Exam 1 Flashcards
Bony ankylosis is the result of which stage of subluxation degeneration?
Stage 3
“Phase of stabilization”
Which nerve is most likely affected by anterior rotation of the atlas?
- Hypoglossal
- Spinal accessory
- Vagus
- Optic
Vagus
Which structure is responsible for determining the direction of the motion of the motion segment?
- facet joint
- IVD
- costovertebral joint
- occiput
facet joint
Motion of the sacrum during gait is called?
Nutation and Counternutation
Which is the term for soft tissue returning to its normal shape after a load has been removed?
- Eccentric
- Elasticity
- Stretch
- Plasticity
Elasticity
Injury to which ligament places the patient at greatest risk of compressive myelopathy?
- Alar Ligament
- Apical Ligament
- Transverse Ligament
- Nuchal Ligament
Transverse Ligament
Accumulation of metabolic wastes, histamine, bradykinins, and cytokines is which component of the subluxation theory?
Pathobiochemisty
proinflammatory nociceptive irritants
Which tract is most lateral in spinal cord?
- spinocerebellar
- dorsal column
- Anterolateral system
- spinoreticular tract
Spinocerebellar
or lateral spinothalamic?
How does a subluxation alter the normal size and shape of the IVF?
When there is a posterior and inferior component, the elliptical shapeof the IVF becomes irregularly shaped and alteration of the anterior and posterior dimension will effect the nerve roots
Which is the most reliable sign of a nerve compression lesion?
fibrofatty consolidation
Which option describes a ligamentous fixation?
Chroniclly sore or asymptomatic fixation that seldom cavitates
Which term best describes changes in the vertebral endplate, the shape of the facet joints and the strength of the ligamentous resulting from the subluxation inflammation?
pathoanatomy
contraction of the rectus captious posterior muscle has what effect?
together: head extension
alone: lateral flexion ipsilateral
Disc block subluxation is caused by
nuclear shift
nucleus shifts position with IVD
annular fibers become inflamed and protrusion of the disc puts pressure on the nerve root or spinal cord
lack of ability to fully depolarize the nerve roots in a zone of compression is called…
???
Which nerve root is both sensory and motor for the brachioradialis reflex?
C6
What structure dissipates force within a joint and protects the joint margins?
meniscoids
How does the dentate ligament cord distortion hypothesis explain changes in the inferior vertebral alignment from upper cervical adjustment?
spinocerebellar tract distortion results in abnormal reception of spinal position
What is the inferior boundary os the IVF?
Pedicle of inferior vertebra
Compression of the vessels supplying the nerve roots results in which phenomenon?
microcirculation ischemia
Which of these causes increased concentration of metabolic wastes in the blood and tissues at a site of subluxation?
Extraavaation of fluid
Which structure is the fulcrum or pivot point for vertebral motion?
nucleus pulposes
Loss of the nutritive inhibition of the IVD results in…
inflammation and circumferential tearing
Which nerve root is responsible for skin sensation along medial leg and medial foot
L4
Blockage of venous drainage results in…
- as blood backs up on the venous side, the increase in pressure blocks oxygenated blood from flowing into capillaries, increases permeability of vessels, extravasation of fluid (edema), micro hemorrhage
- water then leaves the blood on venous side and concentration of metabolic wastes increases
- blood can now reverse flow and transport metabolic wastes back through the capillary
What is the purpose of the aggregate protein in cartilage?
Attract water to lubricate the collagen fibers
Which ligaments connects the odontoid process to the foramen magnum?
Alar ligament
Excessive motion in some directions and decreased motion in others is called…
aberrant motion
What is the significance of an increases atlantodental interspace?
indicates anterior translation instability
What is true about motion in the spine?
increased ROM = increased stability
Deformation and distortion of spinal cord is greater as a result of what?
atlas laterality
What covering is the continuation of dura mater covering peripheral nerves?
Perineurium
What does it mean to be “in pattern”?
The patient is no longer adapting to the environment
Muscular fixation is commonly associated with which type of motion?
Articular fixation
Where is the maximum distortion in the spinal cord?
Posterior spinal cord tracts from direct compression
or
lateral spinal cord tracts at atlas
Which of these results in supine short leg?
Spinocerebellar tract distortion and submaximal muscle contraction
Which is true of capillaries?
nerve capillaries are longer than other capillaries
restriction of the nerve root within the IVE causing traction and compression due to what structure?
transforaminal ligaments
nerve roots arising from which region of the spine arise then drop down then rise up and exit?
cervical
which of these is most likely DIRECT results of upper cervical adjustment?
????
Superior border of IVF
Pedicle
Posterior border of IVF
Z joint
Anterior border of IVF
Posterior aspect of body and disc
contents of IVF (6)
nerve root spinal artery spinal vein lymphatics transforaminal ligamnet loose adipose and areolar
How does the size and shape change when a vertebra sublimates?
- posterior and inferior
- IVF become irregular shaped (not elliptical anymore)
- alteration of anterior and posterior dimension will affect nerve roots
What are the transformational ligaments (TFLs)?
sturdy dense collagenous bands that cross the IVF, holds contents of IVF together
What purpose do TFLs serve?
divide IVF into separate compartments surrounding the nerve root to fix nerve root in constant position
T/F
nerve roots exit superior and horizontal ligament and blood vessels exit inferior
FALSE
nerve root = inferior
blood vessels and ligament = superior
T/F
Cervical path is superior
FALSE
cervical path is inferior
T/F
Thoracic path is in the middle
TRUE
T/F
Lumber path is inferior
FALSE
lumber path is superior
Why do nerve roots have different approach to IVF in different regions of spine?
cervical: slack for arm movement
thoracic: tethered because lack of movement
lumber: path of caudal equina
T/F
Compression of peripheral nerves causes a great variation in conduction velocity because there is a reduction in conduction velocity at site of compression.
FALSE
causes a SLIGHT variation in velocity
T/F
Normal conduction exists prior to the zone of compression and distal to the zone of compression
TRUE
T/F
peripheral nerves require less compression to get same effect as pressure required to block nerve roots
VERY FALSE
nerve root is covered in…
dura mater
very susceptible to compression
peripheral nerves covered in…
epineurium and perineurium
not as susceptible to compression
How are nerve capillaries different than those in the rest of the body?
nerve capillaries are wider, longer, less musculature on arteriole side
Why are never capillaries beneficial?
easily reduce blood flow through capillaries
What moves blood through the capillary?
low pressure gradient
What process makes nutrient waste exchange possible?
simple diffusion
What is retrograde blood flow?
reverse blood flow
What causes retrograde flow?
accumulation of fluid
What is the results of retrograde flow?
transporting waste back into capillaries increases concentration of waste and may diffuse back into tissues. acts as a pro-inflammatory nociceptive irritant
What is the results of chronic compression of a nerve?
fibrotic changes
What anatomical changes happen to a nerve that is chronically compressed?
demyelination of axons
fibrosis of epineurium
alter axon shape
What is the double crush phenomenon
nerve may be compressed at 2 or more sites
(individual compression are asymptomatic, but when both are along the course of a single nerve will results in peripheral nerve symptoms
Winsor’s hypothesis
minor curves of spine (scoliosis) led to sympathetic malfunction resulting in visceral pathology
