T Spine/L Spine Mechanics

Question 1

What is the orientation of the superior articulating facet of the Cervical vertebrae?

Answer 1

Backwards
Upwards
Medial

Question 2

What is the orientation of the superior articulating facets on the thoracic vertebrae?

Answer 2

Backwards
Upwards
Lateral

Question 3

What is the orientation of the superior articulating facets of the lumbar vertebrae?

Answer 3

Backwards

Medial

Question 4

What do you call the tissue that runs along the anterolateral aspects of the vertebral bodies?

Answer 4

Anterior Longitudinal Ligament

Question 5

What do you call the tissue running along the posterolateral aspects of the vertebral bodies?

Answer 5

Posterior longitudinal ligament

Question 6

What do you call the tissue connecting laminae if adjacent vertebrae?

Answer 6

Ligamentum Flava

Question 7

What do you call the tissue connecting the transverse processes of adjacent vertebrae?

Answer 7

Intertransverse ligaments

Question 8

What do you call the tissue connecting spinous processes of adjacent vertebrae?

Answer 8

Interspinous Ligaments

Question 9

Explain the rule of threes

Answer 9

T1-3 transverse processes are found on the same level as their corresponding spinous processes

T4-6 transverse processes are found half a step up to the previous thoracic spinous process in relation it’s corresponding spinous process

T7-9 transverse processes are found a full step up, aligned with the previous thoracic spinous in relation to its corresponding spinous process

T10 transverse processes are aligned with its own spinous process

T11 transverse processes are aligned a half step above

T12 transverse processes are aligned a full step above

Question 10

What are the actions of the Rotatores Muscles, and specifically what section do they act on?

Answer 10

Bilaterally: extension of thoracic spine

Unilaterally: rotation of thoracic vertebrae to opposite side

Question 11

What are the actions of the multifidus Muscles, and specifically what section do they act on?

Answer 11

Bilaterally: extension of spine

Unilaterally: flexes to same side, rotates to opposite side

Multifidus spans cervical, thoracic, and lumbar segments of the spine

Question 12

What are the actions of the Semispinalis Muscles, and specifically what section do they act on?

Answer 12

Bilaterally: extends the cervical, thoracic and head

Unilaterally: bends head, cervical, thoracic spine to same side, rotates to opposite side

Question 13

What are the three spinal land marks?

Answer 13

Spine of the scapula -> T3 spinous process/T3 transverse processes

Inferior Angle of the Scapula -> T7 spinous process/T8 transverse processes

Iliac Crest -> L4 vertebra

Question 14

What direction does the spine bend in dextroscoliosis?

Answer 14

Right

Make sure to pay attention whether you’re looking at an anterior or posterior view

Question 15

What direction does the spine curve in a levoscoliosis?

Answer 15

Left

Make sure to pay attention whether you’re looking at an anterior or posterior view

Question 16

How do you monitor scoliosis based on its severity?

Answer 16

<25 degrees: conservative, monitor with frequent radiograph imaging

25-45 degrees: non operative bracing

> 45 degrees: Surgical fusion

Question 17

At what angles do complications appear?

Answer 17

> 50 degrees shows respiratory complications

> 75 degrees shows cardiac complications

Question 18

What is radiculopathy?

Answer 18

Pinched nerve

Pain with Dermatomal distribution

Neurological function may be impaired: lower extremity weakness and diminished reflexes

Typically may be acute, can become chronic

Work up: straight leg test (patient raises leg while lying down with knee extended, test is positive if pain appears between 15-30 degrees of movement) and MRI

Question 19

How do the symptoms of radiculopathy differs from L4/L5 disc and L5/S1 disc?

Answer 19

L4/L5 disc: weakness with dorsiflexion, difficulty walking on heel

L5/S1: weakness with plantarflexion, difficulty walking on toes, gastrocnemius and soleus atrophy, ankle jerk diminished or absent (calcaneal reflex)

Question 20

What is spinal stenosis?

Answer 20

Bone growth that narrows spinal canal

Bilateral lower limb pain

Neurogenic Claudication (pain with walking)

Neurologic function may be impaired (lower extremity weakness and absent or diminished reflexes)

Typically chronic

Work up: straight leg test (patient raises leg while lying down with knee extended, test is positive if pain appears between 15-30 degrees of movement) and MRI

Question 21

What is cauda equina syndrome?

Answer 21

When the nerves below the spinal cord (cauda equina) are damaged - typically by a herniated disc

Impaired neurologic function: Sadal anesthesia (numb butt), lower extremity weakness, absent or diminished reflexes, and urinary retention

Emergency, usually traumatic

Work-up: MRI

Question 22

What is spina bifida occulta?

Answer 22

Failure of neural tube to close without herniation, sometimes tuft of hair is present on mid back at site of defect.

Question 23

What is meningocele?

Answer 23

Failure of neural tube closure, but herniation is present with protrusion of meninges. No spinal cord tissue in the hernia.

Question 24

What is myelomeningocele?

Answer 24

Failure of neural tube closure with hernia with protrusion of both meninges and spinal cord through the Defect

Question 25

What is sacralization?

Answer 25

Sacralization is when one or both of the transverse processes of L5 fuse with S1

Question 26

What is lumbarization?

Answer 26

When S1 fails to fuse with the rest of the sacrum

Question 27

What is spondylosis?

Answer 27

The general wear of the spinal column

Spinal osteoarthritis

Bony spurs can form - abnormal growths on the spinal column

Question 28

What is spondylolysis?

Answer 28

Defect or stress fracture of the vertebral arch

Question 29

What is Spondylolesthesis?

Answer 29

Slipping of one vertebra on another