lecture 5- spine

Question 1

curves of the spine

Answer 1

-2 Lordotic curves
-Kyphotic curves

We are just one big kyphotic curve when we are born.
As we weight bear we develop kyphotic curves.

Question 2

Vertebrae types

Answer 2

7 cervical
12 thoracic
5 lumbar
5 sacral (fused)
coccyx

Question 3

Features of the spine

Answer 3

• body (anterior mass)
• spinous process
• lateral (transverse) process
  –> articulations w ribs (thoracic spine)
  –> facet joints

Question 4

facet joints=

Answer 4

“little face”

-2 inferior, 2 posterior?

Question 5

C1 pivots/rotates on

Answer 5

C2

Question 6

cervical spine vertebral bodies are

Answer 6

small (not a lot of weight pushing down on them)

Question 7

lumbar bodies are

Answer 7

large (weight bearing)

Question 8

thoracic facet joints are oriented in which plane?

Answer 8

frontal plane

Question 9

cervical spine, thoracic, lumbar: rotation

Answer 9

cervical and thoracic= a lot of rotation
lumbar= flexion and extension

Question 10

Intervertebral discs: where are they, 2 components

Answer 10

lie between vertebral bodies

-annulus fibrosis (fibrocartilage)
-nucleus pulposus (gel)

Question 11

Intervertebral disks functions

Answer 11

shock absorbers
(stability and cushioning)

Question 12

Annulus fibres

Answer 12

15-25 concentric layers (born with them! don’t get more as you age “annually”!)

angled fibres

opposite direction of layers= good tensile strength

Question 13

Nucleus pulposus

Answer 13

high concentration of proteoglycan (protein fibres)= hydrophillic

draws fluid in to the nucleus pulposus

that is why you are taller when you wake up–> fluid accumutates in the nucleus pulposus overnight

Question 14

Joints: 2 types

Answer 14

Fibrocartilaginous
–> between vertebral discs and vertebral bodies

Synovial
–> facet joints (4 per vertebrae)

Question 15

liquids are incompressible, so when there is force down on your spine,

Answer 15

forces are radial in all directions

Question 16

forward bend: what load

Answer 16

axial load increased

Question 17

axial load greater: sitting or standing

Answer 17

sitting bc spine is tilted

Question 18

the further you lean forward,

Answer 18

the greater load on discs
-COM out of BOS= muscles in the back have to work harder to stabilize

Question 19

ligamenta flava has more

Answer 19

elastin (more stretchy)

Question 20

ligaments of the spine restrict

Answer 20

certain movements and stabilize the spine

Question 21

4 ligaments of the spine

Answer 21

1. Anterior and posterior longitudinal
   = connect vertebral bodies
2. Ligamenta flava
   = connect laminae
3. Intertransverse ligaments
   = connect transverse processes
4. Interspinous and supraspinous ligaments
   = connect spinous processes

Question 22

Muscles of the spine

Answer 22

Erector spinae- superficial
Transversospinalis- deep
many others…

Question 23

disc bulge/herniation come with

Answer 23

nerve related symptoms

Question 24

transversospinalis muscles tighten when we

Answer 24

have low back pain

–> tightness doesn’t go away when pain goes away= address tightness in treatment

Question 25

nerves are between each

Answer 25

vertebrae (nerve roots come off each side)

except cervical: 7 cervical vertibrae and 8 cervical nerves

Question 26

spine: dermatomes

Answer 26

sensory nerves at the skin correspond with a specific nerve root

Question 27

spine injuries: 4 causes

Answer 27

congenital predispositions

previous trauma

mechanical factors (poor posture, obesity)

acute or repetitive trauma

Question 28

spine injuries: effects

Answer 28

pain, tenderness, spasm, restricted ROM

neurologic symptoms
(sciatica, weakness, numbness…)

Question 29

Spine (sprain and strains) SSx

Answer 29

pain, tenderness
muscle spasm
restricted ROM
increased warmth

neurological Ssx= HOSPITAL!!!!

Question 30

Spine (sprain and strain) treatment (8)

Answer 30

-rest (supine), no more than 2 days
-NSAID/pain meds
-cold therapy at first
-heat therapy later
-physio/massage
-rehab program (flexibility strengthening, task-specific)
-correct predisposing factors
-gradual RTP

Question 31

explain lumbar disc herniation
- what
- where
- who is most vulnerable

Answer 31

nucleus pulposus breaks through annulus fibrosis

often at L4L5 and L5S1 levels

vulnerable between ages 30 to 50 bc elasticity and water in the nucleus pulposus decreased with age!!!!!

Question 32

4 stages of lumbar disc herniation

Answer 32

protrusion
prolapsed
extrusion
sequestered

Question 33

Disc protrusion (disc bulge)

Answer 33

cracks in annulus fibrosus appear

Question 34

Prolapsed disc

Answer 34

nucleus pulposus moves completely through the annulus fibrosis

Question 35

Extruded disc

Answer 35

nucleus pulposus moves into spinal canal, contacts the nerve root

Question 36

Sequestered disc

Answer 36

portion of nucleus pulposus separates from disc and migrates into spinal canal

Question 37

—% of disc herniations can reabsorb within a year

Answer 37

75

Question 38

Intervertebral disc disease: 3 mechanisms

Answer 38

same as sprains and strains.

herniation of nucleus pulposus.

compression of nerve root(s) or spinal cord

Question 39

What are the effects of intervertebral disc disease?

Answer 39

SSx same as sprains and strains, plus neurologic (sciatica etc.)

instability

osteoarthritis, osteophytes, steosis

Question 40

Intervertebral disc disease treatment

Answer 40

conservative if possible

surgical (discectomy, laminectomy, fusion)

Question 41

when we have a disc herniation

Answer 41

disc height decreases.
we lose disc material (nucleus pulposus), ligament stays the same length, therefore there is excess movement at the disc

–> increased stress at those areas, body will lay done more bone to try to stabilize
(intervertebral disc disease)

Question 42

discography contributes to

Answer 42

more rapid degeneration of the disc
(don’t really use this as an imaging method anymore)

Question 43

Brachial plexus neuropraxia “stinger or burner” Hx

Answer 43

stretching or compression of the brachial plexus

neck forced laterally

Question 44

Brachial plexus neuropraxia SSx

Answer 44

pain and numbness in fingers, tingling from shoulder to hand

lasts for several minutes

Question 45

Brachial plexus neuropraxia Tx

Answer 45

rest

if symptoms don’t go away, hospital

Question 46

Spine fractures: 2 causes

Answer 46

1. Axial load
   - cervical spine (head into boards in hockey, helmet to helmet in football)
   - 4th, 5th, 6th cervical vertebrae most common
2. Hyperextension

Question 47

Spine fractures: 3 SSx

Answer 47

point tenderness, decreased ROM

pain in neck, chest, extremities

numbness/weakness in trunk or limbs

Question 48

Spine fractures Tx

Answer 48

stabilize, c-spine collar, spine board

If unconscious, assume c-spine injury

Question 49

Management of back (spine) injuries

Answer 49

1. key is balance
   - demands w functional capacity, -realistic expectations/goals
2. mainstays
   - time!!
   - cold, heat, NSAIDs, braces
   -physio, massage, chiro
   -correct predisposing factors
   -may need to change job or sport

Question 50

McGill Big 3

Answer 50

= to build endurance in spinal stabilizers

–> bird dog, trunk raise, side plank
–> 10 sec activity, 2 sec rest
–> reps descend: 8-6-4 for example

Question 51

why should we not wear back braces?

Answer 51

increased muscle activity to support the spine bc muscles are trying to overcome the resistance of the brace

no decreased risk of back injuries

actually increased risk, esp if you have never had a back injury

if you have CVD, back braces increase bp

Question 52

when is the only time a back brace would be beneficial?

Answer 52

powerlifting, and only for the time period that they are performing the lift for!