Flashcards in Module 4: The Back Deck (93):
What is the pathology of referred back pain?
The pathology of the viscera may refer pain to back
What are some examples (2) of referred back pain?
AAA - abdominal aortic aneurysm
Renal calculi (Kidney Stones)
3 locations of kidney stones
1. Calyceal stone
2. Renal Pelvic stone
3. Upper ureteral stone
Name some examples of intrinsic back pain
1. Compression fracture
2. Spinal stenoisis
3. Ankylosing spondylitis
Name some factors that contribute to postural/structural imbalances:
1. Overuse, misuse
3. Recreational habits
In total how many vertebrae are there?
How many cervical, thoracic, lumbar, sacral, and coccyx bones?
5 (fused) sacral
4 (fused) coccyx
What is the average length of the vertebral column and is that length solely due to the vertebral bodies?
Ave length: 72-75 inches
1/4 of the length is due to the fibrocartilagenous discs (IVD)
What are the 4 functions of the vertebral column?
1. Protect spinal column
2. Support the weight of head/neck
3. Allow movement of rib cage - costovertebral joints
4. Critical role in posture/locomotion
Name the primary curves in the vertebral column
Thoracic and Sacral
Name the secondary curves in the vertebral column
Lumbar and Cervical
What is the function of the spinal curves specifically?
To absorb shock
* Curves can absorb 10x more than a straight spine
Describe the curvature of the spine in infants
Primary curve only
--> When infants can hold head up/sit upright this means they are beginning to develop secondary curve in cervical
--> when start to stand/walk, their secondary curve in lumbar is beginning to form
Name four curves of scoliosis
4. Double Major
What are the treatments of scoliosis?
If 0-20 degrees: watch it
When it gets to 40-45 degrees: consider surgery
In what plane is scoliosis difficult to see?
A typical vertebrae =
body + arch + 7 processes
What is the epiphyseal ring?
Smooth region of vertebrae along the periphery of the body formed from annular epiphysis (2ndary ossification center during growth)
Vertebral (neural) arch =
pedicles + lamina
When lamina fail to fuse resulting in a defect in the arch this is called....
3 types of Spina Bifida:
1. Spina Bifida occulta
Spina bifida occulta
failure of vertebral arch to fuse, bony defect
meninges protrude through bony defect of vertebral arch
Spinal cord + meninges protrude defect of vertebral arch
What do articular processes form?
Facet (zygapophyseal) joint
What are the distinguishing regional characteristics of the different vertebrae?
i.e: how can you distinguish the different vertebrae?
Transverse, articular, and spinous process
Which vertebrae has the smallest vertebral foramen?
What are the body shapes of the thoracic and lumbar vertebrae?
Thoracic: heart shaped
Lumbar: kidney shaped
What are the accessory and mamillary processes located and what vertebrae are they specific too?
Both specific to lumbar vertebrae!
Accessory: tubercles located at the base of transverse process
Mamillary: tubercles located on superior articular pillar of articular process
What is the shape of the SP on lumbar vertebrae?
What is the function of the sacrum?
Provide stability to pelvis
C1 is also known as:
C2 is also known as:
Where does the superior portion of the lateral mass articulate with?
What is it's function?
Functions to flex and extend head
Where does the inferior portion of the lateral mass articulate?
What is it's function?
Which area of the atlas articulates w/ the dens of the axis?
Anterior arch facets
Describe the transverse processes of C1
They are wide and can be palpated inferior to mastoid process
A disc =
annulus fibrosus + nucleus pulposus
What is the function of a disc?
Acts as a shock absorber
Composition of a disc:
- Collagen fibers
Places where there are no discs:
Between occiput and C1
Between C1 and C2
What is the annulus fibrosis layer composed of?
concentric layers of collagen fibers
What is the orientation of annulus fibrosis layer and why is this orientation important?
Oblique orientation to provide tensile strength
Describe the direction of fibers in annulus fibrosis layer of vertebral disc
Directions alternate creating a "crosswoven effect"
What is important to note about the outside layer of fibers in the annulus fibrosis layer of vertebral disc?
Outside layer will blend with ALL and PLL
Outside layers has innervation thus a potential source for pain
The nucleus pulposus layer of vertebral disc is composed of:
proteoglycans and water
DOES contain fine collagen fibers (loose and random)
What occurs to the nucleus pulposus when people age?
Decrease of proteoglycan content -- thus less water attraction - thus decrease disc height
Spinal degeneration vs. Herniation
Osteoarthritis is an example of spinal degeneration:
--> bone and cartilage are damaged, which compress spinal nerve (pinched nerve)
Herniation is a protrusion of the disc and the hernia is compressing the nerve. No damage to bone or cartilage
What are the Joints of Luschka (uncovertebral) unique too?
What joint is the joints of Luschka similiar too?
Synovial joint (cartilage and capsule) but debatable
What is the function of the facet joints?
Permit gliding movement between the vertebrae
Some weight baring function in Cervical and Lumbar sections
What is the innervation of facet joints?
Dorsal primary rami
Where does the ALL run? (start to finish)
Occiput to sacrum along anterior portion of vertebral column
Does the width of the ALL decrease, increase, or stay the same as it travels down the vertebral column?
Function of the ALL?
Support anterior annulus fibrosis of disc
Where does the PLL run? (start to finish)
C2 to Sacrum
Posterior vertebral column WITHIN VERTEBRAL CANAL (thus anterior to spinal cord)
Does the width of the PLL decrease, increase, or stay the same as it travels down the vertebral column?
Function of PLL?
Supports posterior annulus fibrosis of disc
The Ligamentum flavum connects ______ of each vertebrae
Does ligamentum flavum thicken or thin as it descends from cervical to lumbar regions?
Functions (2) of the ligamentum flavum:
1. Allows "smooth" flexion of vertebrae --> thus decreases potential for IVD injury
2. Elastically assist w/ restoring neutral position after flexion of spine
Interspinour ligaments connect adjacent ______ _______.
Supraspinous runs from ____ to _____.
C7 to Sacrum
Describe the differences is texture of interspinous and supraspnous ligaments
Interspinous = thin membranous ligament
Supraspinous = cord like ligament
Nucal ligament runs from ____ to ______.
EOP to C7
Nucal ligament connects:
Posterior tubercle of C1
Spinous processes of C2-7
Intertransverse ligament connects _____ between adjacent vertebrae.
What is the function of the atlanto-occiptial joint as a whole?
Flexion and extension movement of head and neck
What is the function of the anterior and posterior atlanto-occipital membranes?
Help prevent excessive movement at atlanto-occipital joint (stability)
Where does the tectorial membrane run?
C2 to foramen magnum
Tectorial membrane runs _____ to the cruciate ligament.
Cruciate ligament =
transverse ligament + superior and inferior longitudinal bands
Function of the cruciate ligament:
- stabilize dens against anterior arch of C1
- acts as posterior wall and forms "socket" for dens
The alar ligament extends from _____ to _____.
Sides of dens to lateral margin of foramen magnum
The thoracolumbar fascia of the trunk does what 3 things?
1. Invests the deep muscles of the back
2. Attaches to the SP's and TP's of T/L regions
3. Provides origin for latissimus dorsi, transverse abdominal, and internal oblique mm.
What does the superficial layer of the muscles of the back control?
Control of upper limb
What does the intermediate layer of muscles of the back control?
Assist in control of respiration
What does the deep layer of muscles of the back control?
Control vertebral column
Superficial layer of back muscles contain:
Intermediate layer of back muscles contain:
Serratus posterior superior
Serratus posterior inferior
Deep layer of the back has 3 subgroups:
Superior layer of the deep back muscles contain:
Intermediate layer of the deep back muscles contain:
Erector spinae muscles
Deep layer of the deep back muscles contain:
The spinal cord is a continuation of ______.
Spinal cord extends from ____ to _____.
Foramen magnum to T/L junction (varies from person to person)
What are the two enlargements of the spinal cord?
termination of the spinal cord
"horse's tail" - formed by spinal nerve roots of lumbar and sacral plexus
Where is the cauda equina located?
How many pairs of spinal nerves are there?
What nerve roots make up the spinal cord