Lecture 3 back ppt (part 1) Flashcards
1) Where does the vertebral column start and end?
2) How many vertebrae are there in each section of the spine?
1) Goes from cranium to the apex of the coccyx
2) C7, T12, L5, S5, Co4
True or false: Back pain is one of the most common ICD-10 diagnoses
True
Name 6 things the vertebral column does
1) Main support of the axial skeleton
2) Protects the spinal cord and nerves
3) Supports weight of body superior to sacrum
4) Rigid-flexible axis for body
5) Pivots the head
6) Posture for body
1) What is a major stress point of the vertebral column?
2) What part(s) of the vertebral column allow for significant amount of motion?
1) Lumbosacral angle
2) Superior 25 vertebrae, most in cervical
What two sections of the spinal column is most motion in?
Cervical and lumbar
Which vertebrae are fused? What are these called?
1) 5 sacral vertebrae are fused; sacrum
2) 4 coccygeal vertebrae fused; coccyx
What are two characteristics of the presacral vertebrae?
1) IV disc provide flexibility
2) Zygapophysial synovial joints
What does presacral mean?
The 24 vertebrae above the sacrum
1) How much of vertebral column height is made up of vertebral bodies?
2) How much of the vertebral column height is made up of IVDs?
1) Vertebral bodies = ¾ height of spine
2) IV disc = ¼ height of spine
What 3 things provide stability to the vertebral column?
1) Shape and strength of vertebrae and IV disc
3) Ligaments
4) Muscles
What are the 4 curves of the adult spine? Which are primary and which are secondary?
Primary: Thoracic and sacral kyphosis
Secondary: Lumbar and cervical lordosis
List the 4 curves of the adult spine from top to bottom. Specify whether each is primary or secondary
1) Cervical lordosis, secondary
2) Thoracic kyphosis, primary
3) Lumbar lordosis, secondary
4) Sacral kyphosis, primary
1) What is a developmental condition that can cause abnormal spinal curvature?
2) What is a pathologic condition that can cause abnormal spinal curvature?
1) Scoliosis
2) Osteoporosis
What is kyphosis?
Aka a “Dowager hump”, an abnormal increase in thoracic kyphosis curve.
Define lordosis
An anterior rotation of pelvis, causing an abnormal increase in the lumbar lordosis curve
What kind of curve is scoliosis?
Lateral and rotation
List 2 potential causes of lumbar lordosis
1) Weak anterolateral abdominal wall
2) Pregnancy
What are the 3 components of a typical vertebrae?
1) Body
2) Arch (contains pedicle & lamina)
3) 7 processes
1) What are the endplates of a vertebral body covered in?
2) What is the epiphyseal rim made of?
3) Where on the column do vertebral bodies increase in size?
1) Hyaline cartilage
2) Bone
3) T4-S1
Name 2 features of a vertebral body
1) Endplate
2) Epiphyseal rim
What are the 2 features of a typical vertebral arch? List and describe them
1) Paired pedicles: Connect arch to body; form vertebral notches and adjacent vertebral notches for intervertebral foramen
2) Paired lamina: Unite at midline
1) Define vertebral foramen
2) What do vertebral notches form
3) What is typically between vertebral bodies?
1) Spinal canal where spinal cord resides
2) Intervertebral (IV) foramina
3) IV disc
List the 7 processes of a typical vertebrae
1) Spinus process (dorsal)
2&3) Paired transverse processes
4,5,6,7) Paired superior and inferior articular processes
What forms the zygapophyseal (facet) joints of the spinal column?
Paired superior and inferior articular processes
What do the paired superior and inferior articular processes of the vertebrae form?
Zygapophyseal (facet) joints
What are the two foramen found in cervical vertebrae, and what runs through them?
1) Large triangular vertebral foramen: spinal cord and cervical nerve roots
2) Foramen transversarium (absent C7): vertebral artery & vein, and sympathetic nerves
What is unique about C7?
It doesn’t have a foramen transversarium (unlike the other cervical vertebrae)
Do cervical and thoracic spinal nerves exit via the intervertebral (IV) foramen above or below their same numbered vertebra?
1) Cervical: exit IV foramen above the same numbered vertebra
2) Thoracic: exit IV foramen below their corresponding vertebra
1) What is the atlas?
2) What shape is it?
3) What does its transverse ligament do?
4) What does it allow for?
1) The first cervical vertebrae (C1)
2) Ring shaped
3) Separates vertebral foramen from foramen for dens (C2)
4) Allows flex/ext. of cranium (nodding yes)
What allows flexion/ extension of the cranium? What does this look like?
The atlas (C1); nodding “yes”
1) What is the axis?
2) What is unique about the axis?
3) What does its dens do?
4) What does this allow for?
1) C2
3) It’s the strongest
3) Dens (odontoid) articulates with anterior arch of Atlas and transverse ligament
4) Rotation of head and Atlas about the AXIS as in “NO”
What allows for rotation of the head and atlas? What does this look like?
The axis; shaking your head “no”
Does the axis itself rotate?
No
1) What is a Jefferson’s fracture of Atlas?
2) How can this happen?
1) Vertical force is applied down on the head, causing the lateral masses of the atlas fracture
2) Diving into shallow water and hitting your head
What vertebrae is most likely to fracture if you dive into shallow water and hit your head?
The atlas (C1)
1) What are two unique features of the thoracic vertebrae?
2) What is a unique feature of T1-10 specifically?
1) The bodies have 1 or 2 bilateral Costal facets for ribs, and they have a smaller vertebral foramen
2) T1-T10 have transverse costal facet for ribs
1) Where are bilateral costal facets for the ribs found?
2) Where are transverse costal facets for ribs found?
1) Thoracic vertebrae
2) T1-10
What part of the spine has a smaller vertebral foramen?
Thoracic region
1) Describe the length of the transverse process (TP) of the thoracic vertebrae
2) Describe the length of the spinous process (SP) of the thoracic vertebrae. What does it overlap with and what can’t it access?
1) TP: long, diminish from T1 to T12
2) SP: long, overlaps with sub adjacent Vert body (can not access Subarachnoid space)
1) Describe the size of the vertebral bodies and vertebral foramens of the lumbar vertebrae
2) Where does the spinal cord end in adults?
3) Describe the length of the cauda equina
1) Bodies are massive, vertebral foramens are large
2) L1-2 in adults
3) Extends full length of Vertebral canal
1) What exits each intervertebral (IV) foramen of the lumbar vertebrae?
2) What is the preferred site to access epidural space for anesthesia & SA space for CSF collection?
1) Spinal nerves
2) Below L2 (since spinal cord ends there), between L3-L4 or L4-L5
1) What is a common condition that affects the lumbar spine?
2) What does it result in?
3) What causes it?
1) Spondylolysis
2) Results in low back pain
3) Patients have defect in pars interarticularis of neural arch (lamina between the two articular processes)
Spondylolysis occurs in what vertebrae?
Lumbar
Define claudication
Pain or discomfort in legs that’s aggravated by movement and relieved by rest
1) What is lumbar stenosis?
2) What are its symptoms? Describe the speed of onset as well
3) What makes it feel worse? What makes it feel better?
1) Narrowing of the lumbar spinal canal compressing the spinal nerves
2) Slowly progressive neurogenic claudication (progress from proximal to distal) causing radicular symptoms (with or without LBP) in one or both legs
3) Aggravated by extension of the spine; alleviated by flexing the spine (ex: leaning over on shopping cart)
If a patient comes in complaining of radiating leg pain progressing from their upper to lower legs when walking that’s relieved by bending over (like leaning on a shopping cart), what condition might they have?
Lumber stenosis
What do spina bifida, meningoceles, and meningomyeloceles have in common?
They all result from incomplete closure of the neural tube
1) What makes up the sacrum?
2) What does the sacrum do?
1) 5 Wedge shaped fused bodies
2) Transmits body weight to Pelvic Girdle thru sacral-iliac joints
What do the sacral-iliac joints do?
Transmit body weight to pelvic girdle
1) What is the base of the sacrum?
2) What is this the location of?
1) The superior surface of S1
2) Lumbo-sacral articulation
Describe the anterior and sides of the sacrum
Sacral promontory is the anterior edge of S1 body, and the pelvic surface is smooth and concave
What is the sacral promontory?
The anterior edge of the S1 body
1) Describe the texture and shape of the dorsal side of the sacrum
2) What is found on its surface?
3) What are the 3 sacral crests?
4) What is the sacral hiatus? What does it lead to?
1) Rough and convex
2) 4 pair of foramina
3) Median, intermediate, lateral
4) Inferior end of vertebral canal that leads into sacral canal
1) What leads into the sacral canal?
2) What side of the sacrum is the sacral hiatus found on?
3) What side of the sacrum are the sacral crests found on?
1) Sacral hiatus
2) Dorsal
3) Dorsal
1) What is the coccyx a remnant of?
2) Are its vertebrae fused?
3) What is its clinical significance?
1) Vestigial tail
2) Distal 3 vertebrae fuse in mid life
3) Can palpate it rectally
1) What is the Conus medullaris?
2) Where does it terminate in newborns?
3) What about in adults?
1) The terminal, inferior end of the spinal cord
2) Newborn: opposite L2/3 IV disc
3) Adult: opposite L1/2 IV disc
What are the symptoms of cauda equina syndrome?
1) Acute or gradual onset of low back pain
2) Pain that radiates down the leg
3) Numbness around the anus
4) Loss of bowel or bladder control
Define etiology
Cause
1) What are the 2 potential causes of cauda equina syndrome?
2) What can those be caused by?
1) Disc herniation or spinal stenosis
2) Cancer, trauma, epidural abscess or hematoma
If a patient with an epidural abscess suddenly complains of loss of bowel or bladder control, what might be the cause? What might be the cause of that?
Cauda equina syndrome secondary to disc herniation or spinal stenosis (caused by their epidural absess)
If a patient with a history of lower spinal trauma (below L1/2) suddenly complains of numbness around the anus and radiating pain down their leg, what might be the cause? What might be the cause of that?
Cauda equina syndrome secondary to disc herniation or spinal stenosis (caused by their previous spinal trauma)
