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Question 1

Attachments of the erector spinae muscles

Answer 1

• medial crest of sacrum
• supraspinous ligament
• to back of iliac crest and lateral crest of sacrum to ribs & vertebrae

Question 2

action of the erector spinae muscle

Answer 2

Extension of Vertebral column

Lateral flexion

Head extension

Question 3

innervation of erector spinae

Answer 3

posterior ramus of spinal nerves

Question 4

what muscles are involved in flexion

Answer 4

External/internal oblique (working together), rectus abdominis, psoas major/minor, sternocleidomastoid (working together).

Question 5

what back muscles are involved in extension

Answer 5

Erector spinae, trapezius, quadratus lumborum.

Question 6

muscles involved in lateral flexion

Answer 6

Trapezius, erector spinae, quadratus lumborum, external oblique, internal oblique.

Question 7

define kyphosis

Answer 7

Kyphosis- over-curvature of the thoracic vertebrae.

Question 8

define lordosis

Answer 8

Lordosis- excessive anterior convexity of the cervical and/or lumbar spine.

Question 9

define scoliosis

Answer 9

Scoliosis- lateral curvature of the spine.

Question 10

which sections of the spine have natural lordotic curvature

Answer 10

cervical and lumbar

Question 11

which sections of the spone have a natural kyphotic curvature

Answer 11

Thoracic and sacral

Question 12

why is the spine curved?

Answer 12

To help maintain balance in standing and sitting and help with movement and weight distribution

Question 13

attachments of the nuchal ligament to the skull and the cervical vertebrae

Answer 13

Extends from the external occipital protuberance and median nuchal line to the spinous process of C7.

Question 14

what are the functions of the nuchal ligament

Answer 14

Sustain the weight of the head.

Question 15

Why might an obstetrician be interested in the nuchal ligament of a foetus?

Answer 15

The obstetrician checks nuchal ligament via ultrasound to identify any abnormal developments e.g. translucency shown with downs syndrome

Question 16

what movement stretches the anterior longitudinal ligament

Answer 16

extension

Question 17

why is the posterior longitudinal ligament thicker in the thoracic region

Answer 17

Attenuate posterior forces due to kyphosis.

Question 18

why is the ligamentum flavum yellow?

Answer 18

elastin

Question 19

what does the ligamentum flavum connect

Answer 19

lamina of adjacent vertebrae

Question 20

function of the cruciform ligament

Answer 20

Restrains posterior movement of odontoid process.

Question 21

function of alar ligaments of the axis

Answer 21

Limit side-to-side movements of the head when it is turned.

Question 22

In herniation of the intervertebral disc (slipped disc), in which direction does the nucleus pulposus extrude?

Answer 22

Posterolateral owing to the presence of the posterior longitudinal ligament in the spinal canal and anterior collapse of vertebrae (wedging due to osteoporosis).

Question 23

Which disc is most commonly affected by disc herniation? Why is this?

Answer 23

Lumbar: between L4-L5 or between L5-Sacrum. Weight of the body and propensity for anterior wedge fractures.

Question 24

Why are we taller in the morning than when we went to bed?

Answer 24

During the day our cartilage slowly compresses taking a lot of force, when we rest it returns to its normal state.

Question 25

Why are fractures typically common between T12-L1?

Answer 25

Compression fractures due to osteoporosis

Question 26

L4/L5 disc herniation can produce what neurological problem?

Answer 26

Sciatica

Question 27

At what vertebral level does the spinal cord terminate?

Answer 27

L1, L2 as the Conus | Medullaris.

Question 28

At what level does it terminate in the neonate?

Answer 28

Upper border of L3

Question 29

define strain

Answer 29

stretching or tearing of ligaments

Question 30

define disc prolapse

Answer 30

when the outer fibres of the intervertebral disc are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space.

Question 31

define spondylosis

Answer 31

degenerative process affecting the vertebral disc and facet joints that gradually develops with age. Degeneration of vertebral column

Question 32

define radiculopathy

Answer 32

describes a range of symptoms produced by the pinching of a nerve root in the spinal column. Damage to the spinal nerves as they exit the roots.

Question 33

define spondylolysis

Answer 33

is a crack or stress fracture in one of the vertebrae

Question 34

define spondylolisthesis

Answer 34

the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. Basic- displaced vertebra

Question 35

define spondylitis

Answer 35

Inflammation of one or more of the vertebrae of the spine.

Question 36

what is spinal stenosis

Answer 36

A narrowing of spinal canal e.g. due to osteoarthritis – symptoms – leg heaviness and aching on walking (spinal claudication)

Question 37

symptoms of spinal stenosis

Answer 37

cramp in thigh or leg on walking, worse walking downhill or standing associated with back pain

Question 38

signs of spinal stenosis

Answer 38

pain on straight leg raise and back extension – often no neuro symptoms

Question 39

red flags for back pain

Answer 39

``` Bladder/Bowel changes Fever Weight loss Previous cancer Perianal anaethesia Pulsatile abdominal mass Progressive neurological deficit ```

Question 40

causes of vertebral collapse

Answer 40

Trauma, osteoporosis, tumour

Question 41

signs and symptoms of vertebral collapse

Answer 41

Sudden onset back pain, mild trauma. Central Signs & symptoms: vertebral tenderness, reduced mobility

Question 42

causes of cauda equina

Answer 42

Central disc prolapse, tumour, abscess/TB haematoma, trauma

Question 43

signs and symptoms of cauda equina

Answer 43

Urinary incontinence or retention, faecal incontinence, bilateral weakness and pain – important to remember to catheterise Reduced perianal sensation (saddle), reduced anal tone, bilateral absent ankle reflexes Read around further for management and investigations

Question 44

causes of cord compression

Answer 44

Tumour, abscess/TB trauma central disc prolapse

Question 45

signs of cord compression

Answer 45

- Continuous shooting pains, faecal incontinence, urinary retention

Question 46

define osteopenia

Answer 46

is decreased bone mass. Two metabolic bone diseases decrease bone mass: osteoporosis and osteomalacia.

Question 47

causes of osteomalacia

Answer 47

. Osteomalacia is due to impaired mineralization, usually because of severe vitamin D deficiency or abnormal vitamin D metabolism (see Vitamin D). Osteomalacia can be caused by disorders that interfere with vitamin D absorption (eg, celiac disease) and by certain drugs (eg, phenytoin, phenobarbital).

Question 48

define osteoporosis

Answer 48

decreased bone mass, but ratio of bone mineral to bone matrix is normal