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MSK > Clinical anatomy of the spine > Flashcards

Clinical anatomy of the spine Flashcards

1
Q

do all spine curvatures develop at the same time?

A

no

develop at time with movement - walking etc

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2
Q

what are the 2 atypical vertebrae?

A

atlas

axis

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3
Q

what is the vertebra prominens?

A

C7

no formaena transverse process (vertebral artery)

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4
Q

bifid spinous process is found where?

A

cervical vertebrae

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5
Q

what types of joint is the IV joints?

A

fibrocartilaginous

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6
Q

what do facet joints allow?

A

flexion, extension and lateral flexion at the facet joints and IV discs - cumulative effect

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7
Q

is there more less flexion in the thoracic spine compared to the cervical spine? why?

A

less

due to constraint of ribs

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8
Q

which area has the least rotation?

A

lumbar

due to more vertically orientated facet joints

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9
Q

what gives cervical spine its large rotational ability?

A

more horizontal facet joints

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10
Q

what happens to IV disc structure with ageing?

A

loss of water

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11
Q

what can loss of water in the IV joints cause?

A

overload of facet joints

2 degree OA?

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12
Q

what are the features of a problem with facet joints?

A

pain which is eased by flexion of the spine

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13
Q

what features suggest IV disc problem?

A

pain worse with extension of spine

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14
Q

how can OA be treated if in one or two motion segments?

A

localised fusion

inconsistent results and causes stiff movement

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15
Q

what are the 2 parts of the IV disc?

A

outer annulus fibrosis

inner gelatinous nucleus pulposis

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16
Q

which vertebra does a disc bulge affect?

A

the vertebra below

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17
Q

where is IV disc degeneration most common in the spine?

A

L4/5 and L5/S1

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18
Q

what are the signs of IV disc degeneration?

A

60% asymptomatic over 45 y/o have bulging discs on MRI
10% have disc extrusion
5% have asymptomatic nerve root compression

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19
Q

is an MRI diagnostic of IV disc degeneration?

A

no

20
Q

what causes a disc prolapse? how can this present?

A

nucleus pops out of annulus fibrosis
lifting a heavy object can cause an annulus tear (twang) which can disrupt the rich innervation of the outer annulus resulting in pain in coughing

21
Q

do all prolapsed discs need surgery?

A

no

most settle within 3 months

22
Q

where do motor neurons originate?

A

anteriorly

bodies in anterior grey horn

23
Q

where do sensory nerves originate?

A

dorsally

bodies in dorsal root ganglion

24
Q

what forms the mixed spinal nerve and where does this exit?

A

anterior and posterior roots

exits via IV foramen

25
Q

what nerves run in the lumbar spine?

A

cauda equina
sensory and motor nerve roots run together with 2 pairs at each level
susceptible to compression????

26
Q

where does the spinal cord end and what does it become?

A

L1

becomes cauda equina

27
Q

what is the cauda equina?

A

junction between the upper and lower motor neurons

28
Q

what would a lateral IV disc prolapse compress?

A

exiting nerve root

29
Q

what would a central IV disc prolapse compress?

A

traversing nerve root (traveling through thecal sac)

most common

30
Q

what is the thecal sac?

A

membranous sheath which surrounds the spinal cord and cauda equina in the spinal canal

31
Q

where does the exiting nerve root pass?

A

outside thecal sac

passes under the pedicle of the corresponding vertebra

32
Q

where does the traversing nerve root pair travel?

A

inside the anterior thecal sac (lateral recess)

will later penetrate the sac and become exiting nerve root

33
Q

what does a nerve root compression cause?

A

radiculopathy resulting in pain down dermatome of the nerve root (e.g sciatica)
weakness in any muscle supplied (myotome)
reduced or absent reflexes (LMN signs)

34
Q

what nerves contribute to the sciatic nerve?

A

L4,L5, S1, S2, S3

35
Q

what is spinal stenosis and what can cause it?

A

compression of spinal nerves
can be caused by OA
- osteophytes
- hypertrophied ligaments

36
Q

what are the symptoms of spinal stenosis?

A

radiculopathy or burning leg pain on walking (neurogenic claudication)

37
Q

what is cauda equina syndrome?

A

pressure on all lumbosacral nerve roots at level of lesion including sacral nerve roots for bladder and bowel control
- usually caused by prolapsed disc

38
Q

what are the symptoms of cauda equina syndrome?

A

bilateral lower motor neuron signs
bladder and bowel dysfunction
saddle anaesthesia
loss of anal tone

39
Q

what are the 3 important superficial muscles which make up the erector spinae?

A

iliocostalis
longissimus thoracis
spinalis thoracis

40
Q

what are the main ligaments of the spine?

A

anterior and posterior longitudinal ligaments
ligamentum flavum
infraspinous ligaments
supraspinaous ligament (most posterior)

41
Q

what do the spine ligaments do?

A

contribute to stability

42
Q

what is a chance fracture?

A

fractured vertebral body with disruption of posterior ligaments, with or without fracture of posterior elements (bones intact but ripped all the ligaments, creating gibbus deformity)

43
Q

how can a chance fracture be treated?

A

lumbar puncture and spinal anaesthesia at level of posterior iliac crest (L4) or PSIS (S2)
(want to do it in equina area)

44
Q

is most back pain mechanical or inflammatory?

A

mechanical

45
Q

discectomy and decompression surgery is good for what?

A

sciatica/leg pain which doesn’t resolve within 3 months with conservative management

46
Q

where does sciatica pain go?

A

below the knee

47
Q

most common feature in asymptomatic middle aged patients?

A

disc bulge > disc protrusion > disc extrusion > nerve root compression or deviation

MSK (66 decks)

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