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CABS > Lower Back > Flashcards

Lower Back Flashcards

1
Q

What are the primary curvatures of the spine?

A

Anterior concavities of thoracic and sacral regions (present since fetal stage)

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2
Q

What are the secondary curvatures of the spine?

A

Posterior concavities of cervical and lumbar regions (develop during infancy as child first raises head and walks)

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3
Q

What is scoliosis?

A

Abnormal lateral curvature of the spine with rotation of the vertebrae

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4
Q

Spinous processes rotate ____ the concavity of curvature

A

toward

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5
Q

Ribs rotate ____ thus protruding on side of increased ____

A

posteriorly, convexity

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6
Q

Scoliosis is most common in

A

adolescent girls

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7
Q

What is the function of the sacrum?

A

Transmits weight of body from lumbar vertebrae to pelvic girdle

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8
Q

A continuation of the vertebral canal and contains cauda equina

A

Sacral canal

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9
Q

What is within the cauda equine?

A

nerve roots of all spinal nerves inferior to L1 vertebrae

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10
Q

This serves as an important reference point in obstetrical pelvic measurement

A

Sacral promontory (anterior surface)

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11
Q

This is created by absence of lamina and spinal process of S5 vertebrae and serves as entryway to sacral portion of spinal cord

A

Sacral hiatus

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12
Q

This serves as a guide to sacral hiatus

A

Sacral cornua (inferior articular processes of S5)

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13
Q

Where and what is anesthetized in a caudal epidural anesthesia (block)?

A

Administered via the sacral hiatus and anesthetized S2-S4 nerve roots

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14
Q

Sacralization of L5 vertebrae refers to

A

fusion of L5 to sacrum

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15
Q

Lumbarization of S1 refers to

A

fusion of S1 to L5

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16
Q

What is the most common type of back pain?

A

Mechanical back pain due to anatomic or functional abnormality

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17
Q

What is the most common cause of back pain?

A

Lumbar sprain or strain

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18
Q

What are other causes of mechanical back pain?

A

Herniated disc, degenerative disc or facet, spinal stenosis, and spondylolisthesis

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19
Q

Non-mechanical causes of low back pain are noted by their______

A

red flag symptoms or history (fever, pain at night or while lying down, unexplained weight loss, age > 50, etc.)

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20
Q

What are non-mechanical causes of low back pain?

A

Cancer, infection, fracture, abdominal aortic aneurysm

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21
Q

What would indicate further imaging studies of back pain?

A

Motor or sensory deficits becoming worse or failure to improve after 4-6 weeks of conservative tx (NSAIDs, exercise)

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22
Q

Chronic back pain is defined as?

A

Pain lasting longer than 12 weeks

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23
Q

What is spinal stenosis?

A

Lumbar region, vertebral canal, or intervertebral foramen becomes narrowed due to hypertrophy of facet joints or ligamentum flavum

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24
Q

What can be compressed in spinal stenosis?

A

The spinal nerve roots of cauda equina resulting in bilateral leg pain or paresthesia relieved by sitting or lying

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25
Q

Where does a patient with spinal stenosis typically feel pain, parasthesias and numbness?

A

In the lower extremity

26
Q

What is spondylolysis?

A

Fracture of pars interarticularis of vertebral lamina

27
Q

What is spondylolisthesis?

A

Anterior displacement (slipping) of L4 on L5 or L5 on S1

28
Q

What is the MOA of spondylolisthesis?

A

Hyperextension and axial loading of lumbar spine

29
Q

What is the classic radiologic finding on oblique view of lumbar spine in spondylolisthesis?

A

Scotty dog with collar
Neck of dog = pars interarticularis
Collar = fracture

30
Q

What is the common site for a lumbar puncture (spinal tap)?

A

Lumbar spine inferior to L3 vertebrae

31
Q

The spinal cord terminates at the _______ which is usually located at _____ in adults.

A

conus medullaris, L2

32
Q

This serves as a guide to L4-L5 intervertebral disc or L4 vertebral spinous process for insertion of needle in lumbar puncture

A

Line joining iliac crests (supracristal plane)

33
Q

Where must the needle in a spinal tap be inserted to avoid hitting the spinal cord of spinal nerve roots of cauda equina

A

In midline of L3-L4 or L4-L5 interspace

34
Q

In the embryonic period what is the relationship of the spinal cord and vertebral level?

A

Spinal cord occupies entire length of vertebral column so spinal level matches vertebral level

35
Q

In the fetal period what is the relationship of the spinal cord and vertebral level?

A

Coccygeal vertebrae decreases from 6 to 4, spinal cord atrophies, and vertebral comumn grows faster than spinal cord which means spinal cord becomes shorter than vertebral column and spinal levels do not match vertebral levels

36
Q

This runs on the anterior surface of the vertebral bodies from the sacrum to the occipital bone and prevents hyperextension

A

Anterior longitudinal ligament

37
Q

This is a narrower and weaker ligament and runs along the posterior surface of the vertebral bodies from the sacrum to C2 and prevents hyper flexion and disk herniation

A

Posterior longitudinal ligament

38
Q

Where are the most common sites for lumbar disc protrusions?

A

L4-L5 or L5-S1 discs

39
Q

What direction do most discs protrude?

A

Posterolateral direction

40
Q

Why do most discs protrude in the posterolateral direction?

A

Posterior longitudinal ligament does not cover that area
Annulus fibrosis is narrow in posterior segment
Nucleus pulposus is placed more posteriorly

41
Q

Lumbar spinal nerve roots more susceptible to compression because?

A

They are thicker
Lumbar intervertebral foramina are more narrow
Roots become thicker from L1 to L5 and foramina become narrower from L1 to S1

42
Q

What is the rule of thumb in disc protrusion compression?

A

Disc protrusion compresses the nerve root corresponding to the vertebrae # inferior to the disc

43
Q

Why does a disc protrusion compress the nerve root corresponding to the vertebrae # inferior to the disc?

A

Because the superior 1/2 of the intervertebral foramen is lined by bone and inferior 1/2 of intervertebral foramen is lined by disc which can protrude and impinge nerve corresponding to inferior vertebrae

44
Q

What are the s/sx of L4/L5 herniation?

A

weakened ankle dorsiflexion and extension of great toe
decrease sensation in webspace b/w great and 2nd toes
difficulty walking on their heels

45
Q

What are the s/sx of L5/S1 herniation?

A

weakened foot eversion and ankle plantar flexion
decreased Achilles reflex
decreased sensation along lateral foot and little toe
difficulty walking on toes

46
Q

What nerve roots are part of the sciatic nerve?

A

L4-S3 nerve roots

47
Q

What is the definition of sciatica?

A

Paresthesias (shooting pain) experienced in buttocks radiating down posterior thigh and leg and foot

48
Q

What is the key distinction between sciatica due to herniated disc and true sciatica?

A

True sciatica pain radiates below the knee

49
Q

What tests are done for possible disc herniation of L3/L4?

A

Patellar reflex and strength of leg extension

50
Q

The sciatic nerve is comprised of what 2 nerves?

A

tibial and common fibular

51
Q

Where does the tibial nerve innervate?

A

flexor muscles located in posterior thigh and leg, and plantar region of foot

52
Q

Where does the common fibular nerve innervate?

A

extensor and abductor muscles located in leg

53
Q

Injury to cauda equina or conus medularis can cause

A

Saddle anesthesia because of sensory loss in dermatomes S3-S5

54
Q

S2, 3, and 4 nerve roots form the ____ nerve that innervates ____

A

pudendal, external anal and urethral sphincters

55
Q

How is cauda equina syndrome characterized?

A

Bladder dysfunction which is usually urinary retention with an overflow incontinence. May also be bowel incontinence with decreased external anal sphincter tone, saddle anesthesia, and bilateral neurologic deficits and/or pain

56
Q

These are synovial joints between superior and inferior articular processes. OA may affect them resulting in spinal nerve root compression and dermatomal pain patterns

A

Zygapophyseal (facet) joints

57
Q

Osteoarthritis can affect spine by degenerative disc disease which can cause

A

Annulus fibrosis to bulge promoting a bone spur (osteophyte) which can compress spinal nerve roots. Can resemble a herniated disc

58
Q

What are the superficial muscles of the back and what do they control?

A

Trapezius, lats, rhomboid major and minor, levator scapulae, and serratus posterior and inferior. Controls arm movement and aids in respiration

59
Q

What are the deep or true back muscles and what are their actions?

A

Erector spinae (sacrospinalis group) consisting of spinalis, iliocostalis, and longisimus (SILo). Chief extensors of spinal column and have common origin on iliac crest, and lumbar and sacral spinal processes

60
Q

What are the deeper set of back muscles and what are their actions?

A

Transversospinalis group including (superficial to deep): semispinalis, multifidus, and rotators. They occupy gutter between spinous and transverse processes and interconnect these 2 processes.

CABS (3 decks)

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