Spinal Info

Question 1

Vertebral Body Anatomy and Ligaments of the Spine

Answer 1

Vertebral foramen: spinal chord passes through.
Transverse foramen: vertebral arteries pass through.
Spinous process: provides attachments for ligaments and muscles.

Ligamentum flavum: Connects the laminae of adjacent vertebrae.

Interspinous ligament: Connects the spinous processes of adjacent vertebrae.

Supraspinous ligament: Connects the tips of adjacent spinous processes.

Question 2

Anatomy and Ligaments of the Cervical Spine

Answer 2

• C1: atlas, no spinous process
• C2: axis, has an odontoid process creating the atlanto-axial joint
• Occiput joint to C1: atlanto-occipital
• Cervical vertebrae have bifid spinous processes (where spinous process splits in two) except C7.

Nuchal ligament: It attaches to the tips of the spinous processes from C1-C7.

Question 3

Cervical Muscles

Answer 3

Levator Scapulae
Sternocleidomastoid
Trapezius
Rhomboids Major and Minor
Erector spinae
Multifidus

Question 5

CAD

Cervical Red Flag

Answer 5

Blockage of one or more arteries that supply the heart.

Vertebral artery close to uncovertebral joint and facet joint so any osteophytic changes could impair movement of the artery.

Risks:
Extreme rotation (C1,2 most vulnerable)
Contralateral side more likely to be damaged during rotation.
Manipulative techniques can cause vertebral artery to go into spasm.
Signs:
Dizziness, diplopia (visual impairment, double vision), drop attacks (circulatory deficit), dysphagia (difficulty swallowing), dysarthria (difficulty articulating speech)
Nausea, nystagmus (involuntary eye movement), neuro symptoms

Question 6

Spondylosis

Answer 6

1. Degenerative disc
   The disc becomes thinner and spongy so there’s less space between the vertebrae. Water loss leads to reduced space between vertebrae which increases pressure on facet joints and makes ligaments lax causing decreased stability.
2. Facet joint
   Irritation and inflammation of spinal nerve roots due to wearing cartilage on the facet joints.
3. Osteophyte formation
   Hypermobility in facet joints causing osteophytes form to increase the surface area in vertebral bodies to stabilise the joint and decrease the hypermobility.
4. Osteoporosis
   Often experience morning stiffness, weight gain.

Question 6

Postural Dysfunction

Answer 6

1. IVD
   Wears down, moves position (ant/post pressure = bulge/herniation)
2. Spinal ligaments
   Become lax/tight (depends on posture).
3. Spinal and abdominal muscles
   Used ineffectively the muscles atrophise.
   Overwork to compensate stability v become tight.
4. Joints degenerate
   Osteoporosis and bone spurs could form

Presentation:

• Pain with movement, muscle spasm, headaches, fatigue
• Restriction (usually rotation) with/without pain

Question 7

Cervical Myotomes

Answer 7

C1: cervical flexion
C2: cervical extension 
C3: cervical side flexion
C4: shoulder elevation
C5: shoulder abduction
C6: elbow flexion, wrist extension 
C7: elbow extension, wrist flexion, thumb extension

Question 7

Cervical Reflexes

Answer 7

Bicep: C5-6
Tricep: C7

Question 9

Anatomy of the Lumbar Spine

Answer 9

The vertebrae are bigger and stronger than other regions.
Transverse processes are long and slender.
Spinous processes are short and broad.

Question 11

Lumbar Muscles

Answer 11

Quadratus Lumborum
Latissimus Dorsi
Rectus Abdominis
Transversus Abdominis
Internal Oblique 
External Oblique
Erector Spinae
Multifidus

Question 12

Cauda Equina

Lumbar Red Flag

Answer 12

Affects bundle of nerve roots at lower end of spinal chord.
CE provides innervation to lower limbs, sphincter, bladder retention/overflow and the sensation to skin around bottom and back passage.

Presentation/Symptoms:
Bilateral neurogenic sciatica
Reduced peripheral sensation
Altered bladder function leading to painless retention
Loss of anal tone
Sexual dysfunction
Lower back pain
Saddle anaesthesia
Reduced/absent reflexes

Question 12

Lumbar Myotomes

Answer 12

L2: hip flexors
L3: knee extensors
L4: ankle dorsiflexors
L5: big toe extension

Question 13

Lumbar Reflexes

Answer 13

Achilles tendon

Knee

Question 14

Assessment Techniques and Justification

Answer 14

AROM
Palpation: Soft tissue changes
1. An increase in temperature and/or sweating which might be an inflammatory disorder
2. A dry skin (although sweating can be present) may denote some autonomic changes
PAIVMS: check for undue prominence

Dermatomes
Myotomes
Reflexes

Checks the specific spinal roots aren’t injured/damaged.

Question 15

General Red Flags

Answer 15

Saddle anaesthesia
Unexplained weight loss
Night sweats/pain
Altered bowel habits and bladder retention