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MSK > Lumbar Spine, Clinical Conditions > Flashcards

Lumbar Spine, Clinical Conditions Flashcards

1
Q

Identify the total number of vertebrae in the body, as well as how many are Cervical, Thoracic etc.

Which of these are fused together

A

Total- 33

Cervical: 7
Thoracic: 12
Lumbar: 5
Sacral: 5.        
Coccygeal: 4

Sacral and Coccygeal are fused

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2
Q

Name 4 functions of the vertebral column

A
  1. Support
  2. Protection (Spinal cord + Cauda Equina)
  3. Movement and posture
  4. Haematopoiesis
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3
Q

What is the normal shape of a vertebral body? How much is cancellous and compact

What structures are present in the vertebral arch? How many of them are there?

A
  • Kidney shaped, 10% cortical, 90% cancellous
2 Transverse processes
2 Superior Articular processes
2 Inferior Articular processes
1 Spinous process
2 pedicles
2 Lamina

2 superior and 2 inferior Vertebral notches

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4
Q

What does the lamina do?

What does the pedicle do?

A

Lamina- Connects transverse to spinous process

Pedicle- Connects transverse process to vertebral body

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5
Q

What do you call the joint between the Superior and Inferior Articular process?

What kind of joint is it

A

Facet joint OR Zygapophyseal

Synovial joint

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6
Q

How much of the vertebral column’s height is due to the interverbretal discs

What are the 2 regions?
Which is the major shocks absorber

A

25%

Nucleus Pulposus and Annulus Fibrosus
Annulus Fibrosus

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7
Q

Describe the structure of the Annulus Fibrosus

Is it stronger than vertebral bodies

A

Outer Lamellae- Type 1 collagen
Inner Lamellae- Fibrocartilaginous
Avascular and aneural

YES

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8
Q

Describe the structure of the Nucleus Pulposus

Why does it decrease in height throughout the day?
How does its location differ in infant and adult

A

Gelatinous, made of Type 2 collagen

Water squeezed out due to mechanical pressure

Centrally located- Infant
Becomes more Posteriorly located - Adult

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9
Q

What are the major ligaments
Which is stronger

What are their functions

A

Anterior Longitudinal Ligament- Stronger and prevents Hyperextension

Posterior Longitudinal Ligament prevents Hyperflexion

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10
Q

Describe the location and relationship of the Anterior Longitudinal Ligament to the vertebrae

A

Runs anteriorly to vertebral bodies from C1 to Sacrum

United with periosteum of vertebrae, loosely attached and mobile over intervertebral discs

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11
Q

Describe the location and relationship of the Posterior Longitudinal Ligament to the vertebrae

What is its main clinical function?
What is this called

A

Runs posteriorly to vertebral bodies from C2 to Sacral Canal

Reinforces the Annulus Fibrosus centrally, so that intervertebral disc prolapse tends to occur laterally.

This is a Paracentral Disc Prolapse

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12
Q

Describe the structure and connections of the Ligamentum Flavum

When is it stretched

A

High elastin content-> Appears yellow

Connects laminae of adjacent vertebrae

Flexion of spine

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13
Q

Describe the structure and connections of the Interspinous Ligaments

What other ligament are they connected to?

A

Weak sheets of fibrous tissue
Connect spinous processes along their adjacent borders

Connected to Supraspinous Ligaments

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14
Q

Describe the structure and connections of the Supraspinous Processes

A

Strong band of fibrous tissue

Runs along the tips of adjacent spinous processes

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15
Q

During Spinal Flexion;

which structures are under compression,
which are under tension

A

Compressed: Anterior Longitudinal Ligament, Vertebral bodies, Intervertebral discs

Tensed: Posterior Longitudinal Ligament, Ligamentum Flavum, Interspinous Ligament, Supraspinous Ligament

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16
Q

What is Primary Curvature
What is Secondary Curvature

How are the 2 secondary curvatures produced

A

Kyphosis- Anterior curvature (anterior concave)
Lordosis- Posterior Curvature (posterior concave)

When a child lifts its head, cervical spine develops a posterior concavity

During crawling, lumbar spine straightens out
When walking, lumbar spine develops lordosis

17
Q

Name the regions of the spine that show Kyphosis and Lordosis

A

Kyphosis: Thoracic and Sacrococcygeal

Lordosis: Cervical and Lumbar

18
Q

What is Senile Kyphosis

What is it caused by

A

Re-establishment of primary curvature due to reduced disc height or osteoporotic fractures

19
Q

Through which 4 sites does the Centre of Gravity of the body pass through

A

C1/2
C7/T1
T12/L1
L5/S1

20
Q

What position should a patient be in for a lumbar puncture

At which vertebral level should a needle be inserted

A
  • Lying on their side with the back and hips flexed (Knee to chest)
  • Needle inserted between L3/4 or L4/5 vertebrae
21
Q

What is Mechanical Back pain characterised by?

What are 4 risk factors

A
  • By pain when spine is loaded, worsens with exercise and is relieved at rest

Obesity
Poor posture
Sedentary lifestyle
Incorrect manual handling techniques

22
Q

What is Marginal Osteophytosis

How do Osteoarthritic changes develop

How do these affect the Intervebretal Foramina, Spinal nerves and what is this perceived as?

A
  • Decrease in disc height-> discs bulge-> Altered load stresses on joints-> Syndesmophytes develop adjacent to end plates of discs
  • Increased stress on facet joints-> Osteoarthritic changes
  • Decrease in size of intervertebral foramina, spinal nerves compressed, perceived as Radicular/ Nerve pain (Sciatica)
23
Q

Compare the 4 stages of Disc Herniation (Slipped disc)

A
  1. Disc degeneration: Discs dehydrate and bulge, due to chemical changes associated with aging
  2. Prophase: Protrusion of Nucleus Pulposus with slight impingement into Spinal Canal
  3. Extrusion: Nucleus Pulposus breaks through Annulus Fibrosus, but still in disc space
  4. Sequestration: Nucleus Pulposus separates from main disc body, enters Spinal Canal
24
Q

What causes pain in a ‘slipped disc’

What are the 2 most common sites for slipped disc

A
  • Herniated disc material pressing on a spinal nerve/ nerve root
  • L4/5 and L5/ S1
25
Q

Compare the 3 types of Disc Herniation

Which is most common

A

Paracentral Prolapse
-Nucelus Pulposus herniates at a diagonal angle away from the spinal canal

Central Prolapse
- NP herniates towards spinal canal

Far Lateral Prolapse
- NP herniates laterally into the intervertebral Foramen

Most common= Far Lateral

26
Q

What is the exiting nerve root
In which herniation type, is it at most risk

What is the traversing nerve root
In which herniation type, is it at most risk

A
  • Nerve root that emerges from spinal canal at same level as intervertebral disc
  • Far lateral
  • Nerve root that emerges from spinal canal at the level below the intervertebral disc
  • Paracentral
27
Q

What is Sciatica

Which nerve roots contribute to the Sciatic nerve

A
  • Pain caused by the compression/ irritation of 1+ of the nerve roots that contribute to the Sciatic nerve
  • L4, L5, S1, S2, S3
28
Q

In Sciatica, where is the pain experienced?

Outline the typical pain distribution if affected nerves are;

L4
L5
S1

If Parasthesia is also caused, will this be experienced in the entire path to Dermatome? Or only Dermatome

A

In the back and buttock, radiates to the Dermatome supplied by the affected nerve root.

L4: Anterior Thigh, Anterior Knee, Medial Leg
L5: Lateral Thigh, Lateral Knee, Dorsum of foot
S1: Posterior Thigh, Foot, Sole of foot

Only in affected Dermatome

29
Q

What is Cauda Equina Syndrome

Name 5 possible causes

A
  • When Lumbar and Sacral roots are compressed
  • Central Disc Proplase
  • Tumours in vertebrae/ meninges
  • Spinal infection/ abcess
  • Vertebral fracture
  • Spinal stenosis
30
Q

Name 5 symptoms of Cauda Equina Syndrome

When must this be treated and how

A
  • Bilateral Sciatica
  • Perianal numbness
  • Painless urine retention
  • Erectile Dysfunction
  • Urinary/ Faecal incontinence

By surgery within 48 hours

31
Q

What is Spinal Stenosis

Name 5 possible causes

A

An abnormal narrowing of spinal canal, that compresses either spinal cord or nerve roots

  • Disc bulging
  • facet joint arthritis
  • Ligamentum Flavum hypertrophy
  • Compresson fractures of vertebral body
  • Trauma
  • Spondylolisthesis
32
Q

In Which 2 regions of vertebral column are Spinal Stenosis most common?

Name 4 symptoms

A

Lumbar- Most common
Cervical

  • Discomfort standing
  • Numbness at/ below stenosis level
  • Weakness at/ below stenosis level
  • Neurogenic claudication
33
Q

What is Neurogenic Claudication (a symptom)
What is it caused by?

How can it be relieved

A
  • Pain and/or pins and needles in legs after prolonged standing, and in sciatic distribution after walking
  • Caused by compression of spinal nerves as they emerge from lumbosacral spinal cord. Leads to venous enlargement and arterial ischaemia
  • By rest, change in position and by spinal Flexion
34
Q

What is Spondylolisthesis

What is Spondylolysis

A

Anterior displacement of the vertebra above, relative to the vertebra below.

A fracture in the Pars Interarticularis (Between superior and inferior articular process) without displacement

MSK (21 decks)

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