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MSK > Lumbar spine > Flashcards

Lumbar spine Flashcards

1
Q

describe the vertebral coloumn

A

extends from the skull to the apex of the coccyx

madeup of 7cervical, 12 thoracic, 5 lumbar and 5 sacral and 4 coccygeal vertebrae

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2
Q

describe the curvature of the spine and its importance

A

the spine curves twice

the sacral and thoracic curvature is kyphosis (primary = developed from birth) they are concave anterioly

lumbar and cervical are secondary curvatures known as lordotic (lord with a big belly) , the cerival one occurs when you first look up as a baby, and the lumbar when you take your first step , they are concave posteriorly

they are imporatn for stability and maintainance of a balanced centre of gravity

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3
Q

describe the size and struture of the different vertebrae as you go down

A

at the top is cervical which is rounded

thoracic is tiranglular

lumbar which is kidney bean shaped and large to increase surface area since it undergoes more compressive weight and carries the weight of the body

sacral is fused

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4
Q

the processes of the vertebrae? and whats special about them

A

7

  • 2 superior articualr processes
  • 2 inferior articular processes
  • 2 transverse processes
  • 1 spinous process

all are lined with hyaline except spinous

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5
Q

draw a lumbar spine and describe it

A

image

4 articualr processes

a vertebrae foramen wc contains the conus medullaris, cauda equina and meninges

spinous process

the facet joints are at a 90 angle to axial plane and 45 to coronal

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6
Q

label this

what are the articular processes known as

how are vertebrae held to the vertebrae below it?

how much of the body’sweight is carried in an upright position by ‘x?

A

vertebrae end plaetes and they are covered in hyaline

intervertebral discs

1/3 by posterior elements (everything posterior to the vertebral body)

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7
Q

vertebral arch?

what is the function of the transvere and spinous process

A

protective tunnel in which the spinal cord runs

formed by 2 pedicles and 2 laminae (pedical connects to the transverse process and laminae joint to maek the spinous process)

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8
Q

what is the joint named when facets link?

what space do they create

A

zygapophyseal joint

vertebral notch - passageway for the spinal nerves from the spinal canal to the periphery

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9
Q

due to the arrangement of the zygapophyseal joint in the lumbar spine what movements are permitted

A

some lateral flexion and rotation but they are limited due to the orientation of these joints

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10
Q

describe the intervertebral disc

A

2 regions = the nucleus pulposus and annulus fibrosus

annulus fibrosus

  • made up of layrees of type 1 collagen on the outside going in concentric circles where each layer is a different direction to deal with tension for a wide range of directions and then the inner lamellae of the annulus fibrosus is fibrocartilaginous
  • its major function is shock absorbant
  • avascaular
  • stronger than the vertebral body and can resist axial (top to bottom) compression well = hence when alot of pressure is applied the vertebral body fractures and not the annulus fibrosus

nucleaus pulposus

  • remnant of the embryonic notochord
  • gelatinous and consists fo type 2 collagen
  • high oncotic pressure
  • gradually squeezes height through the day due to the mechanical pressure
  • it also decreases with age
    • in babies itsnt more centrally located but in adults its more posteriorly located
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11
Q

what angle is the intervertebral disc strong

A

axial pressure (top to bottom)n but not loaded tangenital angle (load at an angle)

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12
Q

name the ligaments of the vertbral body

A

posterior longitinal ligament

anterior longitindal ligament

interspinous ligament

intertransverse ligament

supraspinatous ligament

ligamentum flavum

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13
Q

what ligaments run along what and allow for what movement

A

PLL from C2 to sarcal canal = prevents hyperflexion

ALL stronger than PLL runs from anterior tubercule of atlas C1 to the sacrum and is united with ther periosteum of vertebrae body = prevets hypoerextension

interspinatous ligament = weak but highly developed in lumbar and resists hyperfelxion, icnreases the stability fot he vertebral body further, its lax in extension and taught in flexion

ligamentum flavum yellow beucase lots of elastin, stretched during flexion of spine

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14
Q

why do we see osteoarthiric changes of facet joints as we age

A

when young we transmit 80% of body weight vvia teh vertebral body and only 20% via the facet joints, but as we age the nucleolus pulposus dehydrates and decreases in size and so we transmit 65% of weight in our vertebral body and 35% trhoguh facet joints, thats alot more weight = more stress c those osteoarthitic changes

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15
Q

why do our secondary curvatures reutn back to their primary curvatures and what is this called?

A

senile kyphosis

as we age the nucleolus pulposus becomes dehydrates and becomes thinner and undergoes degeneration along side the intervertebral disc, this causes the discs to undergo degeneration causeing loss of height, and some patients even undergo osteoporotic vertebral compressionof the fractures, resulting in a wedge-shaped vertebrae

this disc atrophy with or without osteoporotic fractures mean that secondary curvatures start to disappear and continued primary curvature

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16
Q

label this spine

A
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17
Q

why are the curvatures of our spine balanced?

what are the weak points of the spine?

A

to prevent falling and aid walking

C1/C2 C7/T1 ,T12/L1 L5/S1

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18
Q

what scan do you use for:

  • normal bones
  • herniation
  • stenosis
  • fracture
  • inflammatory bone like infection
    • sites where primary tumours have metastatised to bone
A
  • x ray
  • MRI
  • MRI
  • x ray
  • isotope bone scan
  • isotope bone scan
19
Q

mechanical back pain

% sufferers?

A
  • very common 50% ofthe population have suffred with lumbar pain for at least 24hrs
  • 1/2 of those episodes last more than >4wks
    • 80% of population have lumbar pain lasting >24 hrs in their lifetime
20
Q

what is mechanical back pain and how does it present

A

pain when spine is loaded, that worses when exercising and is relieved with rest

  • intermittent and is triggered by innocuous acitivity
    • risk factors are obesity, incorrect manual handling technqiues, poor posture, sedentary lifestyle with deconiditoning of the paraspinal (core) muscles, poorly-designed seating
21
Q

degenerative changes of the verebrae coloumn

A
  • nucleolus pulposus dehydrates and decompresed and degenerates with age
  • annulus f. degenrates with age

this causes :

  1. decreases size of IV disc
  2. budlging of the disc
  3. alteration of the load stresses on the joints
  • osteophytes (bone spurs) can develop adjascent to the end plates of te discs known as syndesmophytes
  • increased stress on the facet joints causes osteoarthritic changes - this is paintful because facetjoints are innervated by menigeal branch of thespinal nerve so arthitis of these joints is perceived as painful
    • due to the osteoarthiris of the facet joints and the decrease in the height of the IV disc the intevertrbral foramen decreases in size and so you can compress the spinal nerve, this is percieved as radicular or nerve pain
22
Q

why is osteoarhitis of the zygapophyseal painful

A

because these facet joints are innervated byt the meningeal branch of the spinal nerve

23
Q

herniation of the IV aka x?

A

x = slipped disc

  • pain occurs due to the herinated disc material pressing on the spinal nerve
  • most common age group is 30-50 and 90% ofcases solved by 3 montns
  • 4 stages:
  1. disc degeneration: chemical changes int he disc so it decreases in size as it dehydrate
    1. prolapse : protrusion of the nucleolus pulposus occurs c slight impingement of the spinal canal but the annulus fibrosus contains the nucleolus pulposus within it
  2. extrusion: nucleolus pulposus breaks throught he annulus fibrosus but is still contained within the disc space
  3. sequestration: nucleolus pulposus separates from the main disc body and enters into the spinal cana
24
Q

most common locations for hernation and why?

most vulnerable nerve roots?

A

L4/L5 L5/S1 because of the mechanical loading at these joints

  • where they cross the IV disc = paracentrally
  • where they exit the spinal canal via the IV forament = far laterally
25
Q

whats the % of paracentral and lateral hernination of the intervertebral disc

in between L4/5 which prolapse is worse and why

when is paracental hernination worse

A

paracentral prolapse of dic = 96%

lateral is 2% directlly towrds the spinal cord

lateral prolapse because compressing the transversing root which is nerve L5 since the exiting root L4 emerges from the levelabove it

at the cauda equina because can compress several roots and cause cauda equina

26
Q

sciatica?

A

​radicular leg pain

  • ​pain caused by irritation or compresionof one or more of the neve roots that contribute to the sciatic nerve
  • the sciatic nerve = L4 L5 S1 S2 S3
  • causes are ; slipped disc, ostephytosis
  • pain is expereinced in the back,buttock and radiats to the dermatome supplied by the effected nerve root. follows a path from ‘ BACK TO THE DERMATOME’
27
Q

draw the dermatomes where that are affected by sciatica and the senstion loss area and mytome function loss

A

L4 scaitica = anterior thigh, anterior knee and medial leg / ankle dorsiflexion

L5 sciatic = lateral thigh, leg and dorsum of foot excludign the big toe /great toe extension

S1 sciatic : psoterior thigh, leg and heal and sole of foot / anke plantar-flexion

28
Q

cauda equina syndrome

A
  • can develop due to a paracentral slipped disc which compresses the lumbar and sacral erve roots within the spinal canal
  • 5% of cases due to a disc prolapse
  • common age 30-50
    • other causes are tumurs (primary or secondary) affecting the vertebral coloumn or meninges, spinal infection/abcess,spinal stenosis secondary to arthritis,vertebral fracture, spinal haemorrhage and late-stage ankylosing spondylitis
29
Q

whats ankylosing spondylitis

A

inflammation of the small bones of the vertebrae that causes the bones to fuse over time

30
Q

red flag signs of cauda equina

A
  • urinary / faecal incontinence
  • erectile dysfunction
  • painless retention of urine
  • perianal numbness (saddle anaesthesia)
  • bilateral sciatica
31
Q

how do you treat cauda equina

A

decompress the spine in 48 hours or else the patients has these symptoms for the rest of their life and would end up in a wheelchair

32
Q

spinal canal stenosis

A

abnormal narrowing of the spinal canal causing compression of the nerve roots

  • tends to occur in the elderly due to:
    • disc budlging
    • facet joint osteoarthiriis
    • ligamentum flavum hypertrophy
  • other causes :
    • compression fractures of the vertebrae bodies
    • spondylolistesis
      • trauma
33
Q

how do patients with spinal canal stenosis present and whats the prognosis

A
  • discomfort when stadning (95% of patients)
  • discomfort or pain in shoulder, arm or hand for cervival stenosis
  • discofort in lower limb in lumbar stenosis
  • bilateral symptoms
  • numbness at or below the level of stenosis
  • weakness at or below the level of stenosis
  • neurogenic claudication

prognosis:

  • 70%of patients symptoms stay unchanged
  • 15% get progressively worse
  • 15% improve with time
34
Q

neurogenic claudication or x?

A

neurogenic pseudoclaudication

this is a symptom, where patient reports pai or pins and needes in legs on prolonged standing orwalking, radiating in a sciatica distribution

it orgininates in the nerve and because the patient isin pain / discomfort they limp

its causes by compression of the spinal nerves that emerge from the lumbrosacral spinal cord causes venous enorgement (increased b flow to that area) during exerices, this reduced arterial inflow adn cause transietnt arterial ischaemia. this ischaemia affects the nerves and causes pain/paraesthia

can occur in one or both legs, relieved by rest or changing in spine position

35
Q

spondylolisthesis

A

anterior displacement of the vertebrae above relative vertebrae below it

caused by:

  • congential or dysplastic ; congenital instability fo the facet joints
  • isthmis ; defect in the pars interarticularis
  • degenerative: result in facet joint arthritis and joint remodelling (age >50)
  • traumatic; acute fracture in nerual arcg other than the pars articularis
  • pathological: infeciton or malignancy
  • latrogenic: cused by surgical intervention e.g too much lameica and facet joint excised dueing a laminectomy
36
Q

whats the pars interventricularis

A

part of vertebre between the superior and inferior articualr processes

37
Q

how do spondylolisthesis present

A

can be symptomatic, but most complain about discomfort randign from back piin to paraesthisea or neruogenic claudication

38
Q

spondylolitis vs spondylolisthesia and how to spot?

A

spondylolitis = fracture wuthout displacemnt

  • look for scottie dog outline, if the dog has a collar then its a fracture and is spondylolitis

spondylolisthesia = fracture with displacement anteriorly

  • looks like a step
39
Q

lumbar puncture what is it? how is it perfromed?

A

withdrawing fluid from the subarachnoid space of the lumbar cistern,

important in diagnosisnng CNS issues

  1. pateint laying on their side tuckign knees in
  2. skin covering lumbar anesthsiesd
  3. lumbar puncture needle between L4/L5 or L3/L4 , you can find this by following the iliac crest - supracristal plane- and this is at the level of L4 so go above or below it
  4. pass 4-6cm inyou hear a pop and this is going through the ligamentum flavum , just go alittle more and then there
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MSK (17 decks)

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