?
Vertebral bodies Lines (anterior, posterior lumbar regions as well as the spinous processes) Intervertebral discs
Describe sacralization
one or both TPs of L5 are long and articulate with the sacrum
Describe lumbarization
Failure of S1 to fuse with the rest of the sacrum
What is pictured?
Spondylosis
What is pictured?
Spondylosis
What is pictured?
Spondylolithesis: one vertebrae slipping on another vertebrae
List the sympathetic levels for all of the major body systems
- Head/Neck
- Heart
- Lungs
- Upper GI
- Small intestine
- Ascending and transverse colon
- Descending and sigmoid colon
- Adrenal
- Genitourinary tract
- Ureter
- Extremities (upper and lower)
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
