MSK Spine Flashcards
Clinical course for neck/back pain
____ resolve by 1-2 weeks
____ resolve by 6-12 weeks
85% recur by:
50%
90%
1-2 years
____ constitutes the 2nd most common reason for primary care physician office visits
the 10% of patients with residual symptoms of neck/back pain
Red flags for back/neck pain:
Name the condition:
- Gait ataxia/UMN changes
- Bowel/bladder/sexual dysfunction
- Night pain/weight loss
- Fevers/Chills
- Myelopathy
- Cauda Equina syndrome
- Tumor
- Infection
In the work force, what are the top two reasons for absenteeism?
- upper respiratory infections
2. low back pain
Regarding absenteeism and return-to-work expectations for low back pain
Time missed from work: (name RTW percentage)
- ~6 months:
- ~1 year:
- ~ 2 years:
- 50%
- 25%
- 0
Name the atypical C spine vertebrae
typical?
- Atlas (C1) ring shaped with two lateral masses. No vertebral body or spinous process. Axis (C2) has odontoid process, bifid spinous process (like C2-6)
- C3-7
Anterior region: cervical uncinate processes: raised margins along the lateral aspect of the superior surface of the cervical vertebral body.
Posterior region: pedicles, superior articular processes, inferior articular processes, laminae, TP, foramen transversarium, and SP
In cervical disc degenerative disease, the raised margins approximate with the body of the superior vertebra. The end result is the degenerative joint change called _____.
joint of luschka (unconvertebral joint)
the joints of luschka function to limit lateral translation.
Name the unique characteristics of thoracic vertebrae:
- Anterior region
- Posterior region
- VB with articulations for ribs
2. Pedicles, SAP, IAP, laminae, transverse processes with articulations for rib tubercles and spinous processes.
____ is an anomalous fusion of the 5th lumbar vertebrae with the sacrum
Incidence: ____ complete, ____ incomplete
sacralization
1% complete
6% complete
a 3-joint complex is formed between 2 lumbar vertebrae:
- 3.
- vertebral body endplate-disc-endlplate joint
- zygapophyseal joint
3 zygapophyseal joint
____ is an anomalous partial or complete nonunion of the first and second segment of the sacrum. This forms an additional lumbar segment (L6) and leaves 4 remaining fused sacral segments.
Incidence:
Lumbarization
4%
Name the components of the zygapophyseal joint: 5
AKA: ZP-joint, apophyseal joint, facet joint
- Superior articular process (SAP)
- Inferior articular process (IAP)
- Joint capsule
4 Articular cartilage - Meniscus
Name the sacral ligaments:
- Superior iliolumbar
- Anterior iliolumbar
- Inferior Iliolumbar
- Posterior sacroiliac ligament
- Sacrospinous ligament
- Sacrotuberous ligament
- Anterior sacroiliac ligament.
- Interosseous ligaments (at SI joint)
AA and OA joints have no true ___ joints due to their atypical anatomy.
ZP joints
Facet joints are positioned in a ___ plane in C3-7.
In a thoracic plane?
Lumbar?
Frontal (coronal)
Frontal (coronal)
Lumbar begins in sagittal plane, progresses to frontal plane at L5/S1.
Each ZP joint has ___ innervation.
Name them
dual - from medial branches of the dorsal primary ramus off that spinal nerve.
1 ZP joints in the cervical spine contain innervations from what level?
- ZP joints in the thoracic and lumbar spine contain innervations from what levels?
1 same level and one level below
Example:
C5-6 ZP joint is supplied by C5 and C6 medial branches
- Same level and one level below.
Example:
L4/5 ZP joint is supplied by medial branch of L4 and L3.
Name the three primary functions of ZP joints
- Direct vertebral motion
- Resist shearing and rotational forces
- Weight bearing: increased with extension
Intervertebral discs are comprised of what three things?
- Nucleus pulposus: A viscous muco-protein gel mixture of water and proteoglycans in a network of Type II collagen that braces the annulus to prevent buckling.
- Annulus fibrosus: Type I collagen fibers arranged in obliquely running lamellae that encase the nucleus pulposus and are attached to the vertebral endplate plates. This orientation withstands distraction and bending but is relatively weaker for torsional stresses
- Vertebral endplate - cartilaginous covering of the VB apophysis, forming the top and bottom of the disc.
what is the vascular supply of the intervertebral disc?
avascular by adulthood
Innervation of intervertebral disc
- Outer 1/3 of disc
- Nucleus pulposus
- Anterolateral annulus fibrosis
- Posterior part
- outer 1/3 of the disc containing the annulus fibrosis: dual innervation from ventral rami
- Nucleus pulposus lacks innervation
- Anterolateral part of the annulus fibrosis: ventral rami and grey rami communicans
- Posterior part of the annulus fibrosis: sinuvertebral nerves (recurrent branches off of the ventral rami)
name the two functions of the intervertebral disc:
- allows for VB motion
2. Weight bearing
In relation to 100% at erect posture, what is the least amount of pressure (position) and the most pressure:
least: lying supine (25%)
Most: sitting slumped over in a chair 275%; next is bending over with a straightback and legs. 220%
Which positions apply the most pressure to the low back?
Lying supine with legs elevated (35%)
Doing a sit up 210%
if 100% is standing erect.
Aging effects of intervertebral discs
3 things decrease
3 things increase
decreases:
- nuclear water content
- ratio of chondroitin:keratin
- proteoglycan molecular weight
Increases
- Fibrous tissue
- cartilage cells
- amorphous tissue
The following nerves supply:
- Ventral primary rami: (2)
- Dorsal primary rami: (three branches)
- Sinuvertebral nerve (4)
- trunk musculature, plexus contributions
- Lateral: iliocostalis, skin
- Intermedius: Longissimus
- Medial: multifidi, rotators, interspinalis, intertransversarii, posterior spinal ligaments, zygapophyseal joints - Posterior longitudinal ligament, posterior disc, anterior dura, vertebral body
____ runs the entire length of the spine, covering the anterior aspect of each vertebral body and disc.
Function: limits hyperextension and forward movement
Anterior longitudinal ligament
Posterior longitudinal ligament attaches to the posterior rim of the vertebral bodies and disc from ____ to ____. It continues superiorly with _____>
C2-sacrum
superiorly: tectorial membrane to occiput.
Function of Posterior longitudinal ligament:
prevents hyperflexion of the vertebral column.
____ is the superior continuation of the supraspinous ligament extending from the occipital protuberance to C7.
Function:
Ligamentum flavum
boundary of the deep muscle in the cervical region
____ connects adjacent vertebral arches longitudinally, attaching laminae to laminae
Function:
Ligamentum flavum
maintains constant disc tension and assists in straightening the column after flexion.
Supraspinous ligament runs from ___ to ___.
function:
runs spinous process to spinous process (so does interspinous ligament)
weakly resist both spinal separation and flexion
Intertransverse ligament runs:
Function:
runs transverse process to transverse process
resists lateral bending of the trunk.
Cervical region landmarks
Anterior C2 C3 C4, C5 C6
Posterior
C2
C7
articular pillars
Anterior C2 - TP palpated at the angle of the mandible C3 hyoid bone C4/5 thyroid cartilage C6 first cricoid ring, carotid tubercle
posterior
C2 - first palpable midline spinous process (2 finger-breadths below the occiput)
C7 - Vertebral prominens (largest spinous process; nonbifid)
Articular pillars: lateral off the spinous process bilaterally
Thoracic region landmarks
T3
T8
T12
T3 spine of scap
T8 inferior angle of the scap
T12 lowest rib
Lumbar region
L4
S2
L4 iliac crests
S2 PSIS
Name the extrinsic back muscles:
Superficial layer
Intermediate layer:
Superficial layer
- trapezius
- lats
Intermediate
- serratus posterior superior and inferior
Name the intrinsic muscles of the back
- Superficial layer
- Intermediate layer (special group)
- Deep layer
- Superficial layer
- splenius capitis
- splenius cervices - Intermediate layer (erector spinae)
- Iliocostalis: lumborum, thoracis, cervices
- Longissimus: thoracis, cervicis, capitis
- Spinalis: thoracis, cervicis, capitis - Deep layer
- Transversospinal muscles (semispinalis: thoracis, cervicis, capitis). multifidus, rotators
- Interspinalis, intertransversarii muscles
The occipitoatlantal joint has ____ of flexion/extension of the entire cervical spine
50%
The atlantoaxial joint has ____ of rotation of the entire cervical spine
50%
What are the 3 phases of kirkaldy-willis: the degenerative cascade of spondylosis
- dysfunction
- instability
- stabilization.
it is initiated by a rotational strain or compressive force to the spine during lumbar flexion.
Pathology of 1 component (disc or Z-joint) influences deterioration of the other components and adjacent vertebrae.
