The Back Flashcards

1
Q

The most superior vertebral spinous process that can be palpated is at the base of the neck. Which vertebra is this?

A

C7

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2
Q

What is the vertebral level corresponding with the iliac crests?

A

L4

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3
Q

What is lumbago?

A

Lower back pain

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4
Q

What do the dimples in the skin above your butt correlate to?

A

Posterior superior iliac spines.

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5
Q

How many vertebrae are there? How are they divided?

A

~33 total.

7 cervical
12 thoracic
5 lumbar
5 sacral
some coccygeal
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6
Q

What are the possible motions of the spine?

A

Flexion, extension, lateral bending, and rotation.

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7
Q

How many natural curvatures of the spine are there?

A

4 total: 2 primary and 2 secondary.

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8
Q

Describe the primary and secondary spinal curvatures.

A

The primary curves are kyphoses of the thoracic and sacral regions and are concave with respect to the anterior body.

The secondary curves are lordoses of the cervical and lumbar regions and are concave with respect to the posterior body.

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9
Q

Tight hip flexors (iliopsoas and rectus femoris) and/or weak hamstrings may result in what type of lumbar disorder?

A

Anterior pelvic tilt and lumbar lordosis (hyperlordosis).

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10
Q

Tight hamstrings may result in what type of lumbar disorder?

A

Posterior pelvic tilt and hypolordosis (flatback).

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11
Q

What type of spinal condition do many women in late pregnancy suffer from?

A

Lordosis

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12
Q

What is congenital kyphosis?

A

Failure of thoracic spinal separation during development –> hyper-kyphotic thoracic spine.

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13
Q

What is scoliosis and how is it quantified?

A

Lateral bending of the spine. Cobb angle measures it.

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14
Q

What is kyphoscoliosis?

A

A combination of lateral bending and excessive thoracic curvature

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15
Q

What is the major function of the transverse processes of the vertebrae?

A

To act as levers for muscles.

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16
Q

Which vertebral joints are oriented in a sagittal plane? What motions does this allow for and what motions does this inhibit?

A

Facet joints of the lumbar vertebrae - allows for flexion/extension and lateral bending but not rotation.

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17
Q

In a dissection, which part of the vertebrae are cut in order to access the spinal cord?

A

Cuts are made through the lamina bilaterally on each vertebra.

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18
Q

Through what vertebral structure do spinal nerves pass?

A

The intervertebral foramen.

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19
Q

What nerves supply sensation from the facet joints of the vertebrae?

A

Dorsal primary rami from the spinal nerves. Each facet joint receives sensory fibers from dorsal primary rami of two adjacent spinal nerves.

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20
Q

What is the difference between a bulging and a herniated intervertebral disk?

A

Bulging is when the annulus fibrosus bulges into the spinal canal (vertebral foramen). Herniation is when the nucleus pulposus herniates into the spinal canal.

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21
Q

What symptoms are associated with spinal stenosis?

A

Pain and numbness in the back and legs.

22
Q

What are the major differences among the bony structures and articulations in the cervical vertebrae, thoracic vertebrae, and lumbar vertebrae?

A

Cervical vertebrae have intervertebral facets oriented in an AXIAL plane, allowing for all movements (rotation, flexion/extension, and lateral bending).

Thoracic vertebrae have intervertebral facets oriented in the CORONAL plane which facilitates rotation but not flexion or extension.

Lumbar vertebrae have facet joints oriented in the SAGITTAL plane, allowing for flexion and extension but not rotation.

Thoracic vertebrae also articulate with ribs, so they have transverse costal facets that articulate with the rib tubercles.

23
Q

What part of an intervertebral disk bears most of the weight in adulthood?

A

The annulus fibrosus.

24
Q

Describe the intervertebral disks of the sacrum.

A

Trick! There aren’t any, the sacral vertebrae are fused.

25
Q

What structure is palpated to figure out where to inject for a caudal epidural block? What nerves are being affected?

A

The cornua of the sacral hiatus. Bathes the sacral nerves in anesthetic.

26
Q

What’s up with the first two cervical vertebrae?

A

They are different than the rest.

C1 aka Atlas articulates with occipital condyles of the base of the skull and has no vertebral body.

C2 aka Axis has a superior protrusion called the Dens and a small body.

27
Q

What is the condition characterized by incomplete closure of the embryonic neural tube called?

A

Spina bifida

28
Q

What are the three categories of spina bifida? Describe each.

A

Least severe is spina bifida occulta: failure of vertebral closure and spinous process formation, but the spinal cord remains in the canal and is surrounded by meninges.

Spina bifida cystica with meningocele is when the spinal cord remains in the canal but the meninges bulge out and is full of CSF.

Spina bifida cystica with myelomenigocele is severe - when the spinal cord bulges outside the canal into the posterior portion of the meningocele. Patients lose control over bladder (parasympathetic) and motor function.

29
Q

What is the function of the anterior longitudinal ligaments of the vertebrae? What is the function of the supraspinous and intraspinous ligaments?

A

Anterior longitudinal ligaments prevent excessive extension.

Supraspinous and intraspinous ligaments prevent hyperflexion.

30
Q

What structure is responsible for causing posterior disc bulges to occur laterally? Normally, what is the function of this structure?

A

The posterior longitudinal ligament. It normally prevents hyperflexion of the spine.

31
Q

What is the term for anterior displacement of the vertebral column in relation to the vertebrae below? What are some symptoms of this?

A

Spondylolisthesis. Symptoms include low back pain, tight posterior lower limb muscles, stiffness, tenderness in the area of the slipped disc, nerve damage with radiating leg pain.

32
Q

What is spondylolysis?

A

When anterior slippage of a vertebrae (spondylolisthesis) is so severe that it fractures the pars interarticularis of the slipped vertebra - the region between the inferior and superior articular processes. It is referred to a “dog collar” because it looks like a break in the neck of a dog on x-ray.

33
Q

What is ankylosing spondylitis?

A

A chronic, inflammatory arthritis and autoimmune disease. It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine - “bamboo spine.” HLA-B27 association. Rabson.

34
Q

Which disease is characterized by hematogenous spread of tuberculosis from other sites, often pulmonary, to the spine? What is a complication of this disease?

A

Pott’s disease. It may also lead to a psoas abscess which forms under the fascial sheath of the psoas major muscle.

35
Q

How many spinal nerves are there total? What about in each segment (cervical, thoracic, etc.)? How are they numbered?

A
31 total:
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

Since there are only 7 cervical vertebrae, each c-spinal nerve exits the spine ABOVE the vertebrae of the same number. The 8th cervical spinal nerve exits below C7 (above T1), and from then on the nerve numbers correspond to the vertebrae immediately above each nerve.

36
Q

Are spinal nerves mixed (containing both sensory and motor fibers)?

A

Yeah!

37
Q

Where does the spinal cord end? What is that called? What happens after that?

A

It tapers off and ends at L1/L2 - the tapered end is called the conus medularis; the cauda equina continues from there

38
Q

Compare gray vs. white matter in the spinal cord.

A

Gray matter contains neuronal cell bodies, dendrites, and axons.

White matter is myelinated axons and is split up into a dorsal column, ventral column, and two lateral columns (columns are called “funiculi”).

39
Q

What are the divisions of gray matter in the spinal cord?

A

Posterior (dorsal) horns, anterior (ventral) horns, and lateral horns (lumbar only - where sympathetic cell bodies are)

40
Q

What are the three meningeal layers and 3 spaces associated with them?

A

3 layers of meninges:

  1. Dura mater
  2. Arachnoid mater
  3. Pia mater

3 spaces:

  1. Epidural - outside dura mater
  2. Subdural - between dura mater and arachnoid mater
  3. Subarachnoid - contains CSF and is between arachnoid and pia
41
Q

What is the filum terminale? What is it derived from?

A

It is a vestigial extension of the PIA MATER from the conus medularis (the tapered ending of the spinal cord) extending down to the sacral hiatus.

42
Q

Where is a lumbar puncture performed for CSF sampling? What landmarks should be used?

A

Should be performed somewhere between L2 and S1. You can use the top of the iliac crest as a landmark for L4.

43
Q

Describe the blood supply to the vertebral column.

A

There is one anterior spinal artery and two posterior spinal arteries. These run up and down the ventral and dorsal sides of the column, respectively. They both can anastomose with segmental medullary arteries, which come into the column along with dorsal and ventral roots.

Radicular arteries also come into the column along with dorsal and ventral roots, but do not anastomose with the medullary arteries (that’s the difference between these and segmental medullary arteries).

The c-spine also has additional blood supply from the ascending cervical artery and vertebral artery, branches from the subclavian artery.

44
Q

The segmental medullary arteries and radicular arteries are branches from the _______ ________ arteries.

A

posterior intercostal

45
Q

What is the venous plexus called that runs in the vertebral foramen? What is the major clinical correlate that was given in class?

A

Internal (epidural) venous plexus. It can provide a route for metastasis of pelvic cancers like prostate cancer to the spine and brain.

46
Q

What are denticulate ligaments?

A

Extensions of the pia mater (from cervical to T12) on each side (~21 total) that anchor the pia mater to the arachnoid and dura mater.

47
Q

How many layers of back muscles are there? What is the general function of the muscles in each layer?

A

3 - superficial (upper extremity movement), intermediate (for respiration), and deep (move the trunk and back)

48
Q

What muscles are in each of the superficial, intermediate, and deep groups of back muscles?

A

Superficial: trapezius, latissimus dorsi, rhomboids major and minor.

Intermediate: serratus posterior superior and posterior inferior.

Deep: splenius, erector spinae, and transversospinalis muscles.

49
Q

What is the action and innervation of the deep group of the back muscles?

A

Extend the trunk (if acting bilaterally). Innervated by dorsal primary rami of spinal nerves.

50
Q

What are the three layers of the transversospinalis muscles? What is their action?

A

Semispinalis, multifidius, rotatores. They extend the trunk (if acting bilaterally) and rotate the trunk (if acting unilaterally)

51
Q

Compare the orientation of the muscle fibers of the transversospinalis muscles and the erector spinae muscles.

A

Transversospinalis are angled up

and toward spines; erector spinae are parallel to the vertebral column.