MSK- Spine Flashcards
Identify the different bony prominences
What transmits the spinal cord and what level does the spinal cord end?
Vertebral foramen
L1, L2 is the start of the cauda equina
Identify characteristics of the cervical vertebrae
- Bifid spinous process (except C7)
- Transverse foramina
- Large triangular vertebral foramen
State 2 functions of the foramen transversium in the cervical vertebrae
- Transmits vertebral artery (except C7)
- C7 foramen transmits the accessory vertebral vein
Describe the structure of the C1 vertebra (atlas)
- No vertebral body (body is fused with axis to form dens)
- Widest cervical vertebra
- Thick vertebral arches
Describe the structure of the axis
- Odontoid process (/dens)
- Rugged lateral mass
- Large spinous process
What is the purpose of the dens and transverse ligament of the axis?
Dens and transverse ligament prevent horizontal displacement of atlas as well as the independent movement of C1 on to C2
Describe the structure of C7
- Longest spinous process
- Non-bifid spinous process
- Large transverse process is large
- Small transverse foramina
What is the ligamentum nuchae?
The ligament nuchae is a thickening of the supraspinous ligament
State three functions of the ligamentum nuchae
- Maintains secondary curvature of cervical spine
- Helps the cervical spine support the head
- Major site of attachment of neck and trunk muscles e.g. trapezius, rhomboids
Identify 3 characteristics of the thoracic vertebrae
- Demi-facets on vertebral body (whole facets T9-10)
- Costal facets on transverse processes (except T11-12)
- Small circular vertebral foramen
Describe the articulations of the thoracic spine
- Demi facets articulate with respective & inferior head of the rib
- Costal facets articulate with respective tubercle of rib
What is anterior cord syndrome?
Anterior cord syndrome is a condition where the anterior spinal cord artery is interrupted due to ischaemia/infarction of the anterior two-thirds of the spinal cord
Loss of spinothalamic modalities and motor function
What is central cord syndrome?
Central cord syndrome is a common cervical spinal cord injury resulting from neck trauma, leading to major injury to the central grey matter of the spinal cord
What is posterior cord syndrome?
Posterior cord syndrome is a rare condition caused by lesion of the posterior portion of the spinal cord or by an interruption to the posterior spinal artery
How do nerve roots exit the different regions of the spinal cord?
- Initially, nerve roots in cervical spine exit above their vertebral body until the C7/T1 junction
- After this junction, nerve roots exit below their vertebral body but above their respective intervertebral disc
What is cervical spondylosis?
Cervical spondylosis is a degenerative osteoarthritis of intervertebral joints in cervical spine
What are the symptoms of cervical spondylosis?
Sensory e.g. paraesthesia and pain
Myotomal motor weakness
Global weakness
Gait dysfunction & loss of balance
What are Hangman’s fractures and how do they occur?
- Hangman’s fractures are unstable fractures which occur due to hyperextension of head on neck
- Axis fractures through the pars interarticularis leading to the forward displacement of C1 & C2 on C3 (spondylisthesis)
What are Peg fractures and how do they occur?
- Peg fractures (odontoid fracture) occur due to a fracture through the odontoid process often due to a blow to back of head e.g. falling against a wall when balance is compromised
- ‘Open mouth’ X-ray = ‘peg view’
What are Jefferson’s fractures and how do they occur?
- Jefferson’s fractures are fractures of the anterior and posterior arches of the atlas often due to increased axial load e.g. diving into shallow water
- Typically causes pain can damage arteries at base of skullcausing neurological problems e.g. ataxia and Horner’s syndrome
What is whiplash injury?
A whiplash injury is a neck injury caused by sudden hyperextension and hyperflexion of the neck (high mobility, low stability)
What anatomy changes are associated with a cervical prolapsed intervertebral disc?
- Tear of the annulus fibrosis
- Migration of nucleus pulposus into the spinal canal
Which nerve is affected in a left sided C5/6 prolapsed intervertebral disc?
What will the patient complain of?
C6 nerve:
- Pain – biceps into thumb and index finger
- Sensory deficit – paraesthesia in thumb and index finger
- Motor weakness – biceps and wrist extension
Which nerve is affected in a left sided C7/T1 prolapsed intervertebral disc?
What will the patient complain of?
C8 nerve:
- Pain — medial two fingers
- Sensory deficit — paraesthesia in medial two fingers
- Motor weakness — finger flexion, finger extension
What will a patient complain of with a cervical myelopathy at C3/4?
- Pain — neck pain
- Sensory deficit — paraesthesia from shoulder down to feet
- Motor weakness — shoulder abduction
What will a patient complain of with a cervical myelopathy at C5/6?
- Pain – neck pain
- Sensory deficit – paraesthesia from shoulder down and feet
- Motor weakness – elbow flexion, wrist and finger movements
What is the clinical presentation of cervical myelopathy?
- Clumsiness
- Loss of fine motor movements
- Abnormal gait
- Loss of balance
What might a patient complain of in thoracic cord compression (T10 – tumour)?
- Pain – thoracic pain
- Sensory deficit – paraesthesia from umbilicus down, loss of sphincter control
- Motor weakness – weakness of all muscles in the legs
What might a patient complain of in thoracic cord compression (T5 - tumour)?
- Pain: high thoracic pain
- Sensory deficit: paraesthesia below the nipples and loss of sphincter control
- Motor weakness: weakness of all muscles in the legs and intercostals
Identify 2 lumbar vertebrae characteristics
- Large kidney-shaped vertebral bodies
- Triangular vertebral foramen
What are the distinctive features of the sacral vertebrae?
Fused vertebrae
Facets on lateral walls
What are the distinctive features of coccygeal vertebrae?
- Fused vertebral bodies
- No vertebral arches
- No vertebral canal (does not transmit the spinal cord)
What do the anterior and posterior longitudinal ligaments do?
Anterior
Prevents hyperextension
(thicker so its stronger)
Posterior
Prevents hyperflexion
(weaker)
Way to remember
A for anterior comes before P for posterior
E for extension comes before F for flexion
So, Anterior-extension, Posterior-flexion
Identify these ligaments and what they do:
- Ligamentum flavum
- Interspinous ligaments
- Supraspinous ligaments
- Inter transverse ligaments
Ligamentum Flavum
-Yellow, lamina to lamina
Interspinous ligaments
-Weak, fused with supraspinous
-Between spinous processes
Supraspinous ligaments
-Strong, white
-Between tips of spinous processes
Inter-transverse ligaments
-Bleds with muscles
-Between transverse processes
What is the function of the annulus fibrosis?
Major shock absorbed, surrounds nucleus pulposus
What is the structure of nucleus pulposus?
Remnant of notochord, gelatinous, type 2 collagen
Label the picture
Different types of disc prolapse?
- Lateral disc protrusion compresses nerve root above (5%)
- Paracentral disc protrusion compresses nerve root below (95%)
Paracentral herniation of the L4/5 disc, what root is compressed?
L5 root
Emerges above L4/5 disc
What is sciatica?
Compression of nerve roots which contribute to the sciatic nerve
What is cauda equina syndrome and the red flags?
Swelling and compression of the cauda equina
- Bilateral sciatica
- Perianal numbness
- Painless retention of urine
- Urinary / faecal incontinence
- Erectile dysfunction
What is lumbar spinal stenosis?
Spinal canal narrows and compresses at lumbar level
Due to tumour, disc herniation or osteoporosis
What is neurogenic claudication?
Due to lumbar spinal stenosis
Pain of legs when exercising
What is spondylolisthesis?
Slip forwards of the vertebrae above on the vertebrae below due to fracture in the pars interacularis
What are the following conditions?
- Spondylosis
- Spondylitis
- Spondylolysis
- Spondylolisthesis
Spondylosis
Age-related wear and tear to bones of the spine
Spondylitis
Inflammation of the joints of the spine
Spondylolysis
Fractures in pars interarticularis
Spondylolisthesis
Movement of one vertebrae relative to the ones above/below it
Describe the structure of the foetal vertebral column
Vertebral column is flexed in a C-shaped curvature (primary curvature) concave anteriorly (kyphosis)
Cervical lordosis appears when child begins to lift head
Lumbar lordosis develops when child begins to standup and walk
Describe the structure of the vertebral column in adults
Kyphoses
Thoracic and sacrococcygeal
Lordoses
Cervical and lumbar
Lumbar lordosis exaggerated in pregnancy
What is senile kyphosis?
Secondary curvatures disappear as you age
When doing a lumbar puncture where do you do it, why and what layers do you pass through?
L3-4 on the lateral side, to ensure you are at cauda equina level
SSS ILE DAS
Skin
Superficial fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum-THIS IS WHERE YOU HEAR THE POP
Epidural space
Dura mater
Arachnoid mater
Sub arachnoid
