Session 2.2 The Lumber Spine And Associated Disorders

Question 1

How many vertebrae are in the vertebral column and which parts are mobile, fusedand immobile?

Answer 1

33
Mobile = cervical and lumbar
Immobile = thoracic
Fused = sacrum and coccyx

Question 2

What are the functions of the vertebral column?

Answer 2

Central bony pillar of the body
Support the skill, pelvis, upper limbs and thoracic cage
Protect the spinal cord and card equina
Movement, its v flexible
Haemopoiesis = red marrow contributes to development of red cells

Question 3

What are the general characteristics of a lumber vertebra?

Answer 3

Kidney shaped ventral body
Vertebral arch posteriorly
Vertebral foramen contains conus, cauda equina and meninges

Question 4

What is the vertebral body made from and what are the advantages?

Answer 4

10% cortical bone = strength
90% cancellous bone = makes us lighter and more room for haemopoiesis

Linked to adjacent bodies by intervertebral disks

Question 5

What do superior and inferior processes join to make?

Answer 5

A facet joint
Lied with hyaline cartilage
Spinal nerves emerge through intervertebral foramina
Orientated in a Sagittal plane

Question 6

What joints exist in the spine?

Answer 6

• fibrous: ligaments non mobile
• cartilaginous: partially mobile e.g intervertebral disk
• synovial joints e.g facet joints, mobile

Question 7

What chemicals make up the intervertebral disk?

Answer 7

70% water, 20% collagen, 10% proteoglycans (hydrophilic, keep water in centre of disk)

Question 8

Why do people lose height with age?

Answer 8

Proteoglycans lose their ability to attract water =disk gets narrower

Develop fractures which means the spine curves forward =lose height

Question 9

What are the two regions of the intervertebral disk? Tell me about them.

Answer 9

1) annulus fibrosis
- outer ring
- type 1 collagen: each layer has its own orientation
- avascular and aneural, all nutrients provided by diffusion
- acidic area due to low o2 association. If you get leakage, can be an irritant and cause inflammation
- a major shock absorber and resilient under compression.

2) nucleus pulposus
- remnant of notochord
- gelatinous, type 2 collagen
- high osmotic pressure
- disk height changes with age
- central i infant, more posterior in adult

Question 10

What are the two major ligaments of the spinal chord?

Answer 10

Anterior longitudes ligament - covers ventral bodies like a sheet on the outside. Stronger. Prevents hyperextension.

Posterior longitudinal ligament - covers ventral bodies like a sheet on the inside. Weaker.

Question 11

What’s the ligamentum flavum?

Answer 11

Sits at the base of the spinous process
Elastin elastic fibres
Between laminate of adjacent vertebrae
Stretched during flexion

Question 12

What’s the interspinous ligament?

Answer 12

Sheets of spinous tissues
After the ligamentum flavum, between adjacent spinous processes
Fused with supraspinous ligaments

Question 13

What’s the supraspinous ligament?

Answer 13

Joints the tips of adjacent spinous processes
Strong bands of white fibrous tissue
Tight in flexion

Question 14

Why should we carry things close to our body?

Answer 14

Forces increase the further away the mass you are carrying is, so should carry things closer to your body

Otherwise can damage intervertebral disk and get disk prolapse

Question 15

What is the sacrum?

Answer 15

Consists of 5 fused vertebrae
Articulates with L5 superiority
Can give people epidurals through sacral hiatus as this is where the spinal column starts

Question 16

What is the coccyx?

Answer 16

Consists of 4 fused vertebrae

Easily fractures during falls

Question 17

What’s the vertebral column like in a foetus?

Answer 17

In kyphosis
This is the primary curvature
Its retains in thoracic, coccygeal and sacral regions

Question 18

How does the spine develop from a foetus to a young adult?

Answer 18

Develops first lordosis in the cervical spine when a young child begins to lift its head
The lumbar spine loses its primary kyphosis during crawling
Child begins to walk = lumbar lordosis develops and this is the secondary curvature

Question 19

How does the spine change in a young adult?

Answer 19

4 distinct curvatures are present.

Question 20

How does the spine change at old age?

Answer 20

• secondary curvatures start to disappear
• loss of disc and osteoporotic fractures
• senile kypohisis as fractures and loss of disc height occurs. Kind of get back to the primary heights we started with.

Question 21

How does the curvature of the spine Change during pregnancy?

Answer 21

An exaggeration of the lumbar lordosis in order to keep your centre of gravity above your pelvis so muscles are working less hard to keep you standing.

Question 22

What is mechanical back pain?

Answer 22

Pain when the spine is loaded
Made worse by exercise and relieved by stress. Intermittent 
Risk factors
- poor posture 
- overweight
- incorrect manual handeling

Question 23

What is sciatica?

Answer 23

Radicular leg pain
Pain caused by irritation or compression of one or more of the nerve roots that contribute to the sciatic nerve (L4, L5, S1, S2, S3)
Causes. Include marginal osteophytosis, slipped disk, etc
Pain is i back and buttock and radiates to dermatome supplied by affected nerve root = from the back to the dermatome

Question 24

What are degenerative changes in the vertebral column, such as disc degeneration and marginal osteophytosis?

Answer 24

The nucleus pulposus can dehydrate with age.
Leads to a decrease in the height of the disc and alteration of the load stresses on the joint.
Osteophytes (bony spurs) then develop adjacent to the end plates of the disk = marginal osteophytosis
Increased stress on facet joints = osteoarthritis changes
Disk height decreases intervertebral foramina decreases in size = compression of spinal nerves perceived as radicular or nerve pain.

Question 25

What is the nerve root that emerges at the same level as the intervertebral disc called?

Answer 25

The exiting nerve root

Question 26

What is the nerve root that exits at the level below the intervertebral disk called?

Answer 26

The transversing nerve root