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Ortho Test 1 > L Spine Patho > Flashcards

L Spine Patho Flashcards

1
Q

which spinal ligament is most implicated in chronic inflammation?

A

ligamentum flavum

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2
Q

what are the three ZPJ shapes?

A

flat, C, and J

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3
Q

how much load does a ZPJ take

A

14-20%

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4
Q

describe the cartilage consistency of the VE

A

fibrocartilage near the disc and hyaline cartilage near the bone

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5
Q

what is the principle source of nutrition for the root?

A

CSF, arteries provide 35%

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6
Q

what are the three sections of the lumbar vertebrae from A to P

A
  1. body 2. pedicle 3. laminae and processes
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7
Q

what are the characteristics of a healthy NP? (4)

A
  1. 85% water
  2. high GAGs (water attraction)
  3. T2 collagen (compression)
  4. high elastin

think opposite of healthy AF

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8
Q

why can coughing/sneezing cause pain?

A

sudden blood flow in the veins of the spinal canal can irritate the disc, dura, or neuro structures

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9
Q

what does the NP do

A

dissapates loads and protects the ZPJs

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10
Q

how do healthy endplates appear on radiograph? damaged endplates?

A

healthy: curved
unhealthy: flat and/or schmorls nodes

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11
Q

is chronic disc protrusion a tension or mobility problem?

A

mobility: tension reproduces sxs but alleviated by upstream tension

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12
Q

how does stenosis present and why

A

lateral recess stenosis irritates the DRG leading to pins and needles moreso than muscle weakness

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13
Q

what is a characteristic of flat ZPJs

A

hypermobility

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14
Q

what forms the intervertebral foramen? (3)

A

ZPJs, pedicles, disc

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15
Q

what is a characteristic of J ZPJs

A

anteriorly stable and can lead to arthritic changes

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16
Q

where is the NP gel, relatively speaking

A

posterior of the disc

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17
Q

what is the major function of the hoffman complex?

A

attaches the root via the dura to the vertebral body

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18
Q

where is the lateral recess?

A

anterolateral corner of the spinal canal

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19
Q

how much water is in healthy discs

A

70-90%

20
Q

which ZPJ allows for greatest motion in the transverse plane?

A

L5/S1

21
Q

describe the nerve roots within the lateral recess?

A

intraspinal yet extradural

22
Q

what is a GAG and what does it do

A

proteogylcans - attract water

23
Q

what is the significance of VE hyaline cartilage?

A

weakly binds the VE to the bone

24
Q

describe the concentric rings shape and function

A

65 degrees to prevent distraction, shear, and torsion

25
Q

how does the L5/S1 intervertebral foramen differ from the other lumbar spine? (2) how do these features impact pathology?

A
  1. the foramen is narrower
  2. the root is thicker
    A. most frequent site of nerve root compression due to foraminal stenosis
26
Q

what are the characteristics of an aged AF? (2)

A
  1. 50% water

2. T2 collagen (compression)

27
Q

what type of collagen makes up the AF

A

type 1 (superficial) and type 2 (deep)

28
Q

which is more susceptible to compression and chemical events and why, root or peripheral nerve?

A

root because peripheral nerves have protective epi/perineurium

29
Q

what are the two major implications of the lateral recess?

A
  1. most vulnerable spot for posterolateral disc protrusion

2. zone of stenosis in aging

30
Q

what is the significance of VE fibrocartilage?

A

strongly binds the disc to the VE

31
Q

which spinal ligament can produce nonradicular referred pain when irritated by disc protrusion?

A

PLL

32
Q

which ligament resists shearing and is highly connected to the vertebrae (but not the disc)

A

ALL

33
Q

is acute disc protrusion a tension or mobility problem?

A

tension: tension reproduces sxs

34
Q

what is the spinal recurrant nerve?

A

aka sinuvertebral nerve - provides local innervation of spinal segment with sympathetic and sensory fibers

35
Q

what are the characteristics of an aged NP? (4)

A
  1. 70% water
  2. low GAGs (water repulsion)
  3. T1 collagen (compression)
  4. low osmosis through VE and VE thinning

think healthy AF

36
Q

describe the cascade of events from damage to the VE (4).

A
  1. trauma/aging compromises endplate integrity
  2. nuclear material herniates into the vertebral body (schmorls nodes)
  3. outer annulus BS promotes inflammation and healing
  4. nutrient flow is reduced, flattening the endplates
37
Q

does the AF or NP have sensory fibers?

A

only the outermost layer of the AF

38
Q

are the DRG and root mechanosensitive?

A

DRG - yes

root - only when inflamed

39
Q

describe the neural structure divergence

A

dorsal and ventral roots > nerve > dorsal and ventral rami

dorsal rami > cutaneous/articular/motor nerves
ventral rami > sympathetic gang and recurrent nerve

40
Q

what are the characteristics of a healthy AF? (4)

A
  1. 60% water
  2. low GAGs (water repulsion)
  3. T1 collagen (tension)
  4. low elastin

think opposite of healthy NP

41
Q

what is a characteristic of C ZPJs

A

more stable and can lead to arthritic changes

42
Q

what increases ZPJ load? (3)

A

discectomy, aging, extension loading

43
Q

what does type 1 and type 2 collagen do?

A
  1. provides tension 2. provides compression
44
Q

how does ventral root herniation present?

A

muscle weakness without pain

45
Q

what are the three main functions of the VE?

A
  1. vertebral growth
  2. prevents NP bulging/absorbs hydrostatic pressure
  3. semipermeable layer for nutrient exchange
46
Q

what takes up the majority of the spinal canal space

A

veins

Ortho Test 1 (6 decks)

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