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MSK > Session 2, lecture 2.Lumbar Spine And Assosiated Disorders > Flashcards

Session 2, lecture 2.Lumbar Spine And Assosiated Disorders Flashcards

1
Q

How many vertebrae are there in the vertebralcolumn ?

A

33

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2
Q

What makes up the vertebral column?

A
  • 7 cervical vertebrae
  • 12 thoracic vertebrae
  • 5 lumbar vertebrae
  • 5 sacral( fused)
  • 4 coccygeal( fused)
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3
Q

What would the intervertebral disc called between the L3/L4 vertebrae?

A

The L3/L4 intervertebral disc

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4
Q

What parts of the vertebral column are mobile and which are immobile ?

A

1) the vertebrae in the cervical and lumbar spine are relatively mobile , whereas those in the thoracic spine are relatively less mobile as they are joined by the ribs to the sternum.

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5
Q

When does the lumbar spine begin ?

A

Just below the 12th rib

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6
Q

What are the functions of the lumbar spine ?

A

1) HAEMOPOIESIS the bone marrow of the vertebral column is an important site for haemopoiesis
2) PROTECT the spinal cord and the Cauda equina
3) SUPPORT : the thoracic spine and the Pelvis
4) MOVEMENT :highly flexible structure of bones. Intervertebral discs and ligaments allow this.

‘HPSM’

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7
Q

Structure of the lumbar vertebrae

A

Check notes

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8
Q

What is the largest part of the lumbar vertebra?

A

Anterior region

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9
Q

What type of cartilage covers the superior and inferior end plates of the anterior region of the lumbar vertebrae?

A

Hyaline cartilage

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10
Q

What is the anterior region of the lumbar vertebrae made up of - what type of bone ?

A

90% cancellous bone

  • 10% cortical bone
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11
Q

What are the benefits of the anterior region of the lumbar vertebrae having a large amount of cancellous bone ?

A

1( lighter

2) allow for more haemopoiesis
3) MAIN REASON - helps to resist compression

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12
Q

Why does the size of the vertebral body ( anterior region) increase from superior to inferior ?

A

From L1 to L5 , the vertebral body increases in size because there is more weight the vertebrae has to hold.

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13
Q

How are adjacent vertebral bodies linked ?

A

By invertebraal discs

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14
Q

What is contained within the vertebral foramen ?

A
  • conus medullaris
  • cauda equina
  • meninges
  • epidural veins and spinal arteries
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15
Q

Describe the structure of the lumbar vertebra- posterior region

A

2 Pericles , 2 lamina + 7 processes

THE 7 processes :

1) 1 spinous process
2) 2 transverse process
3) 2 superior articular process
4) 2 inferior articular process

CHECK NOTES FOR IMAGE

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16
Q

What two structures does the pedicle connect ?

A

Connects the vertebral body and the transverse process

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17
Q

What two processes does the lamina connect ?

A

Connects the transverse process to the spinous process

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18
Q

What are the superior and inferior articular processes also referred to ?

A

The vertebral end plates

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19
Q

What are the superior and inferior articulR processes covered in?

A

Hyaline cartilage

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20
Q

How is the facet join created ?

A

Formed between adjacent superior and inferior articular processes.

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21
Q

What is the facet joint also referred to ?

A

Zygaphyseal joint

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22
Q

What type of joint is the facet joint ?

A

Synovial joint , lined with hyaline cartilage.

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23
Q

Between the facet joint , what is the hole called ?

A

Intervertebral foramen.

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24
Q

What does the intervertebral formamen allow the passage of ?

A

Spinal nerves

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25
Q

What to facet joints prevent the movement of ?

A

Prevents anterior displacement of vertebrae

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26
Q

What do the facet joints allow the movement of ?

A

Flexion and extension mainly.

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27
Q

What are the three main movements of the lumbar spine ?

A

1) flexion and extension
2) lateral flexion
3) rotation

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28
Q

What are the three types of joints in the lumbar spine ?

A

1) fibrous joints
2) secondary cartilaginous joints
3) synovial joints

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29
Q

What are the relative mobilities of the types of joints in the lumbar spine ?

A

1) fibrous joints - non-mobile
2) secondary cartilaginous : partially mobile
3) synovial joints : highly mobile

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30
Q

What is an example of synovial joints in the lumbar spine ?

A

Facet joints

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31
Q

What is an example of secondary cartilaginous joints in the lumbar spine ?

A

Intervertebral discs

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32
Q

What is an example of fibrous joints in the lumbar spine ?

A

Sacroiliac

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33
Q

What is the composition of intervertebral discs?

A
  • 70% water
  • 20% collagen
  • 10% proteoglycans eg hyaluronic acid
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34
Q

Give an example of intervertebral discs change throughout the day

A
  • in the morning we are a few mm taller than we are at the end of the day, this is because the intervertebral discs are well hydrated compared to at the end of the day.
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35
Q

What percentage of the length of the vertebral column do intervertebral discs account for ?

A

25%

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36
Q

What are the regions that within the intervertebral discs ?

A

1) nucleus pulposus which is central

2) annulus fibrosus which is peripheral

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37
Q

Describe features of the annulus fibrosus

A
  • comprises lamellae of annular bands of collagen in varying orientations
  • the outer lamellae are type 1 collagen and inner lamellae are fibrocartilganous
  • it is avascular and aneural
  • highly resilient under axial ( top to bottom) compression and is stronger than the vertebral body.
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38
Q

What is the remnant of the notochord?

A

Nucleus pulposus

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39
Q

What is the function of the annulus fibrosus

A

Major shock absorber

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40
Q

Describe features of the nucleus pulposus?

A
  • gelatinous, type 2 collagen
  • high oncotic pressure due to large amounts of water being stored in there
  • centrally located in the infant , but located more posteriorally in the adult
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41
Q

Why is important to keep your spine straight whilst lifting heavy loads ?

A

Because intervertebral discs are very strong in axial compression ( top to bottom) but less strong under tangential loading ( load applied at an angle)

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42
Q

Describe the shape of the vertebrae in the fetus ?

A
  • flexed in a single curvature
  • c shaped
  • this curvature is known as the primary curvature - consisting of one kyphosis.
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43
Q

In adult vertebral column , what are the two types of curves present ?

A

1) lordosis

2) kyphosis

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44
Q

What type of shape is the cervical region of the vertebral column?

A

Lordosis

45
Q

What type of shape is the thoracic region of the vertebral column

A

Kyphosis

46
Q

What type of shape is the lumbar region of the vertebral column?

A

Lordosis

47
Q

What type of shape is the sacral region of the vertebral column?

A

Kyphosis

48
Q

What type of shape is the coccyx region of the vertebral column?

A

Kyphosis

49
Q

Outline the evolution of the vertebral column during the first 18 months of birth

A

the primary curvature is remodelled to add two secondary curvatures

1) the cervical spine develops the first cervical lordosis when the young child begins to lift its head
2) the lumbar spine loses its primary kyphosis when it begins to stand , crawl. This develops into lumbar lordosis,

50
Q

What happens to vertebral column in old age ?

A
  • secondary curvatures start to disappear ( lordosis)
  • loss of disc height.
  • this results in continuous primary curvature re establishing. ( C SHAPED)
51
Q

What occurs to vertebral column during pregnancy?

A
  • lumbar lordosis is exaggerated during pregnancy
52
Q

What is the most common lumbar pathological problem ?

A

Mechanical back pain

53
Q

What percentage of the UK population will experience back pain for at least 24 hours in the year

A

50%

54
Q

What percentage of UK population would experience long lasting back pain - longer than 24 hours in lifetime ?

A

80%

55
Q

What is mechanical back pain ?

A

It is characterised by pain when the spine is loaded , that worsens with exercise and is relieved by rest.

56
Q

What are the risk factors for mechanical back pain ?

A

1) obesity
2) poor posture
3) poorly designed seating
4) incorrect manual handling

57
Q

What is herniation of the intervertebral disc

A

Protrusion of the nucleus pulposus into the spinal canal

58
Q

What is the most common age group for ‘ slipped disc’

A

Age 30-50 years

59
Q

What are the 4 stages to a disc herniation

A

1) disc degeneration
2) prolapse
3) extrusion
4) sequestration

60
Q

What is disc degeneration?

A

Chemical changes associated with ageing causes disc to dehydrate and bulge

61
Q

What is prolapse?

A
  • protrusion of the nucleus pulposus with slight impingement into the spinal canal
62
Q

What is extrusion

A

Nucleus pulposus breaks through the annulus fibrosus but remains within the disc space

63
Q

What is sequestration

A

Nucleus pulposus breaks through the annulus fibrosus and separates from the main body of the disc of the spinal canal.

64
Q

Where are the most common sites for slipped disc ?

A

L4/L5

L5/S1

Due to mechanical loading of these joints

65
Q

What is sciatica?

A

Is a pain caused by irritation or compression of one or more nerve roots which contribute to the sciatic nerve

  • nerve roots of the sciatic nerve : L4 , L5, S1 ,S2 ,S3
66
Q

If the L4 sciatica is damaged where is pain experienced ?

A

Lumbar spine - anterior thigh - anterior knee - medial leg

67
Q

If the L5 sciatica is damaged, where is pain experienced ?

A

Lumbar spine - lateral thigh - lateral leg - Dorsum of the foot

68
Q

If S1 sciatica is damaged , where is pain experienced?

A

Lumbar spine - posterior thigh - posterior leg - heel- lateral border and sole of foot

69
Q

What are causes of cauda equina?

A

1) disc prolapse
2) tumours
3) spinal infection
4) spinal stenosis
5) vertebral fracture
6) spinal haemorrhage

70
Q

What are the red flag symptoms of cauda equina?

A

1) perianal numbness
2) painless retention of urine
3) erectile dysfunction
4) urinary / faecal incontinence

REQUIRES SURGICAL EMERGENCY

71
Q

What happens if emergency surgery is not performed on someone with cauda equina ?

A

People will lose control of bladder and bowel

  • loss of sensation
72
Q

Where is pain typically experienced in someone with sciatica?

A

1( buttocks 2( the back 3) lower legs

73
Q

What is the cauda equina?

A

It is the name of the spinal nerves at this particular point - from when the spinal cord ends at L1/L2

74
Q

What is cauda equina syndrome?

A

There is a canal filling disc that compresses the lumbar and sacral nerve roots within the spinal canal.

75
Q

What are degenerative changes in the vertebral column?

A

1) nucleus pulposus of the intervertebral discs dehydrate with age. This leads to a decreased in height of the discs - bulging of the discs and alteration of the load stresses on the joints.
2) osteophytes called syndesmophytes therefore develop adjacent to the end plates of the discs. This is known as marginal osteophytosis. Increased stress is put on facet joints , which also develop osteoarthritic changes. The facet joints are inner stem by the meningeal branch of the spinal nerve , so arthritis in this joints is perceived as painful
3) as the disc height decreases and arthritis develops in the facet joints and vertebral bodies , the intervertebral foramina decreases in size, this can lead to compression of the spinal nerves and is perceived as RADICULAR OR NERVE PAIN,

76
Q

What is an exiting nerve root

A

The nerve root that emerges from the spinal canal at the same level as the intervertebral disc

This is most at risk in a far lateral disc herniation.

77
Q

Transversing nerve root

A

The nerve root that emerges at the level below

  • paracentral herniation is putting the transversing nerve root at risk
78
Q

What are the three ways the nucleus pulposus herniated ?

A

1) paracentral prolapse (96%)

2) central prolapse (2%)
3) fat lateral prolapse (2%)

79
Q

What is a central disc herniation ?

A
  • the nucleus pulposus herniated in the direction of the spinal cord .
80
Q

If there is a paracentral herniation of the

4/L5 disc , which root is most frequently compressed ?

A

The L5 transversing root is most frequently compressed because the L4 root ( exiting ) emerges above the level of the L4/L5 disc.

SIMILARILY , a paracentral herniation of the L5/S1 disc compresses the S1 root , not the L5 root because the S1 root is the transversing root.

81
Q

What is the spinal canal

A

The cavity that contains the spinal cord within the vertabral column.

82
Q

What is spinal canal stenosis ?

A

Abnormal narrowing of the spinal canal that compresses either the spinal cord or the spinal roots

83
Q

In what age group does spinal canal stenosis often occur ?

A

Elderly

84
Q

What is spinal canal stenosis due to ?

A

1) disc bulging
2) facet joint osteoarthritis
3) liagmentum flavum hypertrophy
4) compression fractures of the vertebral bodies
4) trauma
5) spondylolistthesis

85
Q

What is the most common type of canal stenosis ?

A

1) lumbar stenosis

2) cervical stenosis

86
Q

What are common symptoms of spinal canal stenosis ?

A

1) discomfort when standing
2) discomfort in the shoulder , arm or hand or lower limb

3( bilateral symptoms in approx 70% patients

2) numbness at or below the stenosis

Weakness at or below the stenosis

87
Q

What percentage of patients who have lumbar stenosis , remain unchanged , get worse or get better ?

A

.70% patients stay unchanged

15% get worse

15% imporove

88
Q

What is neurogenic claudication ?

A

It is a symptom , rather than a diagnosis

It is where the patient reports parasthesia in the legs on prolonged standing and on walking , radiating in a sciatica distribution

89
Q

What is the cause of neurogenic claudication ?

A
  • results from compression of the spinal nerves as they emerge from the limbo sacral spinal cord.this leads to venous engorgement of nerve roots during exercise , leading to reduced arterial flow = ischaemia . The ischaemia causes the paraesthesia
90
Q

What relieves neurogenic claudication ?

A

Flexion of the spine ( bending forwRd)

91
Q

What is spondylolisthesis?

A

Caused of by the disconnection of the vertebral body from the vertebral arch

92
Q

What is a lumbar puncture ?

A

Withdrawal of fluid from the subarachnoid space of the lumbar cistern. It is an important diagnostic test for a variety of the CNS disorders incl MS and meningitis.

93
Q

How to perform a lumbar puncture ?

A
  • it is performed with the patient lying on the side with the back and hips flexed ( knee-chest position ).
  • flexion of the vertebral column facilitates insertion of the needle by spreading apart the vertebral laminae and spinous processes. - stretching the ligamentum flavum,
  • the skin covering the lower lumbar vertebrae is anathesized and a lumbar puncture needle is inserted in the mid line between the spinous process of L3/L4 or L4/5 vertebrae
  • the needle Enters the ligamentum flavum , then punctures the dura and arachnoid and Enters the lumbar cistern. When the stylet is removed , the CSF escapes and can be collected.
94
Q

How many important ligaments are there in the vertebral column ?

A

5 ( 2 anterior and 3 posterior region )

95
Q

Which ligaments are stronger - the posterior or anterior ones a.

A

Anterior are stronger than posterior

96
Q

What are the two ligaments called in the anterior region ?

A

1) anterior longitudinal ligament

2) posterior longitudinal ligament

97
Q

What is the anterior longitudinal a ligament ?

A

Anterior to the vertebral body ( outer surface of the vertebral body)

  • blends with the periosteum of the vertebral bodies
  • slightly wider than the posterior longitundal ligament.
  • prevents hyperextension
98
Q

What is the posterior longitudinal ligament

A

Throughout the lumbar spine - runs posterior to the vertebral bodies

  • weaker than the anterior longitudinal ligament
  • prevents hyperflexion
99
Q

What are the 3 ligaments called in the posterior region ?

A

1) ligamentum flavum
2) interspinous ligament
3) supraspinous ligament

100
Q

What are supraspinous ligaments ?

A

Found on the tips of adjacent spinous processes

  • they are strong bands of fibrous tissue
  • lax in extension
  • taught in flexion
101
Q

What is interspinous ligaments

A
  • weak sheets of fibrous tissue paper
  • they unite the spinous processes along their adjacent borders
  • they are most highly developed in the lumbar region
  • they increase stability of vertebral column , by resisting hyperflexion.
  • they fuse posterioroly with the supraspinous ligament.
102
Q

What is the ligamentum flavum

A
  • high elastin content
  • appears yellow to the naked eye
  • situated between the lamina of adjacent vertebrae and becomes stretched during flexion of the spine.
103
Q

As we flex the spine , which ligaments are under tension ?

A
  • the posteriorlongitundanal ligament
  • ligamentum flavum
  • interspinous ligament
  • supraspinous ligaments

-

104
Q

What is under compression during flexion of the spine ?

A

1) vertebral bodies
- intervertebral discs
- anterior longitudinal ligament

105
Q

When we are youn , what percentage of our body weight is transmitted to vertebral bodies and facet joints vs when we are old

A

YOUNG - 80% vertebral bodies & 20% facet joints

  • OLD : 35% facet joints and 65% vertebral bodies
106
Q

In an adult standing erect , where is the centre of gravity ?

A
  • C1/C2

C7/T1

T12/L1

L5/S1

These are the weak points - pathology tends to develop here

107
Q

What is the evolutionary remnant of the tail ?

A

Coccyx

108
Q

What are sacroiliac joints ?

A

Joint between the sacrum and I,iliem joint.

109
Q

Where do spinal nerves exit the spinal canal from ?

A

Sacral foramina and sacral hiatus

MSK (14 decks)

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