Lumbar Spine, Clinical Conditions Flashcards
Identify the total number of vertebrae in the body, as well as how many are Cervical, Thoracic etc.
Which of these are fused together
Total- 33
Cervical: 7 Thoracic: 12 Lumbar: 5 Sacral: 5. Coccygeal: 4
Sacral and Coccygeal are fused
Name 4 functions of the vertebral column
- Support
- Protection (Spinal cord + Cauda Equina)
- Movement and posture
- Haematopoiesis
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?
- 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
What does the lamina do?
What does the pedicle do?
Lamina- Connects transverse to spinous process
Pedicle- Connects transverse process to vertebral body
What do you call the joint between the Superior and Inferior Articular process?
What kind of joint is it
Facet joint OR Zygapophyseal
Synovial joint
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
25%
Nucleus Pulposus and Annulus Fibrosus
Annulus Fibrosus
Describe the structure of the Annulus Fibrosus
Is it stronger than vertebral bodies
Outer Lamellae- Type 1 collagen
Inner Lamellae- Fibrocartilaginous
Avascular and aneural
YES
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
Gelatinous, made of Type 2 collagen
Water squeezed out due to mechanical pressure
Centrally located- Infant
Becomes more Posteriorly located - Adult
What are the major ligaments
Which is stronger
What are their functions
Anterior Longitudinal Ligament- Stronger and prevents Hyperextension
Posterior Longitudinal Ligament prevents Hyperflexion
Describe the location and relationship of the Anterior Longitudinal Ligament to the vertebrae
Runs anteriorly to vertebral bodies from C1 to Sacrum
United with periosteum of vertebrae, loosely attached and mobile over intervertebral discs
Describe the location and relationship of the Posterior Longitudinal Ligament to the vertebrae
What is its main clinical function?
What is this called
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
Describe the structure and connections of the Ligamentum Flavum
When is it stretched
High elastin content-> Appears yellow
Connects laminae of adjacent vertebrae
Flexion of spine
Describe the structure and connections of the Interspinous Ligaments
What other ligament are they connected to?
Weak sheets of fibrous tissue
Connect spinous processes along their adjacent borders
Connected to Supraspinous Ligaments
Describe the structure and connections of the Supraspinous Processes
Strong band of fibrous tissue
Runs along the tips of adjacent spinous processes
During Spinal Flexion;
which structures are under compression,
which are under tension
Compressed: Anterior Longitudinal Ligament, Vertebral bodies, Intervertebral discs
Tensed: Posterior Longitudinal Ligament, Ligamentum Flavum, Interspinous Ligament, Supraspinous Ligament
What is Primary Curvature
What is Secondary Curvature
How are the 2 secondary curvatures produced
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
Name the regions of the spine that show Kyphosis and Lordosis
Kyphosis: Thoracic and Sacrococcygeal
Lordosis: Cervical and Lumbar
What is Senile Kyphosis
What is it caused by
Re-establishment of primary curvature due to reduced disc height or osteoporotic fractures
Through which 4 sites does the Centre of Gravity of the body pass through
C1/2
C7/T1
T12/L1
L5/S1
What position should a patient be in for a lumbar puncture
At which vertebral level should a needle be inserted
- Lying on their side with the back and hips flexed (Knee to chest)
- Needle inserted between L3/4 or L4/5 vertebrae
What is Mechanical Back pain characterised by?
What are 4 risk factors
- By pain when spine is loaded, worsens with exercise and is relieved at rest
Obesity
Poor posture
Sedentary lifestyle
Incorrect manual handling techniques
What is Marginal Osteophytosis
How do Osteoarthritic changes develop
How do these affect the Intervebretal Foramina, Spinal nerves and what is this perceived as?
- 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)
Compare the 4 stages of Disc Herniation (Slipped disc)
- Disc degeneration: Discs dehydrate and bulge, due to chemical changes associated with aging
- Prophase: Protrusion of Nucleus Pulposus with slight impingement into Spinal Canal
- Extrusion: Nucleus Pulposus breaks through Annulus Fibrosus, but still in disc space
- Sequestration: Nucleus Pulposus separates from main disc body, enters Spinal Canal
What causes pain in a ‘slipped disc’
What are the 2 most common sites for slipped disc
- Herniated disc material pressing on a spinal nerve/ nerve root
- L4/5 and L5/ S1
Compare the 3 types of Disc Herniation
Which is most common
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
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
- 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
What is Sciatica
Which nerve roots contribute to the Sciatic nerve
- Pain caused by the compression/ irritation of 1+ of the nerve roots that contribute to the Sciatic nerve
- L4, L5, S1, S2, S3
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
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
What is Cauda Equina Syndrome
Name 5 possible causes
- When Lumbar and Sacral roots are compressed
- Central Disc Proplase
- Tumours in vertebrae/ meninges
- Spinal infection/ abcess
- Vertebral fracture
- Spinal stenosis
Name 5 symptoms of Cauda Equina Syndrome
When must this be treated and how
- Bilateral Sciatica
- Perianal numbness
- Painless urine retention
- Erectile Dysfunction
- Urinary/ Faecal incontinence
By surgery within 48 hours
What is Spinal Stenosis
Name 5 possible causes
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
In Which 2 regions of vertebral column are Spinal Stenosis most common?
Name 4 symptoms
Lumbar- Most common
Cervical
- Discomfort standing
- Numbness at/ below stenosis level
- Weakness at/ below stenosis level
- Neurogenic claudication
What is Neurogenic Claudication (a symptom)
What is it caused by?
How can it be relieved
- 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
What is Spondylolisthesis
What is Spondylolysis
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
