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ESA 2 SEMESTER 2 TK > MSK - Lumbar Spine Structure > Flashcards

MSK - Lumbar Spine Structure Flashcards

1
Q

How many vertebrae are there, and what groups are they divided into?

A

There are 33, and they are divided into cervical (7), thoracic (12), lumbar (5), sacral (5) and coccygeal (4)

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2
Q

How many of the vertebrae are discrete and capable of individual movement?

A

24

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3
Q

What are the functions of the vertebral column?

A
  • Provides central bony pillar of the body, supporting skull, pelvis, upper limbs and thoracic cage
  • protects spinal cord and cauda equina (acts as a conduit which cord can pass through, while still allowing nerve roots to leave)
  • allows movement
  • haemopoiesis takes place in the red marrow
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4
Q

Why do vertebral bodies increase in size inferiorly?

A

Due to increase in compression forces

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5
Q

What are the three movements of the lumbar spine?

A
  • flexion/extension
  • lateral flexion
  • rotation
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6
Q

What are the seven ‘processes’ found on the vertebral arch?

A
  • 1 spinous process
  • 2 transverse processes
  • 2 superior articular processes
  • 2 inferior articular processes
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7
Q

True or false - the vertebral body is made entirely of cortical bone?

A

False - it’s 10% cortical bone, 90% cancellous bone

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8
Q

What are the articular surfaces of the vertebral body covered with?

A

Hyaline cartilage

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9
Q

What is the gap created by the vertebral arch called?

A

Vertebral foramen

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10
Q

What connects the transverse process to the spinous process?

A

Lamina

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11
Q

What connects the transverse process to the body?

A

Pedicle

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12
Q

What sort of joint is found at the articulation of the superior and inferior articular processes?

A

Synovial (facet) joint

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13
Q

What is the function of the ‘facet’ joints of the articular processes?

A
  • prevents anterior displacement of vertebrae

- orientation determines amount of flexion and rotation permitted (moves easily in flexion, less easily in rotation)

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14
Q

What are the intervertebral discs composed of?

A

70% water, 20% collagen, 10% proteoglycans

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15
Q

How much of the length of the vertebral column is made up of intervertebral discs?

A

25%

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16
Q

What are the two regions of the intervertebral disc?

A

Nucleus pulposus and annulus fibrosus

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17
Q

What is the annulus fibrosus composed of?

A

Lamellae of annular bands in varying orientations. The outer lamellae are type 1 collagen, and the inner lamellae are fibro-cartilaginous. Avascular and anneural

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18
Q

What is the function of the annulus fibrosus?

A

Surrounds nucleus pulposus and acts as a shock absorber. It is highly resilient under compression

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19
Q

What is the nucleus pulposus derived from embryologically?

A

The notochord

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20
Q

What is the nucleus pulposus composed of?

A

Gelatinous, type 2 collagen with a high water content and high osmotic pressure.

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21
Q

True or false - the size of the nucleus pulposus is constant?

A

False - it changes in size throughout the day, and with age.

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22
Q

What are the five ligaments/ligament groups in the vertebral column?

A
  • anterior longitudinal ligament
  • posterior longitudinal ligament
  • ligamentum flavum
  • suprasponous ligament
  • interspinous ligament
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23
Q

Where is the anterior longitudinal ligament found?

A
  • Anterior tubercle of atlas to sacrum
  • united with periosteum of vertebral bodies
  • mobile over intervertebral discs
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24
Q

Where is the posterior longitudinal ligament found?

A
  • body of axis to sacral canal

- continues superior to axis as ‘tectorial membrane’

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25
Q

How are the functions of the anterior longitudinal ligament and the posterior longitudinal ligament different?

A

Anterior LL - prevents hyperextension

Posterior LL - prevents hyperflexion

26
Q

What is the ligamentum flavum?

A

Ligament which is found between laminae of adjacent vertebrae. Yellow in colour due to elastic fibres. Stretched during flexion of the spine

27
Q

What are the interspinous ligaments?

A

Relatively weak sheets of fibrous connective tissue which unite spinous processes along adjacent borders. Only well developed in the lumbar region. Fuses with supraspinous ligaments

28
Q

What are the supraspinous ligaments?

A

Strong bands of white fibrous tissue which connect the tips of adjacent spinous processes. They are tight in flexion and lax in extension.

29
Q

What does the sacrum articulate with?

A

L5 superiorly, ilium laterally and coccyx inferiorly

30
Q

Which has more vertebrae, the sacrum or the coccyx?

A

Sacrum has 5 fused vertebrae, coccyx has 4

31
Q

What is the name given to a curve posteriorly in the spine?

A

Kyphosis

32
Q

What is the name given to a curve anteriorly of the spine?

A

Lordosis

33
Q

What is the primary curvature of a foetus?

A

Single C-shaped kyphosis of vertebral column in the foetus

34
Q

What are the two kyphoses of the vertebral column?

A

Thooracic and sacrococcygeal

35
Q

What are the 2 lordoses of the vertebral column?

A

Cervical and lumbar

36
Q

How do the secondary curvatures develop in the child’s spine?

A
  • cervical lordosis develops when young child lifts head
  • lumbar spine loses primary kyphosis during crawling
  • lumbar lordosis develops when child begins to walk
37
Q

At which points in the vertebral column does the centre of gravity pass through it?

A
  • C1 and C2
  • C7 and T1
  • T12 and L1
  • L5 and S1

These are the ‘weak points’ of the vertebral column

38
Q

What is ‘senile kyphosis’?

A

This occurs when the secondary curvatures of the spine start to disappear and a continuous primary curvature is re-established

39
Q

What physiological change occurs to the spine during pregnancy?

A

Exaggeration of the lumbar lordosis

40
Q

Why are lumbar punctures always performed after the conus medullaris?

A

Only mobile spinal nerve roots present, not the cord - least chance of neurological damage

41
Q

What is mechanical back pain?

A

Pain which occurs when the spine is loaded - worse with exercise, relieved by rest

42
Q

What factors predispose someone to mechanical back pain?

A

Overweight, unhealthy lifestyle, deconditioned core muscles

43
Q

What is disc degeneration and marginal osteophytosis?

A
  • the nucleus pulposus can dehydrate with age, so the height of the IV disc decreases
  • load stresses on the IV disc alter, leading to reactive marginal osteophytosis adjacent to end plates
  • increased stress placed on facet joints, leading to osteoarthritis
  • decreased size of IV foramen leads to compression of spinal nerves
44
Q

What is disc degeneration?

A

Chemical changes associated with aging cause discs to dehydrate and bulge

45
Q

What is disc prolapse?

A

Protrusion of the nucleus pulposus with slight impingement into the spinal canal

46
Q

What is disc extrusion?

A

Nucleus pulposus breaks through annulus fibrosus but remains within the disc space

47
Q

What is disc sequestration?

A

Nucleus pulposus breaks through annulus fibrosus and separates from the main body of the disc in the spinal canal

48
Q

Whee does ‘slipped disc’ most often occur?

A

L4/5 or L5/S1

49
Q

How does slipped disc most commonly occur?

A

Herniates posterolaterally, causing compression of spinal nerve roots

50
Q

What are the three types of disc prolapse?

A
  • paracentral (96%)
  • far lateral (2%)
  • canal filling (2%)
51
Q

What is sciatica?

A

Compression of the nerve roots which contribute to the sciatic nerve

52
Q

Which nerve roots contribute to the sciatic nerve?

A

L4, L5, S1, S2, S3

53
Q

Where is L4 sciatica felt?

A

Anterior thigh, anterior knee, medial shin

54
Q

Where is L5 sciatica felt?

A

Lateral thigh, lateral calf, dorsum of foot

55
Q

Where is S1 sciatica felt?

A

Posterior thigh, posterior calf, heel, sole of foot

56
Q

Which age group of patients are most at risk of prolapsed intervertebral disc?

A

30 to 50 year olds

57
Q

What is cauda equina syndrome?

A

Disc fills canal and compresses lumbar and sacral nerve

58
Q

What are the symptoms of cauda equina syndrome?

A
  • bilateral sciatica
  • perianal numbness
  • painless retention of urine
  • urinary/faecal incontinence
  • sexual dysfunction
59
Q

What is lumbar canal stenosis?

A

Narrowing of the spinal canal, leading to compression of the spinal cord and nerves.

60
Q

What is claudication?

A

Pain in the legs when walking

61
Q

What is spondylolisthesis?

A

A slip forwards of one vertebra onto the vertebra below

62
Q

What is dysplastic spondylolisthesis due to?

A

Abnormality in the shape of the facet joints

ESA 2 SEMESTER 2 TK (87 decks)

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