Clinical anatomy of the spine

Question 1

do all spine curvatures develop at the same time?

Answer 1

no

develop at time with movement - walking etc

Question 2

what are the 2 atypical vertebrae?

Answer 2

atlas

axis

Question 3

what is the vertebra prominens?

Answer 3

C7

no formaena transverse process (vertebral artery)

Question 4

bifid spinous process is found where?

Answer 4

cervical vertebrae

Question 5

what types of joint is the IV joints?

Answer 5

fibrocartilaginous

Question 6

what do facet joints allow?

Answer 6

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

Question 7

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

Answer 7

less

due to constraint of ribs

Question 8

which area has the least rotation?

Answer 8

lumbar

due to more vertically orientated facet joints

Question 9

what gives cervical spine its large rotational ability?

Answer 9

more horizontal facet joints

Question 10

what happens to IV disc structure with ageing?

Answer 10

loss of water

Question 11

what can loss of water in the IV joints cause?

Answer 11

overload of facet joints

2 degree OA?

Question 12

what are the features of a problem with facet joints?

Answer 12

pain which is eased by flexion of the spine

Question 13

what features suggest IV disc problem?

Answer 13

pain worse with extension of spine

Question 14

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

Answer 14

localised fusion

inconsistent results and causes stiff movement

Question 15

what are the 2 parts of the IV disc?

Answer 15

outer annulus fibrosis

inner gelatinous nucleus pulposis

Question 16

which vertebra does a disc bulge affect?

Answer 16

the vertebra below

Question 17

where is IV disc degeneration most common in the spine?

Answer 17

L4/5 and L5/S1

Question 18

what are the signs of IV disc degeneration?

Answer 18

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

Question 19

is an MRI diagnostic of IV disc degeneration?

Answer 19

no

Question 20

what causes a disc prolapse? how can this present?

Answer 20

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

Question 21

do all prolapsed discs need surgery?

Answer 21

no

most settle within 3 months

Question 22

where do motor neurons originate?

Answer 22

anteriorly

bodies in anterior grey horn

Question 23

where do sensory nerves originate?

Answer 23

dorsally

bodies in dorsal root ganglion

Question 24

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

Answer 24

anterior and posterior roots

exits via IV foramen

Question 25

what nerves run in the lumbar spine?

Answer 25

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

Question 26

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

Answer 26

L1 | becomes cauda equina

Question 27

what is the cauda equina?

Answer 27

junction between the upper and lower motor neurons

Question 28

what would a lateral IV disc prolapse compress?

Answer 28

exiting nerve root

Question 29

what would a central IV disc prolapse compress?

Answer 29

traversing nerve root (traveling through thecal sac) | most common

Question 30

what is the thecal sac?

Answer 30

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

Question 31

where does the exiting nerve root pass?

Answer 31

outside thecal sac | passes under the pedicle of the corresponding vertebra

Question 32

where does the traversing nerve root pair travel?

Answer 32

inside the anterior thecal sac (lateral recess) | will later penetrate the sac and become exiting nerve root

Question 33

what does a nerve root compression cause?

Answer 33

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)

Question 34

what nerves contribute to the sciatic nerve?

Answer 34

L4,L5, S1, S2, S3

Question 35

what is spinal stenosis and what can cause it?

Answer 35

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

Question 36

what are the symptoms of spinal stenosis?

Answer 36

radiculopathy or burning leg pain on walking (neurogenic claudication)

Question 37

what is cauda equina syndrome?

Answer 37

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

Question 38

what are the symptoms of cauda equina syndrome?

Answer 38

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

Question 39

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

Answer 39

iliocostalis longissimus thoracis spinalis thoracis

Question 40

what are the main ligaments of the spine?

Answer 40

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

Question 41

what do the spine ligaments do?

Answer 41

contribute to stability

Question 42

what is a chance fracture?

Answer 42

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)

Question 43

how can a chance fracture be treated?

Answer 43

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

Question 44

is most back pain mechanical or inflammatory?

Answer 44

mechanical

Question 45

discectomy and decompression surgery is good for what?

Answer 45

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

Question 46

where does sciatica pain go?

Answer 46

below the knee

Question 47

most common feature in asymptomatic middle aged patients?

Answer 47

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