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IUSM Anatomy KG > Blue Boxes 1: Deep Back > Flashcards

Blue Boxes 1: Deep Back Flashcards

1
Q

What are the most common areas affected by Osteoporosis?

A

Vertebral bodies, neck of the femur, metacarpals, and the radius

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2
Q

What does a radiograph of vertebral bodies with osteoporosis look like?

A

In early stage the vertebral bodies will appear to have striations.
As it progresses the inner spongy bone of the bodies appears more translucent than normal due to demineralization.

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3
Q

Late osteoporosis results in what type of back shape deformity?

A

Kyphosis of the thoracic vertebra.

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4
Q

What is a Laminectomy?

A

Surgical excision of spinous processes and the adjacent supporting Laminae.
ie –> removing the vertebral arch by cutting the pedicles

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5
Q

What surgical procedure is often used to relieve pressure on the spinal cord or nerve roots cause by a tumor, herniated IV disc, or bony hypertrophy.

A

Laminectomy

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6
Q

Which type of vertebrae can be dislocated more easily than fractured?

A

Cervical

They may dislocate and then come back into place so its easy to miss soft tissue damage, without an MRI

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7
Q

What specific vertabrae is easily fractured by vertical forces to the neck? like a diving accident

A

atlas C1

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8
Q

What is a Jefferson’s or burst fracture?

A

Fracture of the atlas anterior and/or posterior arches

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9
Q

A traumatic spondylolysis of C2 usually occurs as a result of what injury? What part of the bone usually fractures?

A

Hyperextension of the head on the neck

Pars Interarticularis

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10
Q

What is a nickname for a fracture of the pars interarticularis of C2?

A

Hangman’s fracture

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11
Q

What is a lumbar spinal stinosis?

A

Narrowing of the vertebral foramen in one or more lumbar vertebrae

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12
Q

What is thoracic outlet syndrome and what is a common cause?

A

It is a narrowing of the superior thoracic aperture that is often caused by a cervical rib. This can put pressure on the subclavian artery or inferior truck of the brachial plexus.

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13
Q

Where would you place an epidural anesthetic?

A

Into the fat of the sacral canal that lies beneath the sacrococcygeal ligament. Acts on the nerves of the cauda equina

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14
Q

What are the bony landmarks for finding the location of the sacral hiatus to place and epidural?

A

Between the sacral cornua and inferior to the S$ spinous process.

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15
Q

Coccygodynia is a painful syndrome that results from trauma to what bone?

A

Coccyx

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16
Q

When L5 is sacralized, what often happens to the L4 - L5 level?

A

It degenerates, often producing painful symptoms

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17
Q

What happens to vertebrae as they age?

A

There is an overall decrease in bone density and strength, particularly centrally withing the vertebral body. The articular surfaces start to bow inward and look concave.

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18
Q

Why do osteophytes (bone spurs) commonly develop around the periphery margins of the vertebral body?

A

Because there is more pressure on the body periphery due to aging of the IV discs combined with the changing shape of the vertebrae.

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19
Q

What is spina bifida?

A

The neural arches of L5 and/or S1 fail to develop normally and fuse posterior to the vertebral canal.

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20
Q

What often indicates the location of spina bifida?

A

A patch of hair

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21
Q

What is a meningomyelocele?

A

Severe spina bifida associated with a meningeal cyst and/or a herniation of the spinal cord.

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22
Q

Severe forms of spina bifida result from what?

A

Neural tube defects during development

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23
Q

What happens to IV discs as they age?

A

The nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen. This causes them to lose their turgor, becoming stiffer and more resistant to deformation.

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24
Q

Why do people lose height as they age?

A

Bodies of vertebrae break down and become concave

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25
Q

Do IV discs increase or decrease in size as you age?

A

Increase

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26
Q

What does herniation mean?

A

Protrusion

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27
Q

What is the nuclei pulposi primarily comprised of?

A

Water 90%

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28
Q

A herniated IV disc is inappropriately called a _____ by some people?

A

Slipped disc

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29
Q

Where do herniations of the nucleus pulposus usually happen?

A

Extend posterolaterally where the anulus fibrosus is relatively thin and does not recieve support from either the posterior or anterior longitudinal ligaments.

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30
Q

What causes the referred pain of a herniated disc?

A

compression of the spinal nerves

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31
Q

What usually causes the localized pain of a herniated disc?

A

Pressure on the longitudinal ligaments

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32
Q

Where do about 95% of lumbar disc protrusions occur?

A

L4 - L5 or L5 - S1

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33
Q

What is sciatica?

A

Pain in the lower back and hip radiating down the back of the thigh into the leg.
Often caused by a herniated lumbar IV disc that compresses the L5 or S1 component of the sciatic nerve

34
Q

Why is sciatica so common?

A

Because the lumbar nerves increase in size while the lumbar foramina decrease in size.

35
Q

When a Lumbar IV disc protrudes, what nerve root does it normally compress?

A

The one numbered one inferior to the herniated disc.

L4-L5 herniation would likely compress the L5 nerve

36
Q

How could you fracture a cervical IV disc?

A

Hyperflexion of the cervical region.

Head-on collisions or illegal head blocking in football

37
Q

When a cervical IV disc protrudes, what nerve root does it normally compress?

A

The one exiting at the same level, however the numerical relationship is the same because cervical spinal nerves exit superior to the vertebra of the same number.

38
Q

What are the most commonly ruptured cervical discs?

A

C5 - C6 and C6 - C7

39
Q

Why are fractures of the Dens often unstable (do not reunite)?

A

The transverse ligament of the atlas becomes interposed between fragments, and because the separated fragment no longer has a blood supply, resulting in avascular necrosis.

40
Q

Why do fractures of the axis body heal more readily then fractures of the dens?

A

Because the fragments retain their blood supply.

41
Q

What happens when the transverse ligament of the atlas ruptures?

A

THE dens of the axis is set free, resulting in atlanto-axial subluxation, an incomplete dislocation of the median atlanto-axial joint.

42
Q

Which is more likely to cause spinal cord compression, a transverse ligament rupture or fracture of the dens?

A

Transverse ligament rupture, it causes atlanto-axial subluxation, slideing of the atlas forward. When the dens fractures it moves with the atlas because the transverse ligament holds it in place.

43
Q

What is Steele’s Rule of Thirds?

A

Approximately one third of the atlas ring is occupied by the dens, one third by the spinal cord, and the remaining third by the fluid-filled space and tissues surrounding the cord.

44
Q

What can be torn during whiplash injuries of the neck? (hyperextension)

A

Anterior longitudinal ligament

45
Q

What are the most commonly fractured non-cervical vertebrae?

A

T11 and especially T12

46
Q

Why is dislocation much more common in the cervical region than the others?

A

Thoracic and lumbar vertabrae have an interlocking of their articular processes.

47
Q

Look at the scottie dog on pg 479

A

Look

48
Q

Spondylolysis?

A

fracture of the pars interarticularis

49
Q

What does the scottie dog look like with spondylolysis?

A

It has a broken neck

50
Q

What is a dislocation between adjacent vertebrae called?

A

spondylolysis

51
Q

Why are zygapophysial joints of clinical interest?

A

Because they are close to the IV foramina through which the spinal nerves emerge from the vertebral canal.

52
Q

In back pain, pain from nervous tissue is usually what kind of pain?

A

Referred pain, associated with the dermatome of the affected nerve

53
Q

Localized lower back pain is generally caused by what?

A

muscular, joint, or fibroskeletal

54
Q

What is kyphosis?

A

humpback

55
Q

What is Dowager’s hump?

A

Excessive thoracic kyphosis in older women resulting from osteoporosis.

56
Q

What is lordosis?

A

Hollow back or sway back. Characterized by an anterior tilting of the pelvis

57
Q

What type of spine deformity develops in pregnant women?

A

temporary lumbar lordosis

58
Q

What is a back sprain?

A

An injury in which only ligamentous tissue, or the attachment of ligament to bone is involved without dislocation or fracture

59
Q

What do back strains result from?

A

Overly strong muscular contractions, often sports injuries

60
Q

What muscles are usually involved in a back sprain?

A

Erector spinae

61
Q

How can you minimize back strains when lifting?

A

By crouching and holding the back as straight as possible. Use the muscles of the buttocks and lower limbs to assist

62
Q

What is a spasm?

A

A sudden involuntary contraction of one or more muscle groups. Often occur after an injury or i response to ligament inflammation

63
Q

What is arteriosclerosis?

A

A hardening of arteries due to a loss of elasticity, blood flow to a region is reduced.

64
Q

What circulatory system problem can occur from a prolonged turning of the head, as occurs when backing up a motor vehicle?

A

Lack of blood supply to the brainstem, light-headedness, dizziness.

65
Q

Which spinal level has the thickest nerve roots and the narrowest IV foramina?

A

L5

66
Q

What is the clinical name for bone spur?

A

osteophyte

67
Q

What is the name for a radiopaque contrast procedure that allows visualization of the spinal cord and spinal nerve roots?

A

Myelography

CSF is withdrawn by lumbar puncture and replaced with a contrast material injected into the spinal subarachnoid space.

68
Q

What two layers of the spinal cord form the leptomeninges?

A

Pia mater and arachnoid mater

They develop from a single layer of mesenchyme surrounding the embryonic spinal cord

69
Q

What connects the arachnoid mater to the pia mater?

A

arachnoid trabeculae

70
Q

What is a lumbar puncture used for?

A

To withdraw CSF from the lumbar cistern

Used as a tool to diagnose CNS disorders

71
Q

Why are lumbar punctures performed with the patient lying on the side with back and hips flexed?

A

Flexion of the vertebral column facilitiates insertion of the needle by spreading apart the vertebral laminae and spinous processes, stretching the ligamenta flava

72
Q

Between what two spinous processes would you do a lumbar puncture for spinal anesthesia?
For epidural anesthesia?

A

L3 - L4

L4 - L5

73
Q

When would a lumbar puncture not be performed?

A

In the presence of increased intracranial pressure

74
Q

Spinal anesthesia usually occurs within one minute when injected into the subarachnoid space. Why might someone get a headache following this?

A

Leakage of CSF through the lumbar puncture

75
Q

Where are the two places an epidural can be placed?

A

Sacral hiatus

Lumbar spinal puncture

76
Q

What does the great anterior segmental medullary artery of Adamkiewicz do?

A

Reinforces the circulation to two thirds of the spinal cord, including the lumbosacral enlargement. It is on the left side in about 65% of people

77
Q

What is paraplegia?

A

Impairment of the sensory and motor functions of the lower extremities

78
Q

Cross clamping the aorta or the great anterior segmental medullary artery during surgery can lead to what?

A

Ischemia of the Spinal Cord

79
Q

Where is the vertebral canal the narrowest?

A

In the cervical region

80
Q

What happens is the spinal cord is transected at C1 - C3?

A

No function below head level, ventilator is required to maintain respiration.

IUSM Anatomy KG (11 decks)

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