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msk > Spine > Flashcards

Spine Flashcards

1
Q

What are the sections of the vertebral column?

A 
Cervical 7
Thoracic 12
Lumbar 5
Sacral 5
Coccygeal 4
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2
Q

Which sections of the spine are the most mobile?

A

Cervical

Lumbar

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3
Q

What are the functions of the vertebral column?

A
  • Protect spinal cord
  • Haemopoiesis
  • Supports skull, pelvis, upper limbs and thoracic cage
  • Movement
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4
Q

What are the movements of the lumber spine?

A

Flexion & extension
Lateral flexion
Rotation

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5
Q

What are the typical features of a lumbar vertebrae?

A

Large kidney-shaped vertebral body
Short, blunt spinous process
Triangular foramen

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6
Q

What is the composition of the vertebral body?

A

90% cancellous bone - light

10% cortical bone

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7
Q

Why does the size of vertebral bodies increase superior to inferior?

A

Increased compression forces

Lumbar are weight-bearing

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8
Q

The superior and inferior articular joints are strengthened by which ligament?

A

Ligamentum flavum

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9
Q

What is the composition of intervertebral discs?

A

70% water
20% collagen
10% proteoglycans

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10
Q

What are the central and peripheral regions of the discs called?

A

Nucleus pulposus

Annulus fibrosus

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11
Q

What is the nucleus pulposus made from?

A

Remnant of the notochord

Type 2 collagen

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12
Q

What is the annulus fibrosus made from?

A

Lamellae of annular bands
Outer = type 1 collagen
Inner = fibrocartilage

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13
Q

Which is stronger, the anterior longitudinal ligament or the posterior longitudinal ligament?

A

Anterior

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14
Q

What is the function of the anterior longitudinal ligament?

A

Prevents hyperextension

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15
Q

What is the function of the posterior longitudinal ligament?

A

Limits hyperflexion

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16
Q

What is the ligamentum flavum made up of?

A

Elastic fibres

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17
Q

Where is the ligamentum flavum located?

A

Between laminae of adjacent vertebrae

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18
Q

Which region of the spine are interspinous ligaments most developed?

A

Lumbar region

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19
Q

What is the primary curvature?

A

Kyphosis

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20
Q

What is the secondary curvature?

A

Lordosis

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21
Q

Which 2 regions of the spine demonstrate secondary curvature?

A

Cervical and lumbar

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22
Q

When might physiological exaggeration of lumbar lordosis occur?

A

Pregnancy

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23
Q

What level does the spinal cord finish?

A

L1/L2

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24
Q

Where should you carry out a lumbar puncture and why?1

A

L2/3 or below to avoid damaging spinal cord

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25
Q

How does the intervertebral disc degenerate with age? What problems can this cause?

A

Nucleus pulposus dehydrates with age
Height of IV disc decreases
Load stresses on IV discs alter which leads to osteophytes
Increased stress on facet joints which leads to osteoarthritis

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26
Q

What type of joint are facet joints?

A

Synovial

27
Q

What are the 4 types of slipped disc?

A
  1. Degeneration
  2. Prolapse
  3. Extrusion
  4. Sequestration
28
Q

What is disc degeneration?

A

Chemical changes associated with ageing which causes the discs to dehydrate and bulge.

29
Q

What is meant by disc prolapse?

A

Protrusion of the nucleus pulposus with slight impingement into the spinal canal (maintained)

30
Q

What is disc extrusion?

A

Nucleus pulposus breaks through annulus fibrosis but remains within disc space

31
Q

What is disc sequestration?

A

Nucleus pulposus breaks through annulus fibrosis and separates from the main body into the spinal canal

32
Q

Where do disc prolapses most commonly occur?

A

L4/L5 or L5/S1

33
Q

What are the 3 types of disc prolapse, which is most common?

A

Paracentrally - most common
Far lateral - at nerve root exit
Canal filling - compress cauda equina

34
Q

What is sciatica?

A

Compression of the nerve roots which contribute to the sciatic nerve

35
Q

Which nerve roots contribute to the sciatic nerve?

A

L4-S3

36
Q

What is the most common cause of sciatica?

A

Prolapsed disc

37
Q

What are the 3 types of sciatica, based on dermatomes?

A

L4, L5 and S1

38
Q

What areas you expect to be affected by L4 sciatica?

A

Anterior thigh, anterior knee, medial shin

39
Q

What areas you expect to be affected by L5 sciatica?

A

lateral thigh, lateral calf, dorsum of foot

40
Q

What areas you expect to be affected by S1 sciatica?

A

Posterior thigh, posterior calf, sole of foot

41
Q

Which nerve root will be compressed in an L4/L5 paracentral disc prolapse?

A

L5

42
Q

Which nerve root will be compressed in an L4/L5 far lateral disc prolapse?

A

L4

43
Q

What is cauda equina syndrome and what age group does it usually occur in?

A

Canal filling disc compressing the lumbar and sacral nerve roots
30-50 year olds

44
Q

What will patients with cauda equina experience?

A

bilateral sciatica
perianal numbness
painless retention of urine
urinary/faecal incontinence

45
Q

What patients are usually affected by lumbar canal stenosis and why?

A

Elderly patients- degenerative changes

46
Q

Give 3 things that can cause lumbar canal stenosis.

A
  1. Disc bulge into canal
  2. Arthritis in facet joints -> osteophytes
  3. Ligamentum flavum stiffer, deposits and expansion
47
Q

What is claudication?

A

Pain in the legs when walking

48
Q

What is a common neurogenic cause of claudication?

A

lumbar canal stenosis

49
Q

What is spondylolisthesis?

A

A slip forwards of the vertebrae above onto the vertebrae below

50
Q

What happens in isthmic spondylolisthesis?

A

Pars articularis is thinner than usual so is at risk of fracture, often in teenage years.
Present as backpain predominantly.

51
Q

Where is the pars articulates?

A

Between superior and inferior articular process’

52
Q

How does the presentation of degenerative spondylolisthesis differ to isthmic spondylolisthesis?

A

Isthmic presents as backpain predominantly

Degenerative presents with claudication predominantly.

53
Q

What happens in degenerative sponylolisthesis?

A

Arch still intact but develop stenosis via the same mechanism as lumbar canal stenosis.

54
Q

What are the 3 types of spina bifida?

A

Occulta
Meningocele
Meningomyocele

55
Q

What is the end of the spinal cord called?

A

Conus medullaris

56
Q

What is scoliosis?

A

Abnormal lateral curvature of the spine

57
Q

What is spina bifida?

A

Abnormality in development of the bones in the vertebral column

58
Q

What happens in occulta spina bifida?

A

Laminae of lower lumber vertebrae and upper sacral vertebrae fail to fuse completely

59
Q

What are the effects of occulta spina bifida?

A

No physical disability

Not usually detected

60
Q

What happens in meningocele spina bifida?

A

Protrusion of the meninges through cleft in vertebrae.

Spinal fluid fills protrusion to give a cyst-like structure on childs back.

61
Q

What are the potential effects of meningocele spina bifida?

A

May be residual damage to spinal cord, lower limb weakness, urinary or foetal incontinence

62
Q

What happens in meningomyelocele spina bifida?

A

As well as meninges, spinal cord also herniates through vertebral cleft.
Significant spinal cord dysfunction.

63
Q

What are the potential effects of meningomyelocele?

A

Learning difficulties
Paralysis/weakness of lower limbs
Incontinence

64
Q

By what mechanism can meningomyelocele cause hydrocephalus?

A

Brainstem often pulled downward into spinal canal at base of the skull, obstructing flow of CSF.

msk (16 decks)

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