Herniated Nucleus Pulposus

Question 1

Comprises the cartilaginous joint between adjacent vertebral bodies

-allows for mobility between adjacent vertebrae

Answer 1

Intervertebral disk

Question 2

The intervertebral disk functions as a

Answer 2

Shock absorber

Question 3

The outer portion of the intervertebral disk

Answer 3

Anulus fibrosis

Question 4

Composed of rings of fibrocartilage and fibrous connective tissue with a high collagen content

Answer 4

Anulus fibrosis

Question 5

The inner portion of the intervertebral disk is the

Answer 5

Nucleus pulposus

Question 6

Gelatinous in character, contains few cells, and is rich in proteoglycans

Answer 6

Nucleus pulposus

Question 7

There is a high water content bound in the nucleus pulposus, and this provides

Answer 7

Turgor (rigidity) to the disk

Question 8

Serves the function of distributing pressure throughout the disk when the vertebral column is weight bearing (i.e. upright posture)

Answer 8

Nucleus Pulposus

Question 9

What happens when you are standing upright?

Answer 9

Water is squeezed out of nucleus and the nucleus gets thinner

Question 10

When not weight bearing (i.e. when reclined), water returns to the nucleus and the disk gets

Answer 10

Thicker

Question 11

The thinning of the nucleus from water loss due to upright posture explains why we are

Answer 11

Taller in the morning than at night

Question 12

With age, there is a loss of proteoglycans in the nucleus pulposus and therefore the amount of bound water is

Answer 12

Reduced

Question 13

The loss of proteoglycans, and therefore water, from the nucleus pulposus explains what phenomenon of aging?

Answer 13

We get shorter

Question 14

The nucleus pulposus is not centrally positioned in the disk, but rather it is positioned towards the

Answer 14

Posterior side of disk

Question 15

Thinner posteriorly than it is anteriorly because of position of nucleus pulposus

Answer 15

Anulus fibrosus

Question 16

What can happen with degeneration of the anulus fibrosus and with pressure applied to the intervertebral disk during movement?

Answer 16

Anulus ruptures and nucleus pulposus can herniate through anulus

Question 17

Because the anulus is thinner posteriorly and because flexion of the spine stretches the posterior portion of the anulus and squeezes the nucleus pulposus posteriorly, the nucleus is much more likely to herniate in a

Answer 17

Posterior direction

Question 18

However, because the posterior midline of the disk is reinforced by the posterior longitudinal ligament, the nucleus is most likely to herniate in a

Answer 18

Posterolateral direction

Question 19

This posterolateral herniation can result in impingement on the roots of spinal nerves in either the

Answer 19

Lateral portion of vertebral canal, or in intervertebral foramen

Question 20

Compression of the spinal nerves (or spinal roots) may result in

Answer 20

Sensory/motor disturbance

Question 21

The location of these clinical findings will be in regions of distribution of these spinal nerve fibers known as

Answer 21

Dermatomes (for sensory findings) and myatomes (for motor findings)

Question 22

Formed by the apposition of adjacent intervertebral notches, i.e. the inferior notch of one vertebra with the superior notch of the next

Answer 22

Intervertebral foramen

Question 23

Anteriorly, the borders of the intervertebral foramen are

Answer 23

Body of vertebra above, intervertebreal disk, and body of vertebra below

Question 24

Posteriorly, the borders of the intervertebral foramen are the

Answer 24

Inferior articular facet of vertebra above, superior articular facet of vertebra below, and zygopophyseal joint

Question 25

Superiorly and inferiorly, the boundaries of the intervertebral foramen are

Answer 25

Pedicles

Question 26

A spinal nerve passes through each

Answer 26

Intervertebral foramen

Question 27

Named according to which intervertebral foramen it passes through

Answer 27

A spinal nerve

Question 28

At thoracic and lumbar levels, the nerve takes the name of the vertebra

Answer 28

Above the foramen

Question 29

Where does the L1 nerve pass through?

Answer 29

The foramen between L1 and L2

Question 30

At cervical levels, the nerve takes the name of the vertebra

Answer 30

Below the foramen

Question 31

Where does the C3 nerve pass?

Answer 31

The foramen between C2 and C3

Question 32

Where does the C8 nerve pass?

Answer 32

The foramen between C7 and T1

Question 33

Because the lumbar spinal nerve roots descend a considerable distance through the vertebral canal from their origin at the spinal cord to their exit at the intervertebral foramen, they exit through the

Answer 33

Upper portion of the foramen

Question 34

Forms the anterior border of the lower portion of the foramen

Answer 34

Intervertebral disk

Question 35

Thus, lumbar spinal nerves exit through their intervertebral foramina above the level of the

Answer 35

Intervertebral disk

Question 36

Therefore, it is likely that a small herniated nucleus pulposus at lumbar levels will not impinge on the

Answer 36

Spinal nerve exiting that foramen

Question 37

Will impinge on the nerve roots that are in the lateral recess of the vertebral canal, getting ready to exit through the next lower intervertebral foramen

Answer 37

Lumbar nuclear pulposus hernia

Question 38

Thus, a herniation of L3/L4 disk is likely to impinge on the roots of the nerve that will exit between

Answer 38

L4 and L5, (i.e. the L4 nerve)

Question 39

Says that if a herniated nucleus pulposus impinges on one spinal nerve, the nerve that will be impinged has the same name as the vertebra below the disk

Answer 39

The "clinical rule"

Question 40

The foramen is smaller and so the nerve occupies most of the foramen of

Answer 40

Cervical vertebrae

Question 41

At the cervical level, the disk forms the anterior border of the middle of the foramen, so the nerve impinged by the hernia is the nerve that -explains why the "clinical rule" holds for cervical vertebrae

Answer 41

Passes through that foramen

Question 42

A herniation of the C5/C6 disk is likely to impinge on the

Answer 42

C6 nerve

Question 43

May impinge on multiple nerves or nerve roots or even impinge on the spinal cord if above the L2 vertebral level

Answer 43

Larger or more medial hernias

Question 44

Forms the posterior border of the intervertebral foramen

Answer 44

Zygaphosphyseal joint

Question 45

Pathologies of the zygaphosphyseal joint may impinge on the

Answer 45

Nerve

Question 46

Similarly, thickening of the zygapophyseal joint capsule or of the ligamentum flavum may impinge on nerve roots in the

Answer 46

Foramen or canal

Question 47

What are two types of stenosis?

Answer 47

1. ) Foraminal stenosis | 2. ) Central Stenosis

Question 48

The narrowing of an intervertebral foramen

Answer 48

Foraminal Stenosis

Question 49

May be caused by a herniated nucleus pulposus, arthritic changes of zygaphosphyseal joints, inflammation or scarring of the foramen, or other reasons

Answer 49

Foraminal Stenosis

Question 50

Results in compression of spinal nerves

Answer 50

Foraminal stenosis

Question 51

The narrowing of the vertebral canal

Answer 51

Central stenosis

Question 52

Causes compression of the contents of the vertebral canal such as the spinal cord, the cauda equina, or individual spinal nerves, roots, or groups of nerves or roots

Answer 52

Central stenosis

Question 53

A region of skin that receives its sensory innervation from a single spinal nerve

Answer 53

Dermatome

Question 54

A lesion of one or more spinal nerves or dorsal roots will result in sensory symptoms that are referred to the

Answer 54

Dermatomes corresponding to the injured nerves or roots

Question 55

A group of skeletal muscles that receive their motor innervation from a single spinal nerve or ventral root

Answer 55

Myotome

Question 56

Although these motor nerve fibers may reach these muscles by way of various different peripheral nerves, nonetheless, they all arise from the

Answer 56

Anterior horn cells within a single spinal cord segment

Question 57

A lesion of one or more spinal nerves or ventral roots will result in motor symptoms (e.g. paresis, paralysis) in the muscles of the myotome corresponding to the injured

Answer 57

Spinal nerves or ventral roots

Question 58

Failure of pump mechanisms that pump water and waste products out of the nucleus pulposus and water and nutrients in can result in

Answer 58

Back pain

Question 59

May impinge on rootlets of multiple nerves below the level of the disk

Answer 59

Herniated nucleus pulposus

Question 60

Osteophytes from osteoarthritic zygapophyseal joint can encroach on intervertebral foramen and impinge on

Answer 60

Spinal nerves

Question 61

What are other names for the following sensory symptoms? 1. ) Tingling 2. ) Reduced sensation 3. ) Total numbness

Answer 61

1. ) Paresthesia 2. ) Hypesthesia 3. ) Anesthesia