Vertebral column Flashcards

1
Q

Changes in aging IV disks

A
  • Nuclei P dehydrate
  • Elastin & proteoglycan down, collagen up
  • IV disk: turgor lost, stiffer, NP dry & stiff, NP merge with annulus fibrosis
  • AF greater vertical load
  • Vertebral bodies = increasingly concave
  • IV disks = increasingly convex
  • AP diameter increase 10%F & 2%M
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2
Q

Herniation of nucleus pulposi

A
  • Cause lower back, limb pain
  • Posterior portion of AP thinnest
  • Herniations generally extend posterolaterally (here AF is relative thin & no support from post/ant ligaments
  • Most common in Lumbar and Lumbosacral regions
  • 95% of lumbar disk protrusions occur at L4-L5 or L5-S1
  • Diagnosis of acute herniation in old suspicious, more likely increased ossification compressing nerves
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3
Q

Cause of localized back pain following NP herniation

A
  • Usually acute pain
  • Pressure on longitudinal ligaments & periphery of AF
  • Local inflammation from chemical irritation (irritants form NP contents)
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4
Q

Non-local back pain following NP herniation

A
  • Usually referred pain
  • Perceived as coming from dermatome of compressed nerve
  • Chronic pain
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5
Q

Lumbago

A
  • Acute mid/lower back pain
  • Due to mild posterolateral protrusion of lumbar IV L5-S1
  • Affects pain receptors on post longitudinal ligament
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6
Q

Sciatica

A
  • Pain in low back & hip, radiates down back of thigh/leg
  • Caused by herniated lumbar disk compressing L5 or S1 component of sciatic nerve
  • IV formamin in lumbar region small, nerves larger
  • Flexing thigh w/ knee extended (Kerning maneuver) worsens (most of the time)
  • HERNIATION COMPRESSES NERVE EXITING 1 BELOW HERNIATED DISK
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7
Q

Injury and disease of zygapophysial joints

A
  • Injury/osteoarthritis = pain in dermatomes, spasm of myotomes
  • Denervation is treatment
  • Posterior rami of nerve root at affected foramina + 1 above sectioned or destroyed w/ radiofrequency percutaneous rhizolysis
  • Articular branch of post rami at level + 1 level above ablated
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8
Q

Fracture of dens

A
  • Transverse ligament is stronger than dens
  • Fractures = unstable > transverse ligament becomes interposed > den has no blood supply
  • Dens has no blood supply > avascular necrosis
  • If fracture is below dens on body of axis, blood supply maintained > heals
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9
Q

Rupture of transverse ligament of atlas

A
  • Results in atlantoaxial subluxation
  • Softening of transfers ligament and adjacent ligaments > subluxation
  • Spinal cord may become entrapped between posterior arch and dense > quadriplegia or death
  • Steele rule of thirds: 1/3 fluid & CT, 1/3 Spinal cord, 1/3 dens
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10
Q

Rupture of alar ligament

A
  • Alar = weaker than transverse ligament
  • Combined flexion and rotation can tear (FR-ALAR)
  • 30% increase in range of movement to the contralateral side
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11
Q

Compression of the C2 spinal ganglion

A
  • Atlantoaxial rotation may compress C2 SN

- Hyperextention + head turned > compression of C2 SN > headache and cervio-occipital pain

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12
Q

Fractures and dislocations vertebrae

A
  • Sudden forceful flexion > crush/compression fracture
  • Anterior movement of vert + compression > anterior displacement > displaces + fractures articular facets & ruptures interspinous ligaments
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13
Q

Spondylolysis

A
  • Break at pars interarticularis

- Indicated by broken neck of “scotty dog”

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14
Q

Spondylolisthesis

A
  • Dislocation b/t adjacent vertebrae

- Common at L5-S1 due to angle of joint

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15
Q

Structures that receive innervation from back and can be a source of pain

A
  • Fibroskeletal (periosteum, ligaments, AF of IV discs): recurrent meningeal
  • Meninges:recurrent meningeal
  • Synovial: post rami articular branch
  • Muscle: post rami muscular branch
  • Nervous tissue
    (FMSMN)
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16
Q

Most common sources of localized lower back pain (LBP)

A

Muscular, joint, fibroskeletal

17
Q

Source of fracture pain

A

Periosteum

18
Q

Source of dislocation pain

A

ligaments

19
Q

Kyphosis

A
  • Erosion of anterior part of vertebrae > abnormal increase in thoracic curvature
  • Dowager’s hump
20
Q

Lordosis

A
  • Anterior rotation of pelvis > Increase in lumbar curvature
  • Cause weakened trunk muscles
  • Obesity and pregnancy can also cause
21
Q

Scoliosis

A
  • Abnormal curvature and rotation of vertebrae
  • Weakened trunk, especially anterolateral abdominal muscles
  • Myopathic scoliosis: caused by asymmetrical weakness of intrinsic back muscles
  • 80% of all structural scoliosis is idiopathic
22
Q

Hemivertebra

A
  • Failure of 1/2 a vertebra to form

- Cause of structural scoliosis

23
Q

Kyphoscoliosis

A
  • Scoliosis + kyphosis

- Abnormal AP diamater > restriction of thorax and lung expansion