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Moores Blue Boxes > Vertebrae > Flashcards

Vertebrae Flashcards

1
Q

What is vertebral body osteoporosis

A

Common metabolic bone disease that is often detected during routine radiograph

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2
Q

Why get osteoporosis

A

Net demineralization of the bones caused by a disruption of the normal balance of calcium deposition and resorption …quality of bone is reduced and atrophy of skeletal tissue occurs

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3
Q

Most effected areas of osteoporosis

A

Neck of femur and bodies of vertebrae , metacarpals, and radius

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4
Q

How do you see osteoporosis on a radiograph

A

Dismissed radiodensity of the trabeculae (spongy)

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5
Q

What is vertical striping and why get it with osteoporosis

A

Loss of horizontal supporting trabeculae a thickening of vertical struts

Dense stripe seen pillars remain ok longer than rest et stripe

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6
Q

Later stages of osteoporosis what do you see on radiograph

A

Vertebral column collapse
Compression fractures
Increased thoracic kyphosis n

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7
Q

What vertebrae is oosteoporosis most common in

A

Thoracic

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8
Q

Laminectomy

A

Surgical excision of one or more spinous processes and the adjacentt supporting vertebral laminae in a particular region of the vertebral column
Or removing most of the vertebral arch by transectingg the Pedicles

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9
Q

Why do a laminectomy

A

Gain access to the vertebral canal, providing exposure of the spinal cord and/or the roots of the specific spinal nerves providing posterior exposure of the spinal cords and/or roots of specific spinal nerves
-relieve pressure on the spinal cord or nerve roots caused by a tumor , herniated disc, or bony hypertrophy

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10
Q

Because of their more horizontally oriented articular facets, the __ vertebrae are less tightly interlocked than other vertebrae. What does this cause

A

Cervical

Dislocation with neck injuries with less force than is required to fracture them

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11
Q

Does dislocation of the cervical vertebrae damage the spinal cord

A

Due to the large vertebral canal in the cervical region, slight dislocation can occur without damage
But severe dislocations or combined with fractures injure the spinal cord

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12
Q

If the dislocation does not result in facet jumping with locking of the displaced articular processes, the cervical vertebrae may self reduce. Clinically what is issue with this and how correct

A

Radiograph may not indicate cord has been injured ..USE MRI to see soft tissue damage

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13
Q

What is C1 called . Describe it

A

Atlas
Bony ring with two wedge shaped lateral masses, connected by thin anterior and posterior arches and a transverse ligament

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14
Q

What kind of forces damage the atlas and why

A

Vertical forces bc the taller side of the lateral mass is directed laterally …the vertical force compress the lateral masses between the occipital condyles and the axis drive them apart, fracturing one or both of the anterior or posterior arches THIS IS CALLED A JEFFERSON OR BURST FRACTURE

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15
Q

If the vertical force is very strong on the atlas, the __ __ that linkers the arches may also occur

A

Transverse ligament

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16
Q

Does Jefferson fracture/burst fracture damage the spinal cord

A

Not necessarily bc the dimensions of the bony ring actually increase
If also rupture the transverse ligament then spinal cord injury more likely

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17
Q

How would a ruptured transverse ligament be seen radiographically

A

Widely separated lateral masses

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18
Q

What is C2 and what is special about it

A

Axis

Most commonly fractured cervical vertebrae

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19
Q

Axis fracture

A

Usually in bony column formed by the superior and inferior articular processes of the axis, the pars inter articular is

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20
Q

What is a fracture of C2 pars interarticularis, called traumatic spondylolysis of C2, caused by

A

Hyperextension of head on neck

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21
Q

What causes whip lash injury

A

Hyperextension of head and neck

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22
Q

What is hyperextension of the head called

A

Hangman’s fracture

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23
Q

What may a severe injury in which the body of C2 vertebra is displaced anteriorly with respect to the body of the C3 vertebrae with or without subluxation of the aaxis cause

A

Qyadriplegia or death. From injury of spinal cord and or brainstem

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24
Q

What causes Fractures of the dens C2

A

Also common , caused by horizontal blow to the head or as a complication of osteopenia

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25
Q

Lumbar spinal stenosis

A

Stenosis vertebral foramen in one or more lumbar vertebrae
Hereditary
More susceptible to IV disc bulging

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26
Q

The lumbar spinal nerves __ in size as the vertebral column descends but the IV foramina ___ in side

A

Increases

Decreases

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27
Q

In lumbar spinal stenosis, narrowing is maximal where

A

At level of the IV discs

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28
Q

Can lumbar stenosis cause compression of one or more spinal nerve roots occupying the inferior vertebral canal

A

Yup

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29
Q

Surgical treatment of lumbar stenosis

A

Decompressive laminectomy

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30
Q

What happens if there is IV disc protrusion in a patient with spinal stenosis

A

Further compromises a vertebral canal that is already limited , as does arthritic proliferation and ligamentous degeneration

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31
Q

Cervical ribs

A

Common 1-2% of people hav C7 costal element which becomes a small part of the transverse process that lies anterior to the foramen transversarium becomes enlarged
Vary size and is bilateral 60%

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32
Q

What does supernumerary extra rib cause

A

Elevate and place pressure on structures that emerge from he superior thoracic aperture , notable the subclavian artery or inferior trunk of the brachial plexus and may cause thoracic outlet syndrome

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33
Q

In living people, the sacral hiatus is closed bu the membranous __ __, which is pierced by what

A 
Sacrococcygeal ligament 
Film terminate (a connective tissue strand extending front he tip of the spinal cord to the coccyx)
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34
Q

Deep (superior ) to the ligament , the epidural space of the sacral canal is filled with fatty connective tissue.

A

Ya

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35
Q

In caudal epidural anesthesia where is Anastasia injected

A

Into fat around the sacral canal that surrounds the proximal portions of the sacral nerves
Route: through sacral hiatus

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36
Q

How can you locate the sacral hiatus

A

Palpate. It is between the sacral cornea and inferior to the s4 spinous process or median sacral crest

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37
Q

Once through the sacral hiatus and injection into the fat, how does anesthesia spread and work

A

Spreads superiorly and extradurally where it acts on ss2-co1 spinal nerves of causal equine

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38
Q

How do you control the height to which anesthesia spreads

A

Amount that you put in and position of patient

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39
Q

How else can anesthetic be injected into sacral canal around spinal nerves and what is this called

A

Through posterior sacral foramina into sacral canal

Transsacral epidural anesthesia

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40
Q

What may an abrupt fall on buttocks cause

A

Subperiosteal bruising or fracture of the coccyx or a fracture-dislocation of the sacrococcygeal joint

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41
Q

Can coccyx be damaged in child birth

A

Ya

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42
Q

Coccygodynia (coccydynia)

A

Syndrome that often follows coccygeal trauma
Pain in coccyx of tail bone area
Pain management can be hard

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43
Q

In 5% of people, __ is partially or completely incorporated into the sacrum. What is this called

A

L5

Hemisacralization (partially) or sacrilization (completely)of the L5 vertebra

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44
Q

What is lumbrilization fo S1 vertebra

A

S1 is separated from the sacrum. And is partly or completely fused with L5

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45
Q

What clinical problem with L5-S1 lumbrarization

A

L5-S1 is strong

L4-L5 weak and degenerates, often causing PAIN

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46
Q

Between birth and 5 the lumbar vertebra increase in height ____, and between 5 and 12, it increases another ___%

A

3 fold

45-50%

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47
Q

When is longitudinal growth finished

A

18-25

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48
Q

What happens middle age and older

A

Decrease in bone density and strength, particularly centrally in vertebrae body
The articular surfaces graduallly bow inward so that both the superior and inferior surfaces of the vertebrae become increasingly concave and IV discs become convex

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49
Q

Clinical issue with concavities

A

Narrowing or intervertebral space

NOT a loss of IV disc thickness

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50
Q

What does aging of IV discs and changing shape of vertebrae cause

A 
Increase in compressive forces at the periphery of the vertebral bodies, where discs are attached. 
Causes osteophytes(bone spurs) to develop around the margins of the vertebral body esp anteriorly and posteriorly
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51
Q

What happens as altered mechanics place greater stresses on the zygapophysial joint

A

Esteophytes develop along the attachments of the joint capsules and accessory ligaments esp superior articular process, whereas exetensions of the articular cartilage develop around the articular facets of the inferior processes

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52
Q

These bony or cartilaginous growth during advanced age have been viewed as a disease process, ____ in the case of vertebral bodies and ____ in case of zygapophysial joints, but can consider it normal anatomy of people of an age(maybe shouldn’t be pathological bc relating to pain is hard)

A

Spondylosis

Osteoarthrosis

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53
Q

Sometimes the epiphysis of a transverse process fails to fuse. Why is this a problem

A

Don’t mistake it for vertebral fracture in a radiograph or ct

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54
Q

Spina bifida occulta

A

Neural arches of L5 and/or S1 fail to develop normally and fuse posterior to the vertebral canal
24% of pop usually in vertebral arch of L5 and/or S1
Small dimple or tuft of hair from lower back
Back problems
Palpate baby to see if vertebral arches are intact and continuous from the cervical to the sacral regions

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55
Q

Spina bifida cystica

A

One or more vertebral arches may fail to develop completely

Herniation of meninges

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56
Q

Meningocele

A

Spina bifida associated with meningeal cyst

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57
Q

Meningomyelocele

A

Spinal cord protrudes

Neurological symptoms present-paralysis of the limbs and distribances in bladder and bowel control

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58
Q

Severe forms of spina bifida result from the ___ ___ ___

A

Neural tube defects

Such as the defective closure of the neural tube during the 4th week of embryonic development

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59
Q

With advancing age, what happens to nucleus pulposi

A

Dehydrate and lose elastin and proteoglygans while gaining collagen
IV discs lose Turcot, becoming stuff and more resistant to deformation

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60
Q

How does this effect the nucleus pulposi

A

Dehydrate and the two parts of the disc appear to merge as the distinction between them becomes increasingly diminished
Becomes dry and granular and may disappear altogether

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61
Q

As the nucleus pulposi disappears, the ___ ___ assumes an increasingly greater share of the vertical load and the stresses and strains that come with it

A

Annulus fibrosis

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62
Q

What happens as the lamellar of the annulus thicken

A

Develop fissures and cavities

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63
Q

What is the most common reason for slight loss of height as age

A

the margins of adjacent vertebral bodies may approach more closely as the superior and inferior surfaces of the body become shallow concavities
*note the IV discs increase in size

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64
Q

Not only do the intervertebral discs become more convex but between 20 and 70, their __ diameters increases 10% in females and 2% in males .

A

AP

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65
Q

The thickness (height) increases centrally about 10% over both sexes. What if it is more

A

Overt narrowing, especially when it is greater than that of more superiorly located discs, suggests pathology (degenerative disc disease), not normal aging

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66
Q

Top two reasons people visit doctor

A

Cold

Back pain

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67
Q

Two biggest causes of lost work days

A

Headache

Backache

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68
Q

What 5 categories of structures receive innervation in the back and can be sources of pain

A

Fibroskeleton(periosteum, ligaments, annulus fibrosi of IV disc)
Meninges
Synovial joints (capsule of zygapophysial joints)
Muscles
Nervous tissue : spinal nerves or nerve roots exiting the IV foramina

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69
Q

What innervates the fibroskeleton and meninges

A

Recurrent meningeal branches of the spinal nerves

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70
Q

What innervates the synovial joints and intrinsic back muscles

A

Posterior rami (articular and muscular branches)

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71
Q

Pain from nervous tissue-caused by compression or irritation of spinal nerves or nerve roots-is called ___ ___, perceived as coming from the cutaneous or subcutaneous area supplied by that nerve (dermatomes

A

Referred pain

*can be accompanied by localized pain

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72
Q

Localized lower back pain

A

Perceived as coming from the back is generally muscular, joint, or fibroskeletal pain.
Muscular-usually related to reflexive cramping (spasm) producing ischemia, often secondarily as a result of guarding
Zygapophysial-associated with aging (osteoarthritis) or disease (RA)
Pain from vertebral fractures-sharp pain mostly periosteal
Dislocations-ligamentous
IV disc herniation-emanates from the disrupted posterolateral anulus fibrosis and impingement on the posterior longitudinal ligament

Pain in all these latter instances is conveyed initially by the meningeal branches of the spinal nerves

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73
Q

Clinical presentation of herniated nucleus pulposus

A

Lower back pain and lower limb pain

Also can be asymptomatic

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74
Q

IV discs are strong in young people with a high water content . Do they get fractures or rupture first

A

Fracture before discs rupture

More water more Turgor

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75
Q

What may rupture an IV disc and fracture

A

Violent hyperextension

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76
Q

What does flexion of vertebral column cause

A

Compression anteriorly and stretching/tension posteriorly
Squeezing nucleus pulposus further posteriorly toward thinnest part of anulus fibrosis (if degenerated may herneate into vertebral canal and compress spinal cord or nerve roots of cauda equina)

77
Q

Herniation of L4 L5 disc

A

Sparing L4 spinal nerve but compressing L5 and other nerves passing to lower levels

78
Q

What is the cauda equina

A

Bundle of spinal nerve and spinal nerve rootlets consisting of the second through fifth lumbar nerve pairs , the 1-5 sacral nerve pairs, and the coccygeal nerve all of which arise from the lumbar enlargement and the conus medularis of the spinal cord

79
Q

Where does nucleus pulposus usually herniate

A

Posterolaterally where anulus fibrosis is thin and does not get support from posterior or anterior longitudinal ligaments

80
Q

Why is a posterior lateral herniation usually symptomatic

A

Proximity of the spinal nerve roots

81
Q

Is the nucleus pulposus sensitive

A

No

82
Q

Localized back Pain of PL herniated disc

A

Acute pain from pressure on longitudinal ligaments and periphery of the anulus fibrosus and from local inflammation caused by chemical irritation by substances from ruptured nucleus pulposus

83
Q

Chronic pain from compression of the spinal nerve roots by hernaited disc

A

Referred radiating pain

Perceived as coming from he dermatome supplied by that nerve

84
Q

Where are PL herniation of the nucleus pulposus most common and why

A

Lumbar and lumbosacral regions where movements are consequently greater and IV discs are largest

85
Q

Where are 95% of lumbar disc protrusions

A

L4-L5, L5-S1

86
Q

With disc herniation what foes the decrease in intervertebral space (disc height) cause

A

Narrowing of the of the IV foramina exacerbating compression of the spinal nerve roots, especially if hypertrophy of the surrounding bone has also occurred

87
Q

Since nucleus gets more dehydrates and fibrous/granular with age, is acute herniation common in advanced years? What would you suspect over it

A

No

Suspect nerve roots being compressed by increased ossification of the IV foramen as they exit

88
Q

Acute pain in lower back

A

Suspect mild PL protrusion of lumbar IV disc at L5-S1 such as those assocatied with the posterior longitudinal ligament

89
Q

Muscle spasm associated with low back pain

A

Lumbar region of vertebral column becomes tense and cramped as relative ischemia occurs, causing painful movements

90
Q

Sciatica

A

Radiates from lower back into the buttock and down posterior or lateral aspect of the thigh into the leg

91
Q

Common cause of sciatica

A

Herniated lumbar IV disc that compromises L5 or S1 component of the sciatic nerve

92
Q

What movement may produce or exacerbate sciatic pain

A

Flex thigh with knee extended

93
Q

Can osteophytes cause sciatica

A

Ya

94
Q

What other movements may also damage IV discs

A

Violent rotation or flexing

95
Q

When an IV disc protrudes, it usually compresses the nerve root numbered one __ to the herniated disc. L5 nerve root is compressed by what herniation

A

Inferior

L4-L5

96
Q

The spinal nerve roots descend to the IV foramen from which the spinal nerve ____ by their merging will exit

A

Formed

97
Q

The nerve that exits a given IV foramen passes through the ___ bony half of the foramen and this lies ___ and is not affected by a herniated disc at that level

A

Superior

Above

98
Q

The nerve roots passing to the IV foramen immediately and farther below pass directly across the area of herniation

A

Symptom producing IV disc protrusions occur in the cervical region almost as often as in the lumbar region

99
Q

What may chronic or sudden forcible hyperflexion of the cervical region (head on collision or during illegal head blocking in football) cause. Why does that happen in this region

A

Rupture IV disc posteriorly without fracturing the vertebral body
In this region the IV discs are centrally placed int he anterior border of the IV foramen and a herniated disc compresses the nerve actually exiting at the level of the disc (rather than below as in the lumbar region)

100
Q

Soooo if you herniate a cervical disc is the above or below nerve affected

A

Below
C5-6, C6
C6-7, C7

101
Q

Where do cervical disc ruptures cause pain

A

Neck, shoulder, arm, hand

102
Q

Degenerative disc disease that results in a markedly diminished IV disc space causes __ ___ that may be treated with laminectomy with or without spinal fusion

A

Spinal stenosis

103
Q

What do laminectomy and spinal fusion do

A 
Laminectomy-decompress involved nerves 
Spinal fusion (athrodesis)-eliminates movement between two or more segments of the back that may produce additional compression by using bone to make a bridge between adjacent vertebrae  which will be replaced by new bone that unites the adjacent vertebral bodies (rod until bone formed)
104
Q

What does spinal fusion treat

A

Numbness, pain, or weakness in lower limbs rather than back pain
Increase range of motion

105
Q

Artificial disc replacement

A

Alternative to fusion when one or two segments are involved
Restores disc space lost due to disc degeneration , relieving stenosis while allowing motion to occur

Also prevents premature breakdown of adjacent segments

106
Q

Why are zygapophysial joints of clinical interest

A

Close to IV foramina through which the spinal nerves emerge from the vertebral canal

107
Q

What is often affected when the zygapophysial joints develop osteophytes(osteoarthritis)

A

Spinal nerves are often affected , causing pain along the distribution patterns of the dermatomes and spasm in the muscles derived from the associated myotomes

108
Q

What is enervation of lumbar zygapophysial joints

A

Procedure for treatment of back pain caused by disease of these joints. Nerves are sectioned near the joints or are destroyed by radiofrequency percutaneous rhizolysis. The dinner action is directed at the articular branches of two adjacent posterior rami of the spinal nerves because each joint receives innervation from both the nerve exiting at that level and the superjacent nerve

109
Q

Sudden forceful flexion (automobile accident or violent blow to the head)

A

Crush or compression fracture of the body of one or more vertebrae

110
Q

Violent anterior movement of vertebrae with compression

A

Vertebra may be displaced anteriorly on the vertebra inferior to it (dislocate C6 or C7 vertebrae)
Usually displacement dislocates and fractures the articular facets between the two vertebrae and ruptures the interspinous ligaments

111
Q

Sudden forceful extension (head butting. Or illegal face blocking in football )

A

Injure posterior parts of the vertebrae , fracturing by crush or compression of the vertebral arches and Their processes

112
Q

Why do fractures of cervical vertebrae radiate pain to back of neck and scapular region

A

Same spinal sensory ganglia and spinal cord segments receive pain impulses from he vertebrae are also involved in supplying neck muscles

113
Q

Severe hyperextension of neck (whip lash) from rear end motor collision injuries esp with head rest low

A

Anterior longitudinal ligament is is stretched and may be torn

114
Q

Hyperflexion injury of the vertebrae may also occur as the head rebounds after the hyperextension snapping the head forward on the thorax. What does this cause

A

Facet jumping, or locking of the cervical vertebrae may occur because of dislocation of the vertebral arches.

Severe hyperextension may also produce hang mans fracture , rupture of anterior longitudinal ligament and adjacent anulus fibrosis of C2-C3 IV

115
Q

If this injury occurs the cranium, C1 and the anterior portion (dens and body) or C2 are separated from the rest of the axial skeleton ….what happens

A

Spinal cord is usually severed and person doesn’t survive really

116
Q

What causes most fractures of the cervical region

A

Football, diving, falls (from horse), and MVC

117
Q

Is the lumbar region less flexible than thoracic

A

No more

118
Q

What are the most commonly fractures thoracic vertebrae and why

A

T11 and 12 bc of the abrupt change to the lumbar region which has more flexibility
They participate in rotary movements superiorly but only flexion and extension movements inferiorly

119
Q

Why is dislocation of vertebrae uncommon in thoracic and lumbar regions

A

Interlocking of their articular processes

120
Q

What fracture breaks the interlocking mechanism

A

Soondylolysis-fracture of the column of bones connecting the superior and inferior articular processes (pars interarticularis or interarticular part)

121
Q

Subsequently, what may happen after spondylolysis

A

Spondylolisthesis
Fracture of interarticular parts of the vertebral laminae of L5(spondylolysis of L5) may results in spondylolisthesis of L5 vertebral body relative to the sacrum due to downward tilt of L5/S1 IV joint

122
Q

Spondylolisthesis at L5S1 IV joint may result in pressure on the spinal nerves of the __ ___ as they pass into the superior part of the sacrum causing lower back and limb pain

A

Cauda equina

123
Q

Which is stronger: the transverse ligament of the atlas or the dens of C2 vertebra

A

Transverse ligament

*note fractures of the dens make up 40% of fractures of the axis

124
Q

Where does the most common dens fracture occur

A

Base

125
Q

Why are base fractures of the dens unstable(don’t reunite)

A

The transverse ligament of the atlas becomes interposed between fragments and bc the separated fragments no longer have a blood supply which results in AVASCULAR NECROSIS

126
Q

Fractures of the vertebral body inferior to the base of the dens

A

Also common

Heals more readily bc fragments retain their blood supply

127
Q

What happens when transverse ligament of the atlas sutures

A

The dens of the axis is set free resulting in atlantoaxial subluxation -incomplete dislocation of the median Atlanta-axial joint

128
Q

What causes pathological softening of the transverse and adjacent ligaments

A

Connective tissue disorders
May also cause atlantoaxial subluxation
Down’s syndrome

129
Q

Is dislocation owing to transverse ligament rupture or a genesis more likely to cause spinal cord compression than that resulting from fracture of the dens

A

Yup
The dens fragment is held in place against the anterior arch of the atlas by the transverse ligament and the dens and atlas move as a unit

130
Q

In the absence of a competent ligament the upper cervical region of the spinal cord may be compressed between the approximated posterior arch of the atlas and the dens, causing what

A

Paralysis of all four limbs (quadroplegia) or into the medulla of the brainstem resulting in death

131
Q

What is Steele’s rule of thirds

A

1/3 of atlas ring is occupied by the dens, one third the spinal cord, and 1/3 fluid filled space and tissues surrounding the cord

132
Q

Why may some people with anterior displacement of the atlas be asymptomatic

A

Rule of thirds ]

133
Q

Sometimes inflammation in the craniovertebral area may produce softening of the ligaments of the craniovertebral joints and cause dislocation of the atlanto-axial joints

A

Sudden movement of a patient from a bed to a chair may produce posterior displacement of the dens of the axis and injury to spinal cord

134
Q

Are the alar ligaments stronger than the transverse ligaments

A

No weaker

135
Q

What movement tears one or both alar ligaments

A

Combined flexion and rotation or head

136
Q

What does rupture of alar ligaments cause

A

Increase of approximately 30% in the range of movement to the contralateral side

137
Q

Dowager hump

A

Excessive thoracic kyphosis in older women resulting from osteoporosis but also in elderly men

138
Q

What does osteoporosis effect most

A

Horizontal trabeculae or trabecular bone of the vertebral body
The remaining unsupported vertical trabeculae are less able to resist compression and sustain compression fractures, resulting in short and wedge shaped thoracic vertebrae

139
Q

The excessive kyphosis leads to an increase n the AP diameter of the thorax and a significant reduction in what

A

Dynamic pulmonary capacity

140
Q

What is excessive lumbar lordosis associated with

A

Weakened trunk musculature, especially anterolateral abdominal muscles
*pregnancy (low back pain that disappears after birth)
Obesity

141
Q

Scoliosis

A

Curvature accompanied by rotation spinous processes turn upward toward the cavity of the abnormal curvature and when the individual bends over, the ribs rotate posteriorly(protrude) on the side of the increased convexity

142
Q

Hemivertebrae

A

Failure of half of the vertebrae to develop

Cause structural scoliosis

143
Q

Combination of structural scoliosis with excessive thoracic kyphosis

A

Kyphoscoliosis

Abnormal AP diameter produces severe restriction of the thorax and lung expansion

144
Q

Idiopathic scoliosis in girls and boys

A

Girls 10-14

Boys 12-15

145
Q

Myopathy scoliosis

A

Asymmetric weakness of intrinsic back muscles

146
Q

Functional scoliosis

A

Different int he length of the lower limbs with a compensatory pelvic tilt

147
Q

When scoliosis is entirely postural it disappears during maximal __

A

Flexion

148
Q

Why do you need to warm up and stretch before work out

A

Increase tonus of the core muscles to prevent strain and sprains which are common causes of lower back pain

149
Q

Back sprain

A

Only ligamentous tissue or the attachment of ligament to bone is involved without dislocation or fracture
Results from strong contractions related to movements of the vertebral column such as excessive extension or rotation

150
Q

Back strain

A

Sports
From overly strong muscular contraction
Some degree of stretching or microscopic tearing of muscle fibers
-lumbar joint muscles, erector spinae

151
Q

Using back as a lever when lighting weights

A

Strain on the vertebral column and its ligaments and muscles
Strains minimized if I’ve butt and lower limbs by keeping back straight

152
Q

What is protective mechanism of back muscles after injury or response to inflammation

A

A spasm

Cause cramps and pain , involuntary movements

153
Q

When is the winding course of the vertebral arteries through the foramina transversarii of the transverse processes of the cervical vertebrae and theought the suboccipital triangles clinically significant

A

Blood flow through these arteries is reduced, as occurs with ATHEROSCLEROSIS
-under these conditions prolonged head turning (backing up car) cause light headed ness, dizziness, and other symptoms s from decreased blood supply to the brainstem

154
Q

The lumbar spinal nerves ___ in size from superior to inferior

A

Increase

155
Q

The IV foramina ___ in diameter from superior to inferior

A

Decrease

156
Q

The __ spinal nerve roots are the thickest with the narrowest foramina. This increase chance of what

A

L5

Compression if osteophytes develop or herniation of IV disc

157
Q

Myelography

A

Radioopaque contrast procedure that allows visualization of the spinal cord and spinal nerve roots

158
Q

How perform a myelography

A

CSF drawn by lumbar puncture and replaced with a contrast media injected into subarachnoid space

  • this shows extent of subarachnoid space and its extensions around the spinalnerve roots within the dural root sheaths
  • use high resolution MRI instead
159
Q

Together the arachnoid and pia mater form the ____

A

Leptomeninges

160
Q

How do leptomeninges develop

A

As a single layer from the mesenchyme surrounding the embryonic spinal cord

161
Q

Subarachnoid space

A

Fluid filled spaces form between pia and arachnoid

162
Q

Oder of layers

A

Brain and spine -dura, arachnoid, pia on inside

163
Q

Lumbar puncture

A

Withdrawal of CSF from lumbar cistern for evaluating CNS disorders

164
Q

Body position while perform lumbar puncture

A

On side with knees to chest
Flexion facilitates insertion of the needle by spreading apart the vertebral laminae and spinous processes, stretching the ligaments flava

165
Q

Where do lumbar puncture

A

L3 and L4 is L4 L5 between the spinous processes

166
Q

What spinal level at iliac crest

A

L4 spinous process

167
Q

Path of needle

A

Punctures ligamentum Flava, then dura and arachnoid and enters lumbar cistern

168
Q

When do we not perform a lumbar puncture and how can we telll this

A

Increased intracranial pressure

CT or fundus of interior eyeball (papilledema)

169
Q

Spinal anesthesia

A

Anesthesia injected into subarachnoid space..anesthesia within 1 min
Headache may follow from CSF leak

170
Q

Epidural anesthesia (block)

A

Injected into the epidural space using the position described for lumbar puncture or sacral hiatus

171
Q

The segmental reinforcements of the blood supply to the spinal cord front the ___ ___ arteries are important in supplying blood to the anterior and posterior spinal arteries

A

Segmental medullary

172
Q

Fractures, dislocations, and fracture-dislocations may interefere with blood supply to the spinal cord. Why

A

From spinal and medullary arteries

173
Q

What happens if have deficient blood supply (ischemia) of the spinal cord

A

Affect function and can lead to muscle weakness and paralysis
Also circulatory impairment if the segmental medullary arteries (great anterior segmental medullary artery of Adam kite wick) are narrowed by obstructive arterial disease

174
Q

Sometimes the aorta is purposely occluded (cross clamped) during surgery . Patients undergoing such surgeries and those with ruptured aneurysms of the aorta or occlusion of the great anterior segmental medullary artery may have what symptoms

A

Lose all sensation and voluntary movement inferior to the level of impaired blood supply to the spinal cord (paraplegia)secondary to death of neurons in the part of the spinal cord supplied by the anterior spinal artery

175
Q

Why will neurons with cell bodies distant from the site of ischemia of the spinal cord also die

A

Secondary to the degeneration of axons traversing the site

176
Q

Iatrogenic paraplegia

A

Aorta clamp in surgery

177
Q

When. Systemic blood pressure drops for 3-6 minutes, blood flow from the segmental medullary arteries in the anterior spinal artery supplying the midthoracic region of the spinal cord may be reduced or stopped. What may they experience

A

Lose sensation and voluntary movement in the areas supplied by the affected level of the spinal cord

178
Q

Describe cervical vertebral canal

A

Narrow, like lumbar.

179
Q

Narrow cervical vertebral canal dangerous?

A

Of course. Minor fracture and or dislocation of cervical vertebra may damage spinal cord

180
Q

Spinal cord shock

A

Protrusion of cervical IV disc into the vertebral canal after a neck injury associated with transient depression or abolition of reflex activity or paralysis inferior to the site of lesion

181
Q

During autopsy what signs indicate protrusion of IV disc in spinal shock

A

Swollen ligamenta flava, osteoarthritis of zygapophysial joint may exert pressure on cauda equina

182
Q

Lumbar spondylosis

A

Degenerative joint disease.
Osteoarthritis of ZP joint exert pressure on cauda equina
Pain and stiffness

183
Q

Transaction of the spinal cord results in loss of all sensation and voluntary movement inferior to the lesion

A

Yup

184
Q

Transaction C1-C3

A

No function below the head level: a ventilator is required to maintain respiration

185
Q

Transcetion c4-c5

A

Quadriplegia (no function of upper and lower limbs) respiration occurs

186
Q

Transaction C6-8

A

Low of lower limb function combined with a loss of hand and a variable amount of upper limb function; the individual may be able to self feed or propel a wheelchair

187
Q

Transcetion T1-T9

A

Paraplegia (paralysis of both lower legs) amount of trunk movement depends on height of lesion

188
Q

Transcetion T10-L1

A

Some thigh muscle function while may allow walking with long leg braces

189
Q

Transcetion L2-L3

A

Retention of most leg muscle function; short leg braces may be required for walking

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