Lecture 3.1

Question 1

What are the 2 main types of back pain?

Answer 1

Mechanical pain (muscles prains or disk prolapse)
Compressive pain (compression of a nerve root)

Question 2

Relative to their vertebrae which disks are the largest disks in the body?

Answer 2

Cervical disks are largest relative to the vertebral bodies

Question 3

What vertebrae are susceptible to anterior shearing forces?

Answer 3

Cervical and lumbar spine are particularly susceptible to anterior shearing forces

Question 4

What region of the vertebral column are common sites of damage?

Answer 4

Upper cervical and lumbosacral regions are common sites of damage.

Question 5

What is the benefit of having bigger disks?

Answer 5

Bigger disk permits greater movement.

Question 6

What disk is the largest disk of the body (in absolute terms)?

Answer 6

Largest disk is the lumbosacral disk.

Question 7

What vertebrae permit rotation?

Answer 7

Thoracic vertebrae permit rotation in the coronal plane. This rotation is limited by the ribs.
Cervical vertebrae don’t typically permit rotation. But the atlantoaxial vertebrae do.

Question 8

What are the consequences of hyperflexion of the back?

Answer 8

Hyperflexion stretches sciatic nerve and may cause nerve root pain.

Question 9

What is the consequence of hyperextension of the back?

Answer 9

Hyperextension increases stress on facet joints and may cause compression at the intervertebral foramen, particularly if there are osteophytes near that region.

Question 10

What structures in the back can extend?

Answer 10

Extension of the back happens in the lumbar spine.

Question 11

Can the spinal cord perform lateral flexion?

Answer 11

Small degree of lateral flexion in thoracic spine which is limited by the ribs

Question 12

What is the function of erector spinae in the back?

Answer 12

A prime mover responsible for returning flexed trunk upright.

They work eccentrically to control flexion.

They are not able to control flexion from a fully flexed posture.

Question 13

What is the function of transversospinalis? Where are they located?

Answer 13

These muscles are found between transverse and spinous processes.

They are short stabiliser muscles. They create minimal movement and control each segment on the spinal cord alone.

Question 14

What intrinsic back muscles fatigue with long period of standing?

Answer 14

erector spinae

Question 15

What is the function of the anterior abdominal wall muscles?

Answer 15

Muscles of anterior abdominal wall function to resist tension from abdominal viscera. They insert onto lumbar fascia of the back muscles assisting back in their function.

Question 16

What are the steps of typical back pain?

Answer 16

1) Injury to back structure
2) Muscle innervated by same nerve spasms
3) overlying skin becomes highly sensitized

Question 17

What structures are innervated by the recurrant meningeal nerve?

Answer 17

Recurrant meningeal nerve supplies outer 1/3 of the disk and the dura of the spinal cord.

Question 18

Why are nerve roots more likely to get compressed than the spinal cord?

Answer 18

Nerve roots get compressed rather than the spinal cord due to posterior longitudinal ligament and its expansions directing the expansion to the nerve root.

Question 19

What are the causes of compressive pain?

Answer 19

Herniated disk or stenosis

Question 20

Which nerve is injured when a disk prolapses?

Answer 20

The nerve passing below disk prolapse.

Question 21

Where are the most common sites of disk herniation?

Answer 21

L4/5 and L5/S1

Question 22

What are the symptoms of a pathogenic disk prolapse?

Answer 22

Pain, restricted movement at certain sites, and other signs such as muscle wasting of certain muscles.

Question 23

What are the more common injuries to the cervical spine?

Answer 23

Common injury to cervical spine include trauma related in F/E +/- impinging nerve roots in vertebral canal. Eg whiplash injury with acceleration of head in an antero/posterior direction.

Question 24

What are likely structures to be damaged as a result of whiplash injuries? When are these structures most endangered?

Answer 24

Facet joint capsule + articular surfaces + supporting ligaments. These structures are particularly endangered in hyperextension.

Question 25

What are the likely problems that can result from water loss from intervertebral disks?

Answer 25

Osteophytes can develop due to irritation of the edges of vertebrae caused by them rubbing against each other. This can cause stenosis and narrowing of intervertebral foramen.

Question 26

What prosthetics may be used to replace vertebrae?

Answer 26

cobalt polyethylene disks have been designed to replace degenerated disks.

Question 27

What are likely degenerative changes that can happen in the cervical spine, what is the consequence of their action?

Answer 27

Uncinate processes may come in contact with age and as a result may create bony proliferation and in turn these can irritate the nerve roots and the vertebral arteries.

Hypertrophy of intracanal structures

Question 28

What are the symptoms of nerve compression at lumbar or sacral spine?

Answer 28

Deep ching pain radiating to thighs aggravated by activity.

Difficulty walking.

Incontinence of urine and loss of sphincter tone.

Loss of sensation around vulva or anus.

Question 29

What are the symptoms of cauda equina compression?

Answer 29

Loss of reflexes for pelvic viscera.

Sensory loss involving sacral nerve. (saddle anaesthesia)

Question 30

What are the possible degenerative consequences in elderly that can result from a fracture in the front of vertebrae?

Answer 30

Excess kyphosis (due to fracture at the front of underlying vertebra.)

Question 31

What is ankylosing spodylitis?

Answer 31

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that targets the joints of the spine. It first affects the sacroiliac (SI) joint, where the spine attaches to the pelvis, and then starts to affect other areas of the spine.

Question 32

What are other causes of back pain?

Answer 32

Cardiovascular problems (eg. aortic aneurism)

Neoplasia (growth of new tissue eg tumours)

Infection

Question 33

What is a hangman fracture?

Answer 33

Hangman fracture is fracture of the pars interaricularis of c2

Question 34

How is a hangman’s fracture treated?

Answer 34

Halo neck-brace which requires 6 months to be taken off