Herniated Nucleus Pulposus Flashcards Preview

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Flashcards in Herniated Nucleus Pulposus Deck (61):
1

Comprises the cartilaginous joint between adjacent vertebral bodies

-allows for mobility between adjacent vertebrae

Intervertebral disk

2

The intervertebral disk functions as a

Shock absorber

3

The outer portion of the intervertebral disk

Anulus fibrosis

4

Composed of rings of fibrocartilage and fibrous connective tissue with a high collagen content

Anulus fibrosis

5

The inner portion of the intervertebral disk is the

Nucleus pulposus

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Gelatinous in character, contains few cells, and is rich in proteoglycans

Nucleus pulposus

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There is a high water content bound in the nucleus pulposus, and this provides

Turgor (rigidity) to the disk

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Serves the function of distributing pressure throughout the disk when the vertebral column is weight bearing (i.e. upright posture)

Nucleus Pulposus

9

What happens when you are standing upright?

Water is squeezed out of nucleus and the nucleus gets thinner

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When not weight bearing (i.e. when reclined), water returns to the nucleus and the disk gets

Thicker

11

The thinning of the nucleus from water loss due to upright posture explains why we are

Taller in the morning than at night

12

With age, there is a loss of proteoglycans in the nucleus pulposus and therefore the amount of bound water is

Reduced

13

The loss of proteoglycans, and therefore water, from the nucleus pulposus explains what phenomenon of aging?

We get shorter

14

The nucleus pulposus is not centrally positioned in the disk, but rather it is positioned towards the

Posterior side of disk

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Thinner posteriorly than it is anteriorly because of position of nucleus pulposus

Anulus fibrosus

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What can happen with degeneration of the anulus fibrosus and with pressure applied to the intervertebral disk during movement?

Anulus ruptures and nucleus pulposus can herniate through anulus

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Because the anulus is thinner posteriorly and because flexion of the spine stretches the posterior portion of the anulus and squeezes the nucleus pulposus posteriorly, the nucleus is much more likely to herniate in a

Posterior direction

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However, because the posterior midline of the disk is reinforced by the posterior longitudinal ligament, the nucleus is most likely to herniate in a

Posterolateral direction

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This posterolateral herniation can result in impingement on the roots of spinal nerves in either the

Lateral portion of vertebral canal, or in intervertebral foramen

20

Compression of the spinal nerves (or spinal roots) may result in

Sensory/motor disturbance

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The location of these clinical findings will be in regions of distribution of these spinal nerve fibers known as

Dermatomes (for sensory findings) and myatomes (for motor findings)

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Formed by the apposition of adjacent intervertebral notches, i.e. the inferior notch of one vertebra with the superior notch of the next

Intervertebral foramen

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Anteriorly, the borders of the intervertebral foramen are

Body of vertebra above, intervertebreal disk, and body of vertebra below

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Posteriorly, the borders of the intervertebral foramen are the

Inferior articular facet of vertebra above, superior articular facet of vertebra below, and zygopophyseal joint

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Superiorly and inferiorly, the boundaries of the intervertebral foramen are

Pedicles

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A spinal nerve passes through each

Intervertebral foramen

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Named according to which intervertebral foramen it passes through

A spinal nerve

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At thoracic and lumbar levels, the nerve takes the name of the vertebra

Above the foramen

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Where does the L1 nerve pass through?

The foramen between L1 and L2

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At cervical levels, the nerve takes the name of the vertebra

Below the foramen

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Where does the C3 nerve pass?

The foramen between C2 and C3

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Where does the C8 nerve pass?

The foramen between C7 and T1

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Because the lumbar spinal nerve roots descend a considerable distance through the vertebral canal from their origin at the spinal cord to their exit at the intervertebral foramen, they exit through the

Upper portion of the foramen

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Forms the anterior border of the lower portion of the foramen

Intervertebral disk

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Thus, lumbar spinal nerves exit through their intervertebral foramina above the level of the

Intervertebral disk

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Therefore, it is likely that a small herniated nucleus pulposus at lumbar levels will not impinge on the

Spinal nerve exiting that foramen

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Will impinge on the nerve roots that are in the lateral recess of the vertebral canal, getting ready to exit through the next lower intervertebral foramen

Lumbar nuclear pulposus hernia

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Thus, a herniation of L3/L4 disk is likely to impinge on the roots of the nerve that will exit between

L4 and L5, (i.e. the L4 nerve)

39

Says that if a herniated nucleus pulposus impinges on one spinal nerve, the nerve that will be impinged has the same name as the vertebra below the disk

The "clinical rule"

40

The foramen is smaller and so the nerve occupies most of the foramen of

Cervical vertebrae

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At the cervical level, the disk forms the anterior border of the middle of the foramen, so the nerve impinged by the hernia is the nerve that

-explains why the "clinical rule" holds for cervical vertebrae

Passes through that foramen

42

A herniation of the C5/C6 disk is likely to impinge on the

C6 nerve

43

May impinge on multiple nerves or nerve roots or even impinge on the spinal cord if above the L2 vertebral level

Larger or more medial hernias

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Forms the posterior border of the intervertebral foramen

Zygaphosphyseal joint

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Pathologies of the zygaphosphyseal joint may impinge on the

Nerve

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Similarly, thickening of the zygapophyseal joint capsule or of the ligamentum flavum may impinge on
nerve roots in the

Foramen or canal

47

What are two types of stenosis?

1.) Foraminal stenosis
2.) Central Stenosis

48

The narrowing of an intervertebral foramen

Foraminal Stenosis

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May be caused by a herniated nucleus pulposus, arthritic changes of zygaphosphyseal joints, inflammation or scarring of the foramen, or other reasons

Foraminal Stenosis

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Results in compression of spinal nerves

Foraminal stenosis

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The narrowing of the vertebral canal

Central stenosis

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Causes compression of the contents of the vertebral canal such as the spinal cord, the cauda equina, or individual spinal nerves, roots, or groups of nerves or roots

Central stenosis

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A region of skin that receives its sensory innervation from a single spinal nerve

Dermatome

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A lesion of one or more spinal nerves or dorsal roots will result in sensory symptoms that are referred to the

Dermatomes corresponding to the injured nerves or roots

55

A group of skeletal muscles that receive their motor innervation from a single spinal nerve or ventral root

Myotome

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Although these motor nerve fibers may reach these muscles by way of various different peripheral nerves, nonetheless, they all arise from the

Anterior horn cells within a single spinal cord segment

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A lesion of one or more spinal nerves or ventral roots will result in motor symptoms (e.g. paresis, paralysis) in the muscles of the myotome corresponding to the injured

Spinal nerves or ventral roots

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Failure of pump mechanisms that pump water and waste products out of the nucleus pulposus and water and nutrients in can result in

Back pain

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May impinge on rootlets of multiple nerves below the level of the disk

Herniated nucleus pulposus

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Osteophytes from osteoarthritic zygapophyseal joint can encroach on intervertebral foramen and impinge on

Spinal nerves

61

What are other names for the following sensory symptoms?
1.) Tingling
2.) Reduced sensation
3.) Total numbness

1.) Paresthesia
2.) Hypesthesia
3.) Anesthesia

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