Spinal anatomy

Question 1

Vertebral body

Answer 1

Forms front of vertebrae

Flat and thick, provides attachment for intervertebral discs

Question 2

Spinous processes

Answer 2

Project posteriorly, function as lever arm for muscles of postural and active movement

Question 3

Transverse processes

Answer 3

Project laterally off bilateral sides of the spine
Large muscle attachment sites
Lever for deep paraspinal muscles

Question 4

Pedicles

Answer 4

Extend from vertebral body, join with lamina to form vertebral arch

Question 5

Lamina

Answer 5

Connect spinous and transverse processes

Question 6

Articular processes

Answer 6

Form joints between one vertebrae and its inferior and superior (facet joints)

Question 7

Pars intraarticular

Answer 7

Small bone between superior and inferior articular facets. Very prone to stress fracture

Question 8

Facet joint

Answer 8

Synovial joint between inferior vertebraes superior articular process and the superior vertebraes inferior articular process
Direction of movement of spinal segment is determined by position of facet joints, e.g. in lumbar spine, plane of facets is vertically orientated in saggital plane so moves into flexion and extension
Lumbosacral joint is orientated in coronal plane, is at 45 deg angle so also have side flexion and rotation

Question 9

Disc joint

Answer 9

Invertebral disc, between 2 vertebral bodies

Helps joint shock absorb, bear weight of body above

Question 10

Ligaments

Answer 10

Anterior longitudinal, posterior longitudinal, ligamentum flavum, supraspinous ligamentum interspinous ligament, intertransverse ligament

Question 11

Disc function

Answer 11

Disc thickness allows for great deal of ROM
Disc height accounts for 25% of spine height
The greater the height of the disc, the greater possible ROM
Shock absorber
Weight bearing of spine and head

Question 12

Disc Structure

Answer 12

Nucleus pulposus- gel like, in the centre of the intervertebral disc
Annulus fibrosis- layers of collagen fibres, orientation of them provide strength and allow for movement in multiple planes
Inner and outer portions of disc, inner contains type 2 collagen (more flexible) and outer contains more type 1.

Question 13

L2 myotome

Answer 13

Hip flexion

Question 14

L3 myotome

Answer 14

Knee extension

Question 15

L4 myotome

Answer 15

Ankle dorsiflexion

Question 16

L5 myotome

Answer 16

Big toe extension

Question 17

S1 myotome

Answer 17

Ankle plantarflexion

Question 18

L1 dermatome

Answer 18

Back and groin

Question 19

L2 dermatome

Answer 19

Back and front of thigh to knee

Question 20

L3 dermatome

Answer 20

Back, upper buttock, anterior thigh and knee

Question 21

L4 dermatome

Answer 21

Medial buttock, lateral thigh, dorsum of foot and big toe

Question 22

L5 dermatome

Answer 22

Buttock, posterior and lateral thigh, lateral calf, medial half of sole, 1-3 toes

Question 23

S1 dermatome

Answer 23

Posterior thigh, calf, fifth toe

Question 24

Sagittal plane movements

Answer 24

Flexion, extension due to position of facet joints

Question 25

Coronal and transverse plane

Answer 25

Side flexion, some rotation at L5/S1 due to position of facet joint

Question 26

Muscles

Answer 26

Lumbar paraspinals, quadratus lumborum, gluteals, piriformis, psoas, iliacus, latissimus dorsi

Question 27

Biomechanical considerations- pronated foot

Answer 27

Flat foot/ too much pronation
Causes internal rotation of the tibia
Causing internal rotation of the hip and pelvis
Pelvis internally rotates and anteriorly tilts
Causing lumbar spine to become lordotic and cause approximation of the facet joints
Then continually loading the the lumbar facet joints at end range will cause soft tissue and joint irritation and lead to neurological overspill in the surrounding muscles

Question 28

Supinated foot

Answer 28

Supinated foot does not allow for unlocking of the ankle bones so does not absorb shock efficiently
Therefore force will be transferred along the kinetic chain to the hips and lumbar spine

Question 29

Leg length discrepancy

Answer 29

A longer limb will make contact with the ground too early and force will be transferred up the hips and pelvis

Question 30

Disc herniation

Answer 30

Present with specific or non-specific LBP, unilateral or bilateral
Stages 1-4, 1 being stiffness and 4 being disc prolapse
Lower grade injuries- usually no leg or neuro referral

Question 31

Facet degeneration

Answer 31

Insidious pain onset due to biomechanical anomalies
Relatively constant pain, begins to affect ADLs
Symptoms replicated on extension, side flexion or rotation, discomfort on palpation of facet joints
Pts may have neurological referral

Question 32

Stenosis

Answer 32

Insidious pain onset
Often pt reports long history of LBP
Aggravated by standing, walking, eased by sitting and flexion
Pain refers into gluteals

Question 33

Pars fracture

Answer 33

Most common cause of back pain in patients 14-20
Where the growth plate softens and fractures
Non specific onset, pt often active and plays sport
Symptoms aggravated by standing on one leg with extension and rotation
MRI to rule out spondylolisthesis

Question 34

Spondylolisthesis

Answer 34

Can occur as result of bilateral PARS fracture as the vertebrae can slip
Pt will often develop intermittent referral into the legs

Question 35

When to scan/refer for further investigation

Answer 35

Subjective red flags- cauda equina, saddle anaesthesia, impaired sensation around lower back/lower limb, weight loss, feeling unwell, uncoordinated gait
Objective red flags- altered sensation on sharp/blunt or light touch, loss of power, abnormal reflex, UMN tests
0% improvement after 3 treatments
Extensive past medical history- refer to GP to rule out underlying pathology