Spine Flashcards
Sections of the Spine ?
Cervical - C1 - C7
Thoracic - 12 bones
Lumbar - 5 - L1 - L5
Sacrum - 5 ( fused )
Coccyx - 4 (fused)
Structure of spine a vertebrae ?
2 major parts : Vertebral body and arch.
- Vertebral body - anterior part
* the weight bearing part. Vertebral bodies get larger as you go down the spine.
Adjacent bodies separated by fibrocartilaginous intervertebral disc.
- Vertebral arch - posterior aspect.
Has bony prominences - attachment for muscles/ ligaments
The vertebral body + arch - leaves a hole in the middle - forearm -
* When all the bodies and arches line up form the vertebral canal - encloses the spinal cord.
Structure of the vertebrae - different sections of the spine ?
Cervical - C1 - C7
3 FEATURES :
0 Bifid Spinous process
0 Transverse foramina
0 Triangular foramen.
(C1 - no spinous process
C7 - spinous process - may not bifurcate . )
Thoracic -
have 2 demi facets and costal facet.
Circular vertebral foramen.
Lumbar-
Kidney shaped
Vertebral bodies - very large.
Triangular foramen.
- size and orientation allow for needle access not possible in other section e.g. lumbar puncture , epidural anaesthesia administration.
Coccyx - has no veterbral arches thus no vertebral canal.
congenital abnormalities
sacralisation
lumbarisation
Abnormal morpholgy of the spine
Kyphosis - excessive thoracic curvature- hunchback defomity
lordosis - excessive lumbar curvature - sawyback deformity
scolosis - lateral curvature of spine
cervical spondylosis.- decreased size of IV foramen- narrows IV foramina - put pressure on nerves passing through
What is three column concept .
A way of describing & diagnosing spinal fractures.
0 Anterior column
- Anterior
Longitudinal
ligament
- Anterior
disc
- Anterior
half of
vertebral
body.
0 Middle column
- same as anterior just replace anterior with posterior.
0 Posterior column
- Spinous P
- Pedicels
- Lamina
- Ligamentum Flavum
- Interspinous & Supraspinous L
- Superior and inferior articulating P.
IMPORTANT - Fracture is unstable if it affect 2 adjacent columns e.g anterior & middle or middle & posterior. Also, if all three are.
Considered stable - if one affected.
exception - Bilateral pedicle fracture - Happens in posterior column, however effects the other columns (pedicles - connect
STABLE - do not cause spinal deformity or nerve problems . Can still distribute weight well.
UNSTABLE - opposite of stable.
What is a burst fracture ?
Burst fracture - Axial loading injury - disc above is pushed into the IV disc pushed into veterbral body below.
( discs crushed / compressed against each other due to pressure - causing spreading fractures )
Vertebrae break in multiple direction and can cause damage to spinal cord.
(greater the force applied , the more fragaments may be forced into spinal canal and damage the spinal cord - nerve damage - possible paralysis depending on severity
- occur usually from severe trauma - motorcycle accident , fall from height.
Typically - in the back - will complain of severe back pain - if had accident lie patient flat don’t sit them up of flex back - worsen neurological injury. Also complain of Lower limb neurological deficits
Patient may not be also wot walk after injury - if they can should still avoid to avoid further injury.
Summary - clincal presentation when trauma involved
- severe back pain
- lower limb deficits.
Types of Spinal Fractures ?
0 Burst Fracture
0 Veterbral compression fracture
0 Fracture - dislocation
management of Burst fracture ?
CT scan - evaluate extent of retro pulsed fragments - ( retro pulsed fragments
vertebral fragment which has been displaced into spinal canal - potential spinal cord injury.)
Radiological investigation - may see :
0 loss of veterbral height from lateral view - anterior portion of veterbral body compressed more than posterior.
What is a Fracture- dislocation fracture ?
Involves displacement - Vetebrae moves off adjacent veterbrae. ——> often cause serious spinal cord compression.
Occur secondary to high energy trauma ( e.g motorcycle accident.
Unstable and high risk of spinal cord injury.
- complete fracture - dislocation often result in severe neurological injury causing lower extremity weakness & decreased sensation.
- seems to usually occur in Thoracolumbar spine and usually involve all 3 columns - unstable.
What the 3 Spinal fracture patterns ?
0 Flexion fracture pattern :
Compression fractures - compression causes breaking of veterbrae bone ( osteoporosis & trauma)
Axial burst fractures - high eneegy trauma - parts of vetebrae shatter - more severe than compression farctures - can cause long term neurological damage.
0 Externsion FP - veterbrae pulled apart (e.g seat belt injury - in a head on car accdient the seat belt keeps lower body in place while upper body thrust forward. )
0 Rotation
- e.g Transverse frcature - cause by extreme rotation or sideways bending.
- fracture - disloaction - vetebrae displaced - compressing spinal cord.
What is veterbral compression fracture ?
Vetebral body ins spine collaspses causing loss of height , deformity and severe pain.
CAUSES -
- Osteoporosis
Most common fracture in patients with osteoporosis - caused by falling down or trauma.
- if severe osteoporosis - fracture can be ccaused by simple daily task (e.g sneezing forcelly , liftinh heavy object - no traumatic accident)
- also effect postmenapausal women.
- People with Osteporotic VCF more likely to get a second.
- Cancer -
metastic cancers/ tumours - cancer spreads to bone and causes destruction of veterbrae. - weakening bone. - Severe trauma - healthy spine - car accidents etc.
Symptoms of VCF ?
0 Sudden onset of back pain
0 An increase of pain intensity while standing or walking
0 A decrease in pain intensity while lying on the back
0 Limited spinal mobility
0 Eventual height loss
0 Eventual deformity and disability
- Acute VCF - pain is usually well localised to midline
- Chronic VCF - progressive loss of height
- numerous VCF - causes curvature of spine (Hyperkyposis)
What is veterbral compression fracture ?
Vetebral body in spine collaspses causing loss of height , deformity and severe pain.
CAUSES -
- Osteoporosis
Most common fracture in patients with osteoporosis - caused by falling down or trauma.
- if severe osteoporosis - fracture can be ccaused by simple daily task (e.g sneezing forcelly , lifting heavy object - no traumatic accident)
- also effect postmenapausal women.
- People with Osteporotic VCF more likely to geta second.
- Cancer -
metastic cancers/ tumours - cancer spreads to bone and causes destruction of veterbrae. - weakening bone. - Severe trauma - healthy spine - car accidentss etc.
Treatment of VCF ?
Analgesics - pain relief
Physical therpay - early mobilisation - to prevent further bone loss and disability.
( may be delayed if pain not controlled )
if Osteoporosis present - treat e.g biphosphonate.
Bracing
Diagnosis -
X - ray - if osteoporotic fractures
0 Loss of vertebral height (particularly >
6 cm or more than half the height of
the vertebral body)
0 Decreased radiodensity
Loss of trabecular structure
0 Anterior wedging
