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Advanced Spine > M1-2 Class Notes > Flashcards

M1-2 Class Notes Flashcards

1
Q

What happens to the posterior annulus if the flexed position is maintained for many years?

A
  • distention
  • weak
  • cracked
  • decreased strength
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2
Q

What are the risks with a weakened posterior annulus?

A
  • Herniated disc
  • Decrease in tensile strength over years
  • Adaptive lengthening of noncontractile tissue
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3
Q

What changes happen to the anterior annulus with years in a flexed position?

A

Becomes compressed - NP pushed posteriorly

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4
Q

How might long term flexed position change one’s posture after many years?

A
  • Reduced lordotic curve
  • Adaptive lengthening of posterior musculature and ligaments
  • Adaptive shortening of anterior musculature and ligaments
  • Structural change in posture

*Can’t be fixed in one session of tx

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5
Q

Because only the fibers oriented in the direction of rotation become taut, what does this mean for the layers resisting rotation?

A
  • Only HALF of the layers are resisting rotation

- Every other layer will be taut or slackened in the same direction

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6
Q

What happens to the annulus during rotation and why?

A
  • Annulus layers tighten down like a screw and approximate the vertebral bodies
  • Because the layers are not elastic in nature
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7
Q

Which layers of the annulus tighten down during rotation?

A

The layers oriented in the direction of rotation

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8
Q

Which layers of the annulus are put on slack during rotation?

A

Annular layers oriented in the opposite direction

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9
Q

Which is the only ligament that is taut during extension?

A

ALL

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10
Q

Why is the ALL crucial to prevention of anterior slippage?

A
  • resists body weight that is mostly distributed in the anterior L-spine
  • Downhill slide of L5 of S1 caused by lumbar lordosis
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11
Q

What would happen if the ligamentum flavum buckled as opposed to having some elastic rebound?

A

Would protrude into the spinal canal and apply pressure to the SC

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12
Q

Ligamentum flavum: How is it positioned when the spine is in neutral?

A

LF is under a bit of tension

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13
Q

Why is the LF under tension in neutral spine?

A
  • If you were to go into more extension, it could retract some
  • Allows you to move into extension without relying solely on muscles
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14
Q

What would happen to the LF over time if you sit slumped?

A
  • LF adaptively lengthens
  • Lose passive support for extension
  • Muscles have to work harder
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15
Q

Which part of bone has an easier time with nutrient absorption and why?

A
  • trabecular

- easier for stuff to move in and out of webbing

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16
Q

Where is the pars located?

A

Where the lamina and pedicle meet

17
Q

Why is the pars under constant pressure?

A

BW pushed through facets to prevent anterior translation

18
Q

Why don’t you get anterior slippage with spondylolysis?

A

Rest of the vertebra holds it in place

  • facets
  • bony structures
  • connective tissues
19
Q

Rather than anterior slippage, what problems does a spondylolysis cause with respect to the contralateral side?

A
  • Creates more load on the other side

- Increased likelihood of the same problem on the other side » spondylolisthesis

20
Q

What radiographic view is used to dx a spondylolysis/spondylolisthesis?

A

Oblique

21
Q

Which grade of spondylolisthesis is the worst? How is it determined?

A
  • Grade 4

- determined by degree of slippage

22
Q

What happens to the vertebral body/facets with bilateral spondylolisthesis?

A
  • Inferior facet locked in place

- BW pushes vertebral body forward

23
Q

Difference between “spondylitic” and “degenerative” spondylolisthesis?

A
  • Spondylitic = pars fx

- Degenerative = articular surfaces eroded/thin » allows for anterior slippage and excessive lengthening of the pars

24
Q

Increased disc height = increased ______

A

Movement

25
Q

How does the annulus restrict movement?

A

Annulus acts as a ligament to prevent movement

26
Q

Outer annulus fibers are more (horizontal/vertical/oblique)

A

Vertical

27
Q

Inner layers of the annulus are more (vertical/horizontal/oblique)

A

Oblique

28
Q

What is the benefit to different orientations of fibers?

A

Give some resistance in every possible motion you could do

29
Q

What enables the NP to attract water and nutrients?

A

Hydrophilic nature of proteoglycans

30
Q

Aging diminishes the ability of the NP to ________

A

Imbibe water

Advanced Spine (50 decks)

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