4 - Lumbar Spine and Disorders Flashcards Preview

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Flashcards in 4 - Lumbar Spine and Disorders Deck (42)
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What are the mobile and immobile parts of the spine?

Mobile = Lumbar and Cervical 

Immobile = Thoracic 


What are the functions of the vertebral column?

- Protection 

- Haemopoiesis 

- Support 

- Movement 


What do the lamina and pedicle connect?

- Lamina connects transverse process to spinous

- Pedicle connects transverse to body 


What are the joints like between each vertebrae?

Facet/Zygapophyseal Joints 

Lined with hyaline cartilage and synovial joints 

Interlocking design prevents antero-posterior displacement


What movement occurs in each region and why?

Cervical: Flexion, extension, lateral flexion, rotation 

Thoracic: Only lateral flexion and rotation 

Lumbar: Mainly flexion and extension some limited lateral flexion and extension from L5 as facet faces anteriorly


What other joints are there in the spine apart from facet?

Secondary Cartilaginous (Symphyses): Intervertebral discs

Fibrous: Sacro-iliac joint


What is the structure of the intervertebral discs?

- Contains water and proteoglycans too 

- Discs lose height with day and age 

- Slightly wedge shape posteriorly

- Avascular and aneural so all diffusion and osmosis 

- Nucleus goes from central to slightly posterior as get older and has high oncotic pressure


Label this diagram with the main ligaments of the spine.


What do each of the spinal ligaments do?

Posterior Longitudinal: prevents hyperflexion from C2 to S canal. Reinforces annulus fibrosus centrally 


Anterior Longitudinal: stronger than pos and prevents hyperextension. C1 to Sacrum. Blends with periosteum but loosely attached and slides over discs


Ligamentum Flavum: Yellow between laminae and adjacent vertebrae. High elastin. Stretched during flexion


Interspinous: Weak fibrous tissue between spinous processes, well developed in lumbur area, restrict hyperflexion


Supraspinous: Tips of spinous processes, lax in extension, prevent hyperflexion and mechanical stability


How do intervertebral discs mainly prolapse?

Paracentrally as posterior longitudinal ligament supporting annulus fibrosus


How should you lift heavy weights and why?

Close to you with straightback so force picking up is equal to force on back 


Where does force transmission occur in the spine?

Young: 80% vertebral body, 20% facet joints

Old: Disc dehydration so 35% in facet joints, leading to osteoarthritic changes


Describe the structure of the sacral and coccygeal spine and discuss what it articulates with.

Coccyx is remnant of a tail


Where does the central canal end?

Fourth sacral at the sacral hiatus 


What nerves originate from the cauda equina?

- 2nd to 5th lumbar nerves 

- 5 sacral nerves 

- 1 coccygeal nerve


All innervate the pelvic organs and lower limbs



What is the dural sac?

The proximal parts of the cauda equina are enclosed in tough fibrous sac that terminates at around S2


How do nerve fibres leave from the sacral vertebrae?

Posterior sacral foramina


What is the filum terminale?

Continuation of the pia mater from the conus medullaris to the first segment of the coccyx. Approx 20cm and gives longitudinal support to spinal cord


What are the curvatures of the vertebral column?


What happens to the curvature of the spine with age and in pregnancy?

- Senile Kyphosis due to loss of disc height and osteoporitic fractures

- Pregnancy leading to exaggerated lumbar lordosis to reestablish centre of gravity 


Where are the weak points of the vertebral column and why are they weak?

- C1 and C2 

- C7 and T2 

- T12 and L1

- L5 and S1 

Centre of gravity passes through these so curves needed. Junctions are from mobile to stiff so weak spots.

Allows transmission of weight into lower limbs with curves


Label the parts of this spine.

Can assess disc height and some ligaments with this 


Label this MRI of the spine.

Can see ligaments and discs better


Label the ligaments of this spinal MRI


What is mechanical back pain?

Pain when the spine is loaded that worsens with exercise and relived by rest. Intermittent and can be brought on by littlest of activities

Risks: obesity, sedentary, poor posture, deconditioning of core muscles, incorrect manual handling, poor mental health stresses can feed into pain


What are age degenerative changes of the vertebral column?


What condition is this x-ray displaying?

Syndesmophytes leading to marginal osteophytosis 


What are the stages of a disc slipping (herniate)?

- Most common at L4/5 and L5/S1 due to mechanical loading

- Will affect nerve below as nerve passes through superior intevertebral disc, e.g L4/5 herniation will affect L5


Where are nerve roots most vulnerable?

- Where they cross the intevertebral disc (paracentrally) 

- Where they leave the spinal canal (laterally)


Where are the spinal roots?

White dot on left, other side cannot be seen due to herniation