BACK AND SPINAL CORD FINAL

Question 1

L5-S1

Answer 1

-spina bifida occult- fusion -> tuft of hair
-spondylolisthesis -> L5 displaced anteriorly to sacrum -> compresses cauda equina -> lower back and limb pain
-sciatica- herniated IV disc or osteophyte compresses sciatic nerve

Question 2

L1-L2

Answer 2

-spinal cord ends

Question 3

S2-S3

Answer 3

-dural sac ends

Question 4

L3/L4 or L4/5

Answer 4

-lumbar puncture into subarachnoid space
-epidural -> this can also be done in sacral canal via sacral hiatus OR trans-sacral space via posterior sacral foramina

Question 5

localized back pain

Answer 5

-longitudinal ligament compression
-anulus fibrosus compression
-inflammation due to chemicals released from ruptured nucleus pulposus

Question 6

chronic back pain

Answer 6

-posterolateral herniation
-increased ossification of IV foramina (older pts)
-nerve compression!

Question 7

fracture/dislocation of atlas

Answer 7

-rupture of transverse ligament -> dens set free
-atlantoaxial subluxation- partial dislocation
-complete dislocation:
-upper cervical region of spinal cord -> quadreplegia
-medulla/brain stem -> death

Question 8

sprain vs strain

Answer 8

-sprain -> ligament damage without dislocation or fracture (can be caused by strong contraction)
-strain -> muscles (erector spinae) damaged via improper form

Question 9

laseque test

Answer 9

-traction on sciatic nerve

Question 10

Adamkiewicz artery

Answer 10

-segmental medullary artery
-supplies anterior spinal artery -> lower thoracic, lumbar, and sacral spine
-sustained decreased BP, obstructive arterial disease, clamping during surgery -> ischemia
-muscle weakness and paralysis
-supplies inferior 2/3rd of spinal cord
-vertebral arteries and segmental medullary arteries supply

Question 11

vertebral venous plexus

Answer 11

-drains pelvis and abdomen to SVC if IVC is obstructed
-if abdominal or pelvic metastasis -> spreads to vertebrae and brain
-no valves

Question 12

back pain sources

Answer 12

-1. fibroskeleton- periosteum, ligaments, annuli fibrosi of IV discs
-2. meninges
-3. zygapophysial joints
-4. muscles (intrinsic)
-5. spinal nerves

Question 13

spinal nerves

Answer 13

-8 cranial (7 vertebrae)
-12 thoracic
-5 lumbar
-5 sacral
-1 coccygeus (4 vetebrae)

Question 14

triangle of auscultation

Answer 14

-allows for optimal auscultating lung sounds
-laterally- medial border of the scapula
-medially- ascending fibers of trapezius
-inferiorly- superior border of the latissimus dorsi
-intercostal space 6 about

Question 15

superficial (extrinsic/false) back muscles

Answer 15

-connect the axial skeleton (vertebral column) with the appendicular skeleton (pectoral girdle and humerus
-support and move the upper limb
-nerve supply- ventral rami

-trapezius
-latissimus dorsi
-rhomboid major
-rhomboid minor
-levator scapulae
-serratus posterior superior and inferior

Question 16

back dimples

Answer 16

-sacroiliac joint

Question 17

atlanto-occipital joint and atlanto-axial joint

Answer 17

-atlanto-occipital joint- between superior articular facets of C1 and occipital condyles
-atlanto-axial joint- inferior facets of C1 and superior facets of C2 ALSO synovial pivot joint with dens -> axis of pivot

Question 18

lumbar triangle

Answer 18

-medially- latissimus dorsi
-laterally- external oblique muscle laterally
-inferiorly- iliac crest inferiorly
-site of lumbar hernia

Question 19

supracrista plane

Answer 19

-L4
-umbilical region too!

Question 20

disc herniation and nerve impinged

Answer 20

-posterolateral MC bc of strength of centrally located posterior longitudinal ligament
-cervical- nerve impinged = lower vertebra (C5 is impinged at C4-C5) -> bc cervical nerves exit superiorly
-thoracic- nerve impinged = upper vertebrae (T3 is impinged at T3-T4)
-lumbar- nerve impinged = lower vertebrae

Question 21

spinal nerve exits

Answer 21

-thoracic and lumbar nerves exit inferiorly to vertebrae
-cervical nerves exit superiorly
-ex. C1 nerve exits between skull and C1, C2 nerve exits between C1-C2, C8 nerve exits between C7 and T1

Question 22

how many spinal nerves are there

Answer 22

31

Question 23

denticulate ligaments

Answer 23

-21
-from pia matter (traverse arachnoid mater) and attach to dura mater

Question 24

cranial nerves

Answer 24

-1 and 2 exit from cerebrum
-3-12 exit from brain stem

Question 25

parasympathetic innervation

Answer 25

-CN 3, 7, 9, 10
-S2-S4

Question 26

L5 stress fracture case study

Answer 26

-continuous hyperextension / compressive forces of vertebral column -> stress fractures.
-interarticular parts of lamina involved
-spondylolysis -> anterior movement of L5
-diving, gymnastics, wrestling, overhead lifting, repetitive activities, and weightlifting are especially vulnerable

Question 27

severe pain while extending vertebrae lifting heavy weights case study

Answer 27

-severe back spasm
-intermediate and deep layers of intrinsic
(deep) muscles
-constant, dull ache in the lower back
-limited range of motion of vertebral
column
-large areas of palpable tenderness.
-poor posture / improper lifting mechanics -> advise to lift with the lower limbs instead of the
back

Question 28

spina bifida occulta

Answer 28

-failure of vertebral arch (laminae) to fuse
-spina bifida cystica- arch (laminae) is not there

Question 29

severed cervical spinal cord

Answer 29

-superior to C5 -> quadriplegia
-superior to C4 -> respiratory arrest / possible death -> phrenic nerve derived from C3, C4, C5 -> innervate diaphragm

Question 30

spondylolisthesis vs spondylosis

Answer 30

-spondylosis- FRACTURE of pars interarticularis
-Spondylolisthesis- FORWARD DISPLACEMENT of vertebrae
-Can occur secondary to spondylolysis
-Often occurs in L5 vertebral body relative to sacrum
-Can possibly cause pressure in cauda equina