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Spinal Orthotics > Spinal Anatomy & Pathology > Flashcards

Spinal Anatomy & Pathology Flashcards

1
Q

What are the 4 levels of the spine?

A

Cervical, thoracic, lumbar and sacral

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2
Q

How many vertebrae are in each spinal region?

A

Cervical: 7
Thoracic: 12
Lumbar: 5
Sacral: 5
Coccyx: 4

33 total

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3
Q

Two adjacent vertebrae and an intervertebral disc is called:

A

Functional spinal unit

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4
Q

Which spinal region allows the greatest range of motion?

A

Cervical

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5
Q

Which vertebrae are limited in rotation due to rib attachments?

A

Thoracic

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6
Q

Which vertebrae are designed to bear more weight than other regions of the spine?

A

Lumbar

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7
Q

Lateral flexion & Rotation of the cervical spine musculature is known as:

A

Torticolis

Unilateral contracture of the SCM; bilateral contraction of SCM is neck flexion.

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8
Q

Degeneration of the vertebrae at the weakest point; pars interarticularis.

A

Spondylolysis;

Lumbar: L4-L5, L5-S1 (also thoracic)

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9
Q

Stress fracture, which results in ā€œScotty dog w/decapitationā€:

A

Spondylolysis

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10
Q

Autoimmune disorder w/progressive bone fusion:

Marie-Strumpell/Bekhterevā€™s Disease

A

Ankylosing Spondylitis (AS)

Onset: 22-40yrs

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11
Q

Spondyloarthropathy OR Spondyloarthritis

A

Spondylitis, inflammation of 1+ vertebra; non-degenerative

Onset: 15-45yrs

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12
Q

Anterior slippage of a vertebra on the one below:

A

Spondylolithesis

MC: L4-L5, L5-S1

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13
Q

What are the subtypes of Spondylolisthesis?

A

Type I: Spondylolytic (Isthmic)
Type II: Degenerative
Type III: Congenital
Type IV: Traumatic
Type V: Pathological

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14
Q

Grading of Spondylolisthesis

A

Grade 1: 0 - 25%
Grade 2: 25 - 49%
Grade 3: 50 - 74%
Grade 4: 75 - 99%
Grade 5: 100%, complete slippage: spondyloptosis

Orthoses indicated for 1 & 2

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15
Q

Spinal osteoarthritis; mechanical, degenerative arthritis of the spine:

A

Spondylosis

formation of osteophytes

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16
Q

Pathological Fractures

What is the precursor to osteoporosis?

A

Osteopenia

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17
Q

What conditions result in pathological fractures?

A
  1. Osteopenia
  2. Osteoporosis
  3. Osteogenesis Imperfecta
  4. Osteosarcoma
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18
Q

MOI: Axial load at the top of the head.

A

Jefferson Fracture

Unstable; C1 (atlas) split in multiple fragments.

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19
Q

What orthotic device is used to treat a Jefferson fracture?

A

Halo

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20
Q

MOI: Hyperextension followed by distraction

A

Hangman Fracture
Fracture through pedicles of C2 that separates posterior neural arch from the vertebral body.

Unstable in 3 planes; traumatic spondylolisthesis

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21
Q

MOI: Hyperextension or hyperflexion

A

Fracture of Odontoid

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22
Q

Fracture through the base of odontoid; unstable

A

Type II

Tx: Halo

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23
Q

Fracture into the body of vertebra; unstable

A

Type III

Better prognosis compared to Type II because of increased surface contact and blood supply to promote healing. Tx: Halo

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24
Q

Rare fracture through the tip of odontoid; stable

A

Type I

No halo required; tx with Philadelphia collar

25
Q

Compression fracture

MOI: Flexion followed by compression

Stable

A

Denis Type I

Anterior column; CASH, Jewett Knight-Taylor (in hyperextension)

26
Q

Why is Denis Type I a stable fracture?

A

Anterior & posterior longitudinal ligaments, and posterior ligamentous complex are intact; spinous processes are not separated.

Osteoporosis; thoracic

27
Q

Vertebroplasty:

A

Injection of bone cement into fractured vertebra to relieve pain and restore mobility

Tx: compression fracture

28
Q

Burst fracture of the anterior and middle spinal columns:

Stable fracture

A

Denis Type II

Ruptured ligaments: supra/interspinous; fragments may enter spinal canal

29
Q

MOI: Compression followed by flexion

A

Denis Type II

Stable: Rigid Orthosis
Unstable: ORIF & Rigid Orthosis

30
Q

MOI: Flexion followed by distraction

A

Denis Type III

Posterior & Mddle Columns

31
Q

What is a Chance fracture?

A

A subtype of Denis Type III; fracture through bone

Mild: Jewett
Moderatre++: Body Jacket (Bivalve TLSO)

32
Q

What is a Slice fracture?

A

A subtype of Denis Type III; fracture through soft tissue that typically requires surgical repair.

More severe compared to Chance fracture.

33
Q

Fracture & dislocation of the ant, mid, post columns:

A

Denis Type IV

Fracture through vertebral body; rupture of post. ligaments; articular facets

34
Q

MOI: Excessive translatory, flexion & rotatory forces

A

Denis Type IV

Surgery with post-op TLSO; may result in complete spinal cord transection

35
Q

Holdsworth Fracture is also known as:

A

Denis Type IV

36
Q

MOI: Axial load & flexion

A

Teardrop Fracture

Spinal cord injury & spinous process fx; highly unstable. MC in cervical spine due to high mobility.

Tx: ORIF + Halo

37
Q

What landmarks are used for brace measurements?

A
  1. Sternal Notch
  2. Xiphoid Process
  3. Iliac Crests
  4. ASIS
  5. Greater Trochanter
  6. Pubis
38
Q

Internal & External Obliques
Rectus Abdominus

A

Spinal flexion muscles

39
Q

What are the spinal flexion muscles?

A

Psoas major
Iliacus (Iliopsoas)

40
Q

What are the layers of spinal extension muscles?

A

Deep
Intermediate
Superficial

41
Q

Transversospinalis

A

Deep extensor muscles;

Semispinalis, multifidus, rotatores

42
Q

Erector Spinae

A

Intermediate extensor muscles

Longissimus thoracis, spinalis thoracis, iliocostalis lumborum

43
Q

Trapezius & Latissiumus Dorsi

A

Superficial extensor muscles of the spine

44
Q

Which ligament attaches the ilium to lumbar vertebrae like guy wires?

A

Iliolumbar Ligament

45
Q

Which structure attaches vertebra to vertebra on the posterior spine?

A

Ligamentum flavum

Flexibility: for vertebral distraction and movement, in a controlled speed to maintain stability

46
Q

Large ligementous structure which stabilizes spine from C7 to sacrum:

A

Supraspinous Ligament

Superiorly, it is the nuchal ligament (above C7)

47
Q

Resists flexion; narrow & weak compared to other spinal ligaments:

A

Posterior Longitudinal Ligament

48
Q

Resists hyperextension; originates from cranium; longest ligament in body; broadest of all spinal ligaments:

A

Anterior Longitudinal Ligament

49
Q

Which ligament prevents anterior displacement of C1 over C2

A

Transverse Ligament

Also stabilizes the odontoid; allows rotation, limiting displacement.

50
Q

What is the purpose of spinal ligaments?

A
  1. Protection
  2. Stability
  3. Posture
51
Q

23, 3-9mm thick, 25% of spinal column hgt and provides shock absorption:

A

Intervertebral Discs

Contribute to spinal curves - thicker on one side in cervical & thoracic regions.

52
Q

What material allows IVD to resist tension and compression?

A

Collagen

Also made up of proteoglycans, which attract water.

53
Q

What is the mode of nutrition for IVDs?

A

Osmosis

Nutrients received from cartilage end plate; imbibition - process in which spinal discs absorb nutrients & fluids.

54
Q

How do IVDs change with aging?

A
  1. Decreased fluid w/age
  2. Degeneration begins ~20yrs of age

gradual loss of water in nucleus, progressive fibrosis.

55
Q

What are the components of the IVD?

A
  1. Nucleus pulposus - gel-like center
  2. Annulus fibrosus - crisscrossing outer fibers
56
Q

What are the joints btwn the ribs and thoracic vertebrae?

A
  1. Costovertebral joint - body of vertebra & head of rib
  2. Costotransverse joint - transverse process of vertebra & rib notch
57
Q

How does facet orientation affect movement in the thoracic region?

A
  1. Limits flexion & extension in upper area
  2. Allows free lateral flexion
  3. Rotation in superior area that decreases caudally
58
Q

Primary Curve

A
  • Long ā€œCā€ curve at birth;
  • Thoracic & Sacral curves
  • Kyphotic (convex posteriorly)
59
Q

Secondary

A
  • Cervical & lumbar curves
  • Lordotic (convex anteriorly)

Spinal Orthotics (3 decks)

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