Ortho Test 1 Flashcards
How many lumbar vertebrae and nerve roots are there?
5 of each
Do nerve roots of the lumber spine exit above or below their corresponding pedicle?
below
If there’s a disc herniating into the L4-L5 space, what nerve root will be affected?
L5
What is the classification of fractures of the thoracolumbar spine based on?
the involvement of the three columns (anterior, middle, posterior)
contents of the thoracolumbar anterior column
- anterior longitudinal ligament
- anterior aspect of the vertebral body
- anterior aspect of the annulus
contents of the thoracolumbar middle column
- posterior longitudinal ligament
- posterior aspect of the vertebral body
- posterior annulus
contents of the thoracolumbar posterior column
- pedicles
- facet joints and capsules
- ligamentum flavum
- osseous neural arch
- interspinous ligaments
- supraspinous ligaments
Manners in which the thoracolumbar columns can fail
- compression
- distraction
- rotation
- shear
four main types of thoracolumbar spine injuries
- compression fx
- burst fx
- flexion-distraction injuries
- fracture-dislocations
describe the flexion-distraction injury through thoracolumbar vertebrae
it’s like the vertebra has been ripped through the middle in a horizontal plane, from posterior to anterior
describe the flexion-distraction injury through thoracolumbar soft tissue
it’s like the tissue in between the vertebrae has been ripped through the middle in a horizontal plane, from posterior to anterior
fracture of the thoracolumbar spine that involves a failure of the anterior column, but the middle column remains intact
compression fracture
describe a burst fx of the thoracolumbar spine
- failure of the anterior and middle columns
- retropulsion of bony fragments into the spinal canal
what thoracolumbar spine columns are injured in a flexion-distraction injury?
all three columns
are flexion-distraction injuries of the thoracolumbar spine stable?
- bony chance injuries are stable because the posterior ligaments remain intact
- soft tissue chance injuries are unstable because of disruption of the posterior ligaments
describe fracture-dislocations of the thoracolumbar spine
failure of all three columns with resultant instability
describe the pain associated with a coccyx fx
- hurts a lot and for a long time
- point tende
- tender with DRE
- helped when sitting on a donut or phone book
Describe a simple wedge fx of the cervical spine
- fx of the anteriosuperior end plate of the vertebral body
- can be unstable if associated with posterior ligament disruption
describe an anterior teardrop fx of the cervical spine
- Fracture of the cervical spine caused by the sudden pull of the anterior longitudinal ligament on the anterior, inferior aspect of the vertebral body following extreme hyperextension of the neck
- unstable
- associated with complete diruption of ligaments
what are the 2 flexion injuries of the cervical spine?
- clay shoveler’s fx
- bilateral facet dislocation
describe a clay shoveler’s fx
- avulsion of the spinous process of lower vertebrae, usually C7
- stable
describe a bilateral facet dislocation of the cervical spine
- extremely unstable
- can have associated disc herniation
- occurs when a vertebra’s inferior facet dislocates anteriorly over the lower vertebra’s superior facet, locking in the intervertebral foramens
what are the “flexion with rotation” injuries of the cervical spine?
- unilateral facet dislocation with fracture
- pilar fracture
- pediculolaminar fx
describe a pilar fx of the cervical spine
- vertical or oblique fx of the articular mass
- stable
describe a pediculolaminar fx of the cervical spine
- involves part of the pedicle and part of the lamina
- variety of severities
what are the extension injuries of the cervical spine?
- fx of the anterior arch of Atlas
- fx of the posterior arch of Atlas
- Hangman’s fx
describe a fx of the anterior arch of Atlas
- avulsion fx
- unstable
describe a fx of the posterior arch of Atlas
- compression between the axis and occiput
- high association with other fractures
describe a Hangman’s fx
- fracture of C2 pedicles with anterior displacement
- unstable
what are the lateral flexion injuries of the cervical spine?
- uncinate process fx
- Jefferson fx
describe an uncinate process fx of the cervical spine
transverse fx of the base of the uncinate process by the superior vertebral body
describe a Jefferson fx
- occipital condyles are driven into C1, forcing the lateral masses apart
- often associates with rupture of the transverse ligament
- unstable
describe a type I odontoid fx
- fx of the superior tip
- transverse ligament remains intact
- stable
describe a type II odontoid fx
- at the junction of the odontoid and the vertebral body
- most common
describe a type III odontoid fx
-through the superior portion of C at the base of the odontoid
