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term 2 movement yr 2 > week 1 Back pain/vertebral column > Flashcards

week 1 Back pain/vertebral column Flashcards

1
Q

what does your back include?

A 
Skin 
Subcutaneous tissue
Vertebral column
Spinal cord and meninges
Ribs
Nerves and vessels
Muscles
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2
Q

how many cervical verterbral column are there?

A

7

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3
Q

how many thoracic verterbral column are there?

A

12

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4
Q

how many lumbar verterbal column are there?

A

5

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5
Q

how many sacral verterbral column are there?

A

5

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6
Q

how many coccygeal verterbral column are there?

A

depends on who you ask. From 1 too 4 does not really matter

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7
Q

how much of the verteral column does the intervertebral disc acount for?

A

1/4 of the length

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8
Q

why do you get smaller as you get older?

A

the intervertebral disc dehydrate and shrink–> so get smaller

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9
Q

when you tilt your head forward what vertebra can be palpated?

A

C7

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10
Q

where are the vertebral notches positioned?

A

superior and inferior to the pedicles on the vertebra

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11
Q

what forms the intervertebral foramen?

A

the inferior vertebral notch of the superior vertebra and the superior vertebral notch of the inferior vertebra plus the intervertebral disc

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12
Q

what passes through the interverebral foramen?

A

spinal nerves

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13
Q

what are the general key structures of the vertebra?

A 
Vertebral foramen
Processes
 Articular facets
 Vertebral arch
Body
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14
Q

how does the body of the cervical vertebra vary?

A

it is smaller and has a uncus

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15
Q

what is the position of the uncus in cervical vertebra and what do they do?

A

positioned laterally and hold together adjacent bodies

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16
Q

how does the body of vertebra change as you go down the vertebra column?

A

it gets bigger/thicker

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17
Q

what part of the neck does the scalene muscles attach to and what is there action?

A

it attatched to the transverse proces and pedicles of cervical vertebrae. Allows fine movements of the neck

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18
Q

how does the spinous process of cervical vertebrae vary?

A

it is BIFID –> split

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19
Q

what is the directions of the articular facets of the cervical vertebrae

A

superior directed superoposteriorly

- inferior directed infero-anteriorly

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20
Q

what passes through the transverse foramina of the cervical vertebrae?

A

Passage of vertebral artery and vein to/from the brain

however do not pass through C7

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21
Q

which cervical verbrae does vertebral artery and vein not pass through?

A

C7 because it has a small or absent transverse foramina

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22
Q

why is cervical vertebrae prone to dislocation?

A

Relatively flat articular facets –> not the best fit

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23
Q

why might a sublaxation of the cervical vertebrae not compress the spinal nerves?

A

The transverse foramen is relatively wide

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24
Q

which two cervical vertebrae are atypical and what are there names?

A

C1–> Atlas

C2–> Axis

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25
Q

what is different about C1 atlas

A

1) The atlas has no spinous process or body
2) Consists of anterior and posterior arches (each of which has a tubercle and a lateral mass.
3) There is a tubercle each on the medial surface of the lateral mass for the transverse ligament, which holds in place the dens of the axis.

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26
Q

what does Atlas articulate with?

A

the base of the skull and sits on Axis –> C2

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27
Q

what are the key features of C2 –> Axis

A

C2 has two large flat surfaces, the superior articular facets, upon which the atlas rotates.

It’s distinguishing feature is the dens (G. tooth), also known as the odontoid process

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28
Q

how is the Dens of C2 held in place and why?

A

This held in position by the transverse ligament of the atlas - prevents horizontal displacement of the atlas

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29
Q

what movements does the Dens allow?

A

The dens acts as a pivot that allows the atlas and

attached head to rotate from side to side

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30
Q

why is the dens prone to fracture?

A

it is less dense so therefore more prone to fracture

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31
Q

what causes the fracture of dens?

A

hyperextension or hyper flexion

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32
Q

what is the shape of the body of thoracic vertebrae?

A

heart shaped with superior and inferior costal demi-facets for articulation with head of rib

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33
Q

what are the features of the spinous and transverse process of the thoracic vertebrae?

A

Spinous process - Long and extends postero-inferiorly

Transverse process – costal facet for articulation with tubercle of rib

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34
Q

what direction does the articulate facet face of the thoracic vertebrae?

A

superior faces posteriorly,

inferior faces anterior

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35
Q

what articualation occurs in Costovertebral joints?

A

Head of rib articulates with the superior demifacet of the corresponding (same number) vertebra and the inferior demifacet of the vertebra above

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36
Q

what are the varations of the lumbar vertebrae?

A

Spinous process short and sturdy
Vertebral body - large
Articular facets –> Inferior face laterally + Superior face medially

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37
Q

what are vertebrae held together by?

A

zygapophysial joints, intervertebral discs and ligaments

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38
Q

how are zygapophysial joints formed?

A

Zygapophysial joints occur between superior and inferior articular processes of adjacent vertebrae

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39
Q

what does the orientation of articulate facets determine?

A

determines the types of movements that are possible

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40
Q

what is the Intervertebral discs made up of?

A

Annulus fibrosis

Nucleus pulposus

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41
Q

what is Annulus fibrosis ?

A

fibrocartilage ring attached to epiphysial rim of vertebral body

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42
Q

what is Nucleus pulposu?

A

gelatinous substance that acts as a shock absorber

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43
Q

what determines the intervertebral discs flexibility?

A

thickness

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44
Q

What does Ligamentum flavum do?

A

Binds lamina of adjacent vertebrae

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45
Q

what does the Posterior longitudinal ligament do? Give the origion and insertion?

A

C2 to sacrum

Prevents posterior herniation of IV discs

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46
Q

what does Anterior longitudinal ligament do? Also what is its origion and insertion?

A

Occipital bone and C1 to sacrum

Only ligament to resist hyperextension of vertebral column, all the others resist hyperflexion

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47
Q

what is the action of ligaments to the vertebral column?

A

make the vertebral column more stable

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48
Q

what is whip lash and how is commonly caused?

A

Hyperextension of cervical neck

Commonly caused by rear-end car crashes, especially if head rest too low

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49
Q

which ligament is torn in whip lash

A

anterior longituidinal ligament

50
Q

what occurs in severe cases of whip lash?

A

part of vertebral body is avulsed and vertebrae dislocate – compression of spinal cord

51
Q

how does the movement of the vertebral column vary?

A

Movements vary in different regions depending on orientation of zygapophysial joints and thickness of intervertebral discs

52
Q

what part of the vertebral column is lordosis?

A

cervical and lumbar

53
Q

what part of the vertebral column is kyphosis?

A

sacral and thoracic

54
Q

who is most likely to have Osteoporosis

A

menopusal females

55
Q

why is it more likely for menopusal females to get Osteoporosis?

A

the decrease in estrogen causes a reduction in trabeculae and cause compression

56
Q

what occurs in Osteoporosis?

A

loss of trabeculae and this causes comperession of the column

57
Q

What is the effects of ageing on the vertebral column?

A

Loss of bone density with age leads to concave vertebral bodies

This puts increased force on rims of vertebrae and osteophytes develop in response

58
Q

what is another name for slipped disc?

A

herniation of nucleus pulposus

59
Q

where does slipped disk commonly happen?

A

Normally happens in posterolateral direction between L4/L5 or L5/S1

60
Q

what is the symptoms of slipped disk?

A

Can compress spinal nerve roots – lower back pain or sciatica

In severe cases, compresses most of cauda equina – cauda equina syndrome

61
Q

Which of the vertebrae sections is the smallest?What is there distinctive feature?

A

Cervical vertebrae is the smallest.

Distinctive feature is the transverse foramen

62
Q

Which of the cervical vertebrae has a smaller or absent transverse foramen?

A

C7

63
Q

What are the features of the spinous process of C3-C6?

A

Short and Bifid

64
Q

Wht are the features of the spinous process of C7?

A

It is very long and is used as a bony landmark to count vertebra –> Vertebra prominens

65
Q

Where are intervertebral diss found and what are there function?

A

Intervertebral discs between all non-fused vertebrae provide flexibility to the spine and act as shock absorbers

66
Q

What do the intervertebral discsin the vertebral column do?

A

Intervertebral discs between all non-fused vertebrae provide flexibility to the spine and act as shock absorbers

67
Q

What do the ligaments in the vertebral column do?

A

The ligaments bing vertebrae together

68
Q

What are the primary content of the vertebral canal?

A

Spinal cord, spinal nerve roots and there meningeal covering

69
Q

At which verebral level does the spinal cord end in adults ?

A

L1/2

70
Q

At which verebral level does the spinal cord end in children?

A

L2/3

71
Q

At which verebral level does the spinal cord end in adults ?

A

CSF

72
Q

What does the epidural contain?

A

Fat
Venous plexus
loose connective tissue

73
Q

What do you administrate in the epidural space?

A

Administer anaesthetics for an epidural nerve block

74
Q

What is the venous drainage of the spinal cord?

A

Veins that drain the spinal cord form a number of longitudinal channels
These longitudinal channels drain into an extensive internal vertebral plexus in the extradural
(epidural) space of the vertebral canal, which then drains into segmentally arranged vessels that
connect with major systemic veins, such as the azygos system in the thorax.

75
Q

What are the different longitudinal channels in the spinal cord?

A

two pairs of veins on each side bracket the connections of the posterior and anterior roots to
the cord;
one midline channel parallels the anterior median fissure;
one midline channel passes along the posterior median sulcus.

76
Q

What is the venous arrangement at each vertebral level

A

There are connections at each level with thoracic, abdominal and intercostal veins and the external vertebral venus plexus.

77
Q

Describe the structure of the spinal veins?

A

They have no valves and blood passess directly into the systemic venous system

78
Q

What is the theory of how prostatic neoplastic cells metastasize to the CNS?

A

It can occur by the continuity of the vertebral venous plexuses with the prostatic plexus –> possible cause

79
Q

What is cauda equine?

A

Collection of nerve rootlets

80
Q

How many cervical nerves are there ?

A

8

81
Q

What two groups are the muscles of the back divided into?

A

Superfecia (extrinsic) group and deep (intrinsic) group

82
Q

What muscles are in the superficial group of the extrinsic muscles?

A

Rhomboid major and minor
Levator scapulae
Trapezius
Latissimus dorsi

83
Q

What muscles are in the intermediate group extrinsic muscles?

A

Serratus posterior superior

Serratus posterior inferior

84
Q

What two groups is the extrinsic muscles divided into?

A

Superficial and intermediate group

85
Q

What innervates extrinsic muscles of the back?

A

Ventral rami of spinal nerve and accessory nerve

86
Q

What are the actions of the extrinsic back muscles?

A

Act as weak accessory muscles for respiration

87
Q

What innervates the deep intrinsic back muscles?

A

Posterior rami of spinal nerve

88
Q

What 3 groups is the intrinsic back muscles divided into?

A

Superficial
Intermediate
Deep

89
Q

What muscels are invovled in the superfecial group of the intrinsic back muscles?

A

Splenic muscles of the posterolateral surfaces of the neck.

Subdivided into splenius capitus and cervicis

90
Q

What muscles is in the intermediate group of the intrinsic back muscle??

A

The large erector spinae muscles that lie on each side of the vertebral column.
It is the chief extensor of the vertebral column and consists of 3 muscles:
Spinalis
Longissimus
iliocostalis

91
Q

What is the deep group of the intrinsic muscles? What are there attachments?

A

Transversospinalis group
Deep to erector spinae –> smaller muscles that originate from the TP of the vertebrae and insert onto the SP of more superior vertebrae

92
Q

What muscels does the Transversospinalis group consist of?

A

Semispinalis
Multifiidis
Rotares

93
Q

How is the spinal nerve formed?

A

Dorsal and ventral rootlets combine to form the spinal ganglion –> spinal nerve

94
Q

What are the features of the lateral mass on the C1 (atlas)?

A

The lateral mass contains tubercle for the attachment for the transverse ligament.

Also contains transverse foramina, transverse process and a superior and inferior articular surface

95
Q

what are the two facets of the den of the Axis? What do they articulate with?

A

Anterior articulate facet for anterior arch of the Atlas

Posterior articulate facet for transverse ligament of the Axis.

96
Q

What are the 2 types of fracture of the Axis?

A

Fracture of the Dens

Fracture of the body of Axis as well as the Dens

97
Q

How is fracture of the Axis treated?

A

Do surgery where you do atlantoaxial arthrodesis using bone graft from iliac crest

98
Q

What are all the ligaments that prevent hyperflexion of the vertebral column?

A 
Posterior longituidinal ligament
Ligament flavum
Superaspinous ligament
Intertransverse ligament
Interspinous ligament
99
Q

What ligament prevents hyperextension of the vertebral column?

A

Anterior longituidinal ligamnet

100
Q

Give examples of abnormal curvature of the spine?

A

Excessive lordosis
Excessive Kyphosis
Scoliosis

101
Q

What is scoliosis?

A

It is lateral curvature of the spine

102
Q

What happens with ageing of the intervertebral disc?

A

Hernation of the nucleus polposus

103
Q

What is sciatica?

A

It is any pain or irritation caused by compression of the sciatic nerve

104
Q

What are the symptoms of the sciatic nerve?

A

It is pain, tinglingness and numbness that radiates from your lower back down one of the leg to the toes and foot.

105
Q

What structures run trough the transverse foramina of the cervical vertebrae?

A

The vertebral artery and vein

Plexus of sympathetic nerves

106
Q

What is the distinctive feature of the cervical vertebrae?

A

Transverse foramina

107
Q

Describe the spinous process of C7?

A

Long -> verebra prominens and used as a bony landmakr to count vertebra

108
Q

What verterbral body does the iliolumbar ligament attach to?

A

It attaches to the transverse process of the fifth lumbar vertebrae. Much larger than the others and attaches it to the pelvic bone

109
Q

What is the attachments of anterior longitudinal ligament and its action?

A

Attach to the base of the skull (occipital bone) to the anterior surface of sacrum. Along it length it is attached to the vertebral bodies and intervertebral discs.–> anterior surface of the vertebral body

Prevents hyperextension of the vertebral column

110
Q

What is the attachments of posterior longitudinal ligament and its action?

A

From C2 to the posterior surface of sacrum–> on the posterior surface of the vertebral body but anterior surface of the vertbebral canal.

Prevent hernation of the IV discs into the spinal cord

111
Q

What is the attachments of ligament flavum and its action?

A

It is on either side and attaches the lamina of adjacent vertebrae.

It resists seperation of the lamina in flexion and assists with extension back into the anatomical position.

112
Q

What is the attachments of ligament nuchae and its action?

A

It is a triangular structure in the medial sagittal plane

Base is the skull attached to the external occipital protrubence too the foramen magnum
Apex is the spinous process of cervical vertebrae 7
Deep side of the triangle is the posterior tubercle of C1 and the spinous process of the rest of the cervical vertebraes

Action: Support the head, resist flexion and return the head back to its anatomical position

113
Q

What is the attachments of infraspinatous ligament and its action?

A

It runs between the spinous process of adjacent vertebrae. They attach between the base and apex of adajcent vertebrae, blending with the supraspinatous ligament posteriorly and the ligament flavum anteriorly.

Prevent hyperflexion

114
Q

What is the continuation of the ligament nuchae?

A

Supraspinatous ligament

115
Q

What is the consequence on the lower spinal nerves that the vertebral column is longer than the spinal cord?

A

The lower spinal nerves are longer as they pass through the conus medullaris and into the respective intervebral foramina

116
Q

Within the grey matter there is the dorsal, lateral and ventral horns. What do each of them contain?

A

The ventral horn contains motor nuerones
The dorsal horn cotains sensory neurones
The lateral horn contains preganglionic sympathetic neurones

117
Q

In the spinal canal what is found in the subarachanoid space?

A

CSF and trubeculae

118
Q

What is the epidural space?

A

Space between the dura and the vertebrae

119
Q

What is the arterial supply to the vertebrae?

A

The vertebrae recieves arterial supply from 3 small longitudinal arteries; one anterior and 2 posterior spinal arteries

120
Q

What is the origion of the anterior and posterior spinal arteries?

A

Originate from the vertebral arteries

ASA –> run into the anterior median fissue
PSA –> anastomose with one another in the pia matter

121
Q

What supports the Anterior and posterior spinal arterie?

A

They are reinforced by radicular branches of the intercostal and lumbar arteries.

They enter the vertebral column via the intervertebral foramina

122
Q

What supplies the extrinsic muscles of the back? They act as week accessory muscles for what?

A

Ventral rami of spinal nerves and accessory nerve

They act as weak accessory muscles for respiration

term 2 movement yr 2 (9 decks)

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