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Spinal anatomy > Unit Three Intervertebral Disc > Flashcards

Unit Three Intervertebral Disc Flashcards

1
Q

How many discs in the spine

A

23

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2
Q

How many discs in the cervical region

A

6

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3
Q

How many discs in thoracic region

A

12

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4
Q

How many discs in the lumbar region

A

5

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5
Q

Where are there no intervertebral discs in the spine

A

Occiput -C1, and C1-C2, sacrum and coccyx

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6
Q

What is replaced for disc in sacrum and coccyx

A

Fibrocartilage with no nucleus

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7
Q

What percentage of the intervertebral disc makes up the height of the spinal column

A

25%

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8
Q

Where are the discs the thickest

A

Lumbar

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9
Q

Where are the discs the thinnest

A

Upper thoracic

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10
Q

Where are the discs thicker ventrally

A

Cervical and lumbar

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11
Q

What makes up a symphysis joint

A

2 vertebrae plus the disc

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12
Q

A motion segment is

A

2 vertebrae plus the disc

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13
Q

What is the intervertebral disc attached to

A

Vertebral bodies, ALL, PLL, intra-articular, ligaments and ribs 2-9

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14
Q

What are the functions of the disc

A

Maintain the changeable space between vertebrae, aids in flexibility of spine, acts to properly assimilate compressive loads

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15
Q

The disc gives what type of stability to the vertebral column while the paravertebral muscles provide what type of stability to the spine

A

Intrinsic with disc and muscles are extrensic

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16
Q

What is considered the largest avascular structure in the human body

A

Disc

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17
Q

What are the three parts of the disc

A

Nucleus pulposis, annulus fibrosis, cartilaginous end-plate

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18
Q

The cartilaginous end plate is made up of

A

Hyaline cartilage

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19
Q

Intervertebral disc allows for what

A

Compressive, tensile and rotational motion

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20
Q

In between the two bodies contains

A

Intervertebral disc, end plate and apophyseal ring

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21
Q

The annulus fibrosis is where on the disc

A

Outer part

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22
Q

The annulus is able to sustain the forces of

A

Compression, torsion and flexion

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23
Q

Why is the annulus fibrosis able to sustain the forces of compression, torsion, and flexion

A

Due to the way the rings are located

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24
Q

What are sharpey’s fibers

A

Fibrous parts of the annulus fibrosis that attaches to the endplates of the vertebral bodies

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25
Q

Water content of the annulus fibrosis at birth is

A

78%

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26
Q

What is the water content of the annulus fibrosis by age 30

A

70%

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27
Q

In order for the disc to function properly is must have

A

High water content

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28
Q

If the disc becomes dehydrated, it loses the ability to

A

Support the axial load placed on it (loses hydrostatic pressure)

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29
Q

When the disc becomes dehydrated is causes a weight bearing shift which is

A

Shift from the nucleus, outward onto the annulus and the outer part of the vertebral body, and places more pressure on the Z joints

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30
Q

Weight bearing shift of dehydrated disc can result in

A

Pathological degenerative disc disease

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31
Q

What holes water in the disc

A

Proteoglycans, glycoaminoglycans (GAGs)

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32
Q

Function of proteoglycans in disc

A

Hold 500 times their own weight and gives disc hydrostatic pressure to support axial compression

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33
Q

Over night the height of the disc

A

Increases up to .5 to 1 inch due to non-axial loading

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34
Q

Diurnal change is

A

Exchange of water in and out of the disc

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35
Q

Diurnal change is only found in

A

Non-degenerated discs

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36
Q

How does water move in the disc during the day

A

Fluid moves out of the nucleus, through the annular rings and into the vertebral body

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37
Q

What happens to hydration of disc at night

A

Nucleus fills up with fluid and presses against the inner annular fibers and makes more tense and less flexible

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38
Q

Tears in the annular rings occur especially with

A

Coupled motion of flexion and torsion

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39
Q

How is the distribution of load in the disc

A

Nucleus distributes load equally throughout the annulus

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40
Q

In the severely degenerated disc, the nucleus has lost all its ability to Cushion the load and causes

A

Disc herniation

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41
Q

What nerve provides the outer 1/3 of the annular fibers have nociception

A

Sinuvertebral nerve

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42
Q

Since outer 1/3 of disc has nerve supply, what about other 2/3

A

No nerves so patient cant tell if damaged or not

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43
Q

How does disc received blood supply

A

Diffusion through the vertebral body endplates from network of vessels located centrally in endplate

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44
Q

What part of the disc has blood supply

A

Outer annular fibers

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45
Q

Since outer annulus fibers has blood supply that means

A

Outer 1/3 of annular fibers will heal/scar

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46
Q

Since inner 2/3 of annular fibers does not have blood supply what does that mean

A

Do not heal and remains a source of problems after being damaged

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47
Q

How do the rings (lamellae) progressively tear

A

From center outwards

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48
Q

How does a disc repair itself

A

From outward in

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49
Q

The nucleus pulposus is what percentage of water at birth

A

88%

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50
Q

By age 70, the water percentage of nucleus pulposis is what

A

69 to 70%

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51
Q

What part of the nucleus pulposis comes from the embryonic notochord

A

Center part of the nucleus

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52
Q

How long does the nucleus pulposis have a direct blood supply

A

Until age 8 then becomes avascular

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53
Q

Permanent dehydration of the nucleus pulposis occurs through

A

Aging process

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54
Q

Until what age is the nucleus pulposis disc fully hydrated

A

Age 40

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55
Q

By what age does the nucleus pulposis disc have reached their maximum state of dehydration

A

Age 60

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56
Q

The maximum state of dehydration of the nucleus pulposis causes

A

Decrease ROM and a slight narrowing of the IVF

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57
Q

What makes up about 40% of the total disc

A

Nucleus pulposus

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58
Q

Where is the nucleus pulposus best developed

A

Lumbar spine then cervical spine then the thoracic spine

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59
Q

Where is the nucleus pulposis placed in the cervical disc

A

Centrally

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60
Q

Where is the nucleus pulposis placed in the lumbar disc

A

Posterior

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61
Q

The composition of the nucleus polposus is

A

80% water and solid 20%

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62
Q

The solid portion of the nucleus pulposus is made up of

A

65% proteoglycans and 17% collagen 2 fibers, small amount of elastin

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63
Q

What are the cells located in the nucleus pulposis

A

Chondrocytes

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64
Q

The nucleus of the disc receives nutrition from

A

The blood that is inside the subchondral bone

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65
Q

The fluid that goes in and out of the disc goes to the

A

Subchondral bone

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66
Q

The nutrition is transferred from the subchondral bone to the fluid through what process

A

Diffusion

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67
Q

The nutrition then enters the fluid and is transported back into the nucleus where it is received is done by what process

A

Imbibition

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68
Q

What is imbibition

A

Absorption of a fluid by a solid body or gel

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69
Q

Is the cartilaginous vertebral end plate part of the bone or the vertebrae

A

No

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70
Q

How thick is the hyaline cartilage of the vertebral end plate

A

3 to 4 mm

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71
Q

The cartilaginous portion of the vertebral end plate is what with the annulus

A

Strongly interwoven into the annulus

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72
Q

Does the the permeability of the end plate increase or decrease with age

A

Decrease

73
Q

The decrease in permeability of the disc is a major cause of

A

Disc degeneration

74
Q

Decrease permeability of the disc causes

A

The nutrition from getting to the disc and metabolic waste products from leaving the disc

75
Q

Is the very outer rim of the vertebral body covered by the end plate

A

No

76
Q

What is the ring apophysis

A

The exposed peripheral area of the vertebral body

77
Q

What is often the site for development of spur formation associated with the degeneration process

A

Ring apophysis

78
Q

The vertebral end plate is part of what and not part of what

A

Part of the disc and not part of the vertebra

79
Q

What does the nucleus pulposus look like

A

Thick, yellow gelatinous fluid

80
Q

The nucleus pulposis makes up what percent of the total disc content

A

33 to 66%

81
Q

Function of proteoglycans

A

Attract water molecules and help protect against shock

82
Q

What are the two most common proteoglycans or GAGs

A

Glucosamine sulfate and chondriton sulfate

83
Q

Are all discs the same in the spinal cord

A

No depends on length of vertebral body

84
Q

What is in proteoglycans and GAGs that trap and hold water

A

Aggrecans

85
Q

In the C spine the disc is larger

A

In the front than the back

86
Q

The C region has what size disc

A

3 mm

87
Q

The c spine disc contains what height of the body

A

2/5th

88
Q

The T spine disc is larger

A

In the front than the back

89
Q

What is the thickness of the disc in the T spine

A

5 mm

90
Q

The disc in the T spine measures the height of the body to be3

A

1/5th

91
Q

The L spine disc is larger

A

In the front than the back

92
Q

The thickness of the disc is the L spine is

A

9 mm

93
Q

The disc of the L spine measure the height of the vertebral body to be

A

1/3rd

94
Q

What is an annular tear/ fissure

A

Separations between annular fibers, avulsion of fibers from their vertebral body insertions, or breaks through fibers that extend radially, transversely or concentrically, involving one or more layers of the annular lamellae

95
Q

What are the three types of tears in a disc

A

Concentric tears, radial tears and transverse annular tears

96
Q

What is a concentric tear

A

Separations of the tissue between the lamellae and allows fluid or mucoid material to accumulate here causing more pressure or separation

97
Q

What are radial tears

A

Horizontal or obliquely horizontal tears that begin within the nucleus and progress outward toward the annular surface

98
Q

Aka of transverse annular tears

A

Rim lesions

99
Q

What are transverse annular tears

A

Tears of the very outer fibers of the disc (sharpey’s fibers) near the insertion into the ring apophysis

100
Q

What are the meningeal branches of the spinal nerves

A

Number of small nerves that branch from the spinal nerve near the origin of the anterior and posterior rami, but before the rami communicantes branch

101
Q

AKA of meningeal branches of the spinal nerves

A

Recurrent meningeal nerves, sinuvertebral nerves, or recurrent nerves of luschka

102
Q

The size and severity of the disc herniation does not correlate to

A

The patients degree of pain, disability or suffering

103
Q

Which type of contained herniation responds less favorably to surgery

A

Small contained herniations

104
Q

In order for a disc to herniate, it’s structural components must first

A

Weaken

105
Q

The structural components of a disc weaken as a result of

A

Disc degeneration

106
Q

The degeneration of the disc begins as

A

The annulus becomes dried and more brittle allowing for the pressure of the nucleus to bulge out and tear the annulus fibers

107
Q

What is desiccation

A

Annulus becomes dried

108
Q

Most disc herniation occur at what age

A

30s or 40s when nucleus pulposus is still a gelatin like substance

109
Q

With age the nucleus pulposus dries out and the risk of herniation is

A

Greatly reduced

110
Q

After age 50 or 60, what is the cause of low back pain or leg pain

A

Osteoarthritic degeneration (spondylosis) or spinal stenosis

111
Q

Diagnosis is based on

A

History, symptoms, and physical examinations

112
Q

The majority of spinal disc herniation cases occur where in the spine

A

Lumbar region

113
Q

The second most common site spinal disc herniation cases occur where in the spine

A

Cervical region

114
Q

Cervical disc herniations most often occur where

A

C5/6 and C6/7

115
Q

The herniations in the c spine can have symptoms that affect

A

Back of the skull, neck, shoulder girdle, scapula, shoulder, arm and hand

116
Q

What nerve plexus are affected by the cervical disc herniation

A

Cervical plexus and brachial plexus

117
Q

What disc herniations can mimic cervical disc herniations

A

Upper thoracic

118
Q

What are the three main classifications of disc herniations

A

Bulge, herniation and sequestration

119
Q

Aka protrusion herniation

A

Contained herniation or sub-ligamentous herniation

120
Q

Aka of extrusion herniation

A

Non-contained herniation or trans-ligamentous herniation

121
Q

Aka of sequestration

A

Free fragment

122
Q

By convention, a herniation is a localized process involving less than what percent of the disc circumference

A

50% or 180 degrees

123
Q

Definition of disc bulge

A

Disc in which the contours of the outer annulus extends in the horizontal plane beyond the edges of the disc space

124
Q

A bulge of the disc involves what percentage of the circumference of the disc

A

More than 50%

125
Q

Definition of the disc herniation

A

Focal incomplete extension of the contents of the nucleus pulposus through an incomplete tear of the annulus fibrosis in less than 50% of the circumference of the disc

126
Q

Herniation has what percentage of disc circumference

A

Less than 50%

127
Q

What are the two subclassifications of herniation

A

Protrusion and extrusion

128
Q

Protrusion herniation

A

Disc material sticks backward into the canal

129
Q

The disc protrusion looks

A

Less than its width

130
Q

Extrusion disc herniation

A

Disc material sticks backward into the canal and then goes either upward or downward into the canal

131
Q

Extrusion herniation appears

A

Longer than it is wide

132
Q

What results in an anterior epidural mass

A

Extrusion of disc contents through complete tears of annulus fibrosus and the PLL

133
Q

What are focal disc bulges

A

Less than 25% of the disc circumference is herniated

134
Q

What is a broad based disc bulge

A

25 to 50% of the disc circumference is herniated

135
Q

What is a contained herniation

A

The displaced portion of disc is covered by the outer annular fibers

136
Q

What is uncontained herniation

A

The displaced portion of the disc protrudes through the outer annular fibers and into the spinal canal by itself

137
Q

What is sequestration

A

An extruded disc in which a portion of the disc tissue has become displaced from the disc space of origin and lacks any continuity with the parent disc.

138
Q

Herniated disc causes an inflammatory reaction that eventually

A

Reabsorbs most of the disc material

139
Q

Is it better to have an uncontained disc herniation or contained one

A

Uncontained due to it being reabsorb more rapidly and completely

140
Q

What is a good thing to do if patient has herniated disc

A

Walk

141
Q

Bad thing to do if patient has herniated disc

A

Sitting

142
Q

What is Knutsons vacuum disc phenomenon

A

Disc hardens due to decrease in water which makes it more easy to fracture. The fracture produces nitrogen gas formation and can be seen on X ray dark radiolucent line within disc

143
Q

Aka of knutsons vacuum disc phenomenon

A

Phantom dis or vacuum defect or lucent cleft

144
Q

Most common cervical disc herniation is at

A

C5/6

145
Q

Mose common lumbar disc herniation is at

A

L4/5 and L5/S1

146
Q

What is the most common cause of pain down the legs, along with low back pain, numbness and tingling in arms and other extremities

A

Disc herniation

147
Q

Leaning to one side while having herniated disc is what type of mechanism

A

Voluntary or involuntary mechanism to alleviate nerve root irritation

148
Q

What is lateral disc herniation posture

A

Patient will list or lean away from the side of sciatica because leaning into the side puts more pressure on the nerve root and causes more pain

149
Q

What is medial disc herniation posture

A

Patient will lean into the side of sciatica because leaning away will pull the nerve root over the disc more and cause pain

150
Q

What is central disc herniation posture

A

The patient tends to lean forward which open the joint and takes pressure off the spinal cord which the disc is pushing on

151
Q

What disc herniation posture is most common

A

Lateral disc herniation

152
Q

Which disc herniation posture is the least common

A

Central disc herniation

153
Q

Leg raise test 0 to 35 degrees, if pain then

A

Muscle

154
Q

Straight leg test 35 to 70 degrees

A

Tension now applied to sciatic nerve roots. The nerve tenses over the disc during this range

155
Q

Straight leg raise 70 to 90 degrees

A

Pain at this level is probably joint pain as there is no further deformation of the nerve, nerve not pulled over disc, it relaxes at 70 degrees

156
Q

If raise well leg (leg not with pain) and it hurts on the other leg side in low back then

A

Medial disc as it pulls opposite nerve root over disc

157
Q

Positive straight leg raise is called

A

Lasegue sign

158
Q

Finding of a negative straight leg raise sign is important in helping to

A

Rule out the possibility of a lower lumbar disc herniation

159
Q

How to adjust lateral disc protrusion

A

Adjust with the disc protrusion (leg pain) up

160
Q

How to adjust a medial disc protrusion

A

Adjust with the disc protrusion (leg pain) down

161
Q

Adjusting medial and lateral disc protrusion with what

A

Side posture adjusting

162
Q

Features of cauda equina syndrome

A

Bladder and bowel incontinence, perineal numbness, bilateral sciatica, lower limb weakness, crossed straight leg raising sign

163
Q

What is a discetomy or microdiscectomy

A

Procedure that removes part of an intervertebral disc that is compressing the spinal cord or a nerve root

164
Q

What is a laminectomy

A

Remove lamina

165
Q

Purpose of laminectomy

A

Relieve spinal stenosis or nerve compression

166
Q

Purpose of hemilameniectomy

A

Help alleviate the symptoms of an impinged or irritated nerve root in the spine

167
Q

What is a hemilaminectomy

A

Remove one side of lamina

168
Q

What are the two types of disc arthroplasty

A

Artificial disc replacement or total disc replacement

169
Q

What is disc arthroplasty

A

Surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial devices in the lumbar or cervical spine

170
Q

Disc arthroplasty used to treat

A

Chronic to severe low back pain and cervical pain resulting from degenerative disc disease, or for cases of cervical disc herniation

171
Q

What is a kyphoplasty

A

Special material injected into fractured vertebral body which then hardens and stabilizes vertebra

172
Q

What is dynamic stabilization surgery

A

Surgical technique designed to allow for some movement of the spine while maintaining enough stability to prevent too much movement

173
Q

Anterior lumbar fusion is done where

A

On the front (anterior region) of the lower spine

174
Q

Lumbar fusion is used when patients have symptoms of

A

Disc degeneration, disc herniation or spinal instability

175
Q

Lumbar fusion is only indicated for

A

Recurrent lumbar disc herniations and not primary herniations

176
Q

What is limbus bone

A

Disc herniation or migration of the nucleus through a secondary growth center in the anterior superior aspect of the body resulting in a non-union of the anterior superior portion of the body and leaving a free ossicle

177
Q

What is schmorl’s node

A

Break in the vertebral end plate and body by the nucleus. A form of disc herniation. Remnants of notochord cells produce weakness in the cartilage end plates, which can lead to herniation of the nucleus pulposis

178
Q

Schmorls node can lead to

A

DJD

179
Q

What is intercalary bone

A

A free ossicle found between the annular fibers and the ALL, mainly in the cervical spine q

Spinal anatomy (18 decks)

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