Thoracic and Lumbar Spinal Mechanics Flashcards
What are the different spinal junctions?
Craniocervical, cervicothoracic, thoracolumbar, and lumbosacral
Where does the gravitational line run through?
External auditory canal, head of the humerus, L3, anterior 1/3 of sacrum, lateral malleolus
For T1-3, T12, what is the relationship between the spinous and transverse processes?
Spinous process located at the level of the corresponding transverse process
For T4-6, T11, what is the relationship between the spinous and transverse processes?
Spinous process located 1/2 segment below the corresponding transverse process
For T7-10, what is the relationship between the spinous and transverse processes?
Spinous process located at the level of the transverse process of the vertebra below
What is the superior facet orientation of cervical vertebrae?
Backwards, upwards, medial
What is the superior facet orientation of thoracic vertebrae?
Backwards, upwards, lateral
What is the superior facet orientation of lumbar vertebrae?
Backwards, medial
Define the anterior longitudinal ligament
Covers and connects the anterolateral aspects of the vertebral bodies and intervertebral discs; limits extension
Define the posterior longitudinal ligament
Runs within the vertebral canal along the posterior aspect of the vertebral bodies; resists hyperflexion and prevents posterior herniation of nucleus pulposus
What does the ligamentum flava connect?
Connects laminae of adjacent vertebrae
What do interspinous ligaments connect?
Connects adjoining spinous processes
What do intertransverse ligaments connect?
Connects adjoining transverse processes
When were Fryette’s principles published? What portions of the spine do they apply to?
1918 (for 1 and 2) and 1948 (for 3 by Nelson); Thoracic and lumbar spine only for 1 and 2
What is the 1st Fryette principle (Type 1 mechanics)?
In the neutral range (not flexed/extended), sidebending and rotation are coupled in opposite directions; rotation is towards the convexity of the spine; tends to be a group of vertebrae
What is the 2nd Fryette principle (Type 2 mechanics)?
In sufficient flexion or extension, sidebending and rotation are coupled in the same direction; rotation is towards the concavity; tends to be a single vertebrae
What is Fryette’s 3rd principle?
If motion is restricted in 1 direction, motion will also be restricted in other directions; if motion is improved in 1 direction, motion will improve in other directions
The spine of the scapula is at the same level as what spinal landmark?
T3 spinous and transverse processes
The inferior angle of the scapula is at the same level of what spinal landmarks?
Spinous process of T7 and transverse process of T8
The iliac crest is at the same level of what spinal landmark?
L4 vertebra
A patient presents with a scoliosis that obscures the heart. What is this called?
Levoscoliosis
A patient presents with scoliosis that frames the heart. What is this called?
Dextroscoliosis
What is the treatment for a patient with a Cobb angle of < 25 degrees?
Monitor with frequent radiographs
What is the treatment for a patient with a Cobb angle between 25-45 degrees?
Non-operative bracing
What is the treatment for a patient with a Cobb angle of > 50 degrees?
Surgical fusion - prevents progression
A patient presents with a Cobb angle of 58 degrees. What complications can you expect?
Respiratory may be compromised
Respiratory compromised with a Cobb angle of > 50
A patient presents with a Cobb angle of 72 degrees. What complications can you expect?
Respiratory complications ONLY
Cardiac is compromised with a Cobb angle of > 75
Define radiculopathy
Pain with dermatomal distribution; lower extremity weakness and diminished reflexes; typically acute, but may become chronic; + straight leg test; MRI
What is considered a + straight leg test and what does it indicate?
Pain is reproduced; pain from 15-30 degrees indicates a lumbar disc etiology
Define spinal stenosis
Bilateral lower limb pain; neurogenic claudication; lower extremity weakness and diminished reflexes; typically chronic; + straight leg test; MRI
Define cauda equina syndrome
Saddle anesthesia, lower extremity weakness, diminished reflexes, urinary retention; emergency, usually traumatic; MRI
Define spina bifida occulta
Failure of neural tube to close without herniation
Define meningocele
Failure of the neural tube to close with protrusions of the meninges through the defect
Define myelomeningocele
Failure of the neural tube to close with protrusion of the meninges and spinal cord through the defect
Define sacralization
1 or both transverse processes of L5 are long and articulate with the sacrum
Define lumbarization
Failure of S1 to fuse with the rest of the sacrum
Define spina bifida
Defect in the closure of the laminate
Define spondylosis
Bony spurs
Define spondylolesthesis
Slipping of one vertebra on another
Define spondylolysis
Fracture or fractures
