Spinal orthopaedics 1 - Clinically relevant anatomy of the spine Flashcards
what is mechanical back pain?
Back pain related to joints, ligament and muscles with no sinister features
What is spondylosis?
Degeneration of intervertebral discs (lose water content with age = less cushioning and increased pressure on facet joints) leading to secondary OA
What is a radiculopathy?
One or more nerves are compressed/ irritated = does not work properly
What is spondylolisthesis?
Vertebrae bone slips out of position
Benign tumour seen on the spine?
Osteoid osteoma
Malignant tumours seen in the spine? (2)
Metastatic disease
Multiple myeloma
How many vertebrae are there?
33
5 sections of the spine?
Cervical Thoracic Lumbar Sacral (fused) Coccygeal (fused)
How many cervical vertebrae?
7
How many thoracic vertebrae?
12
How many lumbar vertebrae?
5
How many sacral vertebrae?
5
How many coccygeal vertebrae?
4
Which 2 areas of the spine are naturally lordotic?
Cervical and lumbar
Which 2 areas of the spine are naturally kyphotic?
Thoracic and sacral
Name of C1?
Atlas
Name of C2?
Axis
Name of C7?
Vertebra prominens
How is vertebra prominens (C7) different?
Larger and longer spinous process
Name of centre of vertebral disc?
Nucleus pulposus
Name of periphery of vertebral disc?
Anulus fibrosus
What type of joints are intervertebral joints?
Secondary cartilagenous (made from fibrocartilage)
Why is lumbar rotation less than thoracic rotation?
Due to more vertically orientated facet joins
Why does the cervical spine allow the greatest amount of movement?
Due to more horizontal facet joints
Other name for facet joint?
Apophyseal joint
What is spondylosis often used synonymously for?
OA
Give 2 treatments for facet joint OA at one level of the spine?
Facet joint injections under fluoroscopy
Localised fusion
What is a disc bulge?
Disc is compressed evenly leading to it bulging out equally on all sides
2 other names for disc herniation?
Prolapsed or slipped disc
What does disc herniation involve?
Tearing of the cartilage rings
2 types of disc herniation/ slip/ prolapse?
Protrusion (only a few cartilage rings are torn = no leakage of entire)
Extrusion (all rings in a small area are torn = jelly like material flows out of a disc)
At what level is disc bulge/ prolapse most likely to occur?
L4/5 and L5/S1
Why is MRI not diagnostic of a disc bulge/ prolapse?
Many people will have these but be asymptomatic
Do motor neurones originate anteriorly or dorsally?
Where are their bodies located?
Anteriorly
Anterior grey horn
Do sensory neurones originate anteriorly or dorsally?
Where are their bodies located?
Dorsally
dorsal root ganglion
What is the name for the bundle of nerves at the lower end of the spinal column/ distal continuation of nerves after the spinal cord?
Cauda equina
At what vertebral level does the spinal cord end?
L1
Where does the upper motor neurone synapse to the lower motor neurone?
In the spinal cord
Does the following symptoms/ signs signal an upper or lower motor neurone pathology? - weakness, spasticity, increased tone, hyperreflexia
Upper
Does the following symptoms/ signs signal an upper or lower motor neurone pathology? - weakness, flaccidity, loss of reflexes
Lower
What is the name of the membranous sheath of dura matter that surrounds the spinal cord and the cauda equina?
Thecal sac
What are the 2 nerve roots that are susceptible to being compressed? e.g. in disc prolapse
Transversing
Exiting (outside thecal sac passing under the pedicle)
Transversing (anteriorly in the thecal sac, preparing to the next exiting nerve root)
What does compression of a nerve root cause?
Radiculopathy
Name of the sensory distribution of a nerve root?
Dermatome
Name for the group of muscles that a single nerve root supplies?
Myotome
Name for the ligaments of the spine?
Ligamentum flavum
What is myelopathy another name for?
Spinal cord compression e.g. tumour, disc prolapse
Signs of myelopathy? (3)
Upper motor neurone signs
Patient will walk with a large gait
Babinski sign
Describe babinski sign?
When plantar of foot is scratched, the big toe will go up rather than down
3 erector spinae muscles?
Iliocosalis
Longissimus thoracis
spinalis thoracis
Name the 5 ligaments of the spinal column?
Anterior longitudinal ligament Posterior longitudinal ligmanet ligamentum falvum supraspinous ligmanet interspinous ligament
At what level are lumbar punctures or spinal anaesthesia given?
Posterior iliac crest (L4)
Posterior superior iliac spine (S2)
When is spinal discectomy or decompression good?
Sciatica/ leg pain which doesn’t settle within 3 months with conservative management
