MSK 7.2 Injuries to Vertebral Column Flashcards
(17 cards)
Two types of Exaggerated Curvatures
- Lordosis
- exaggerated lumbar curvature
- preganncy, large central body mass - Senile kyphosis
exaggerated forwrd cuvrature, upper spine
Increasing age, secondary curvatures start to disappear
Pathological Curvatures
- Scoliosis
- Abnormal laterl curvature of spine
- Primary, congenital
- Idiopathic, ange age,unkown cause
- Secondary: neuromsucalr condition
- Cosmetic
- Severe cases, decreased lung capacity - Kyhphoscoliosis
- Kyphosis + scoliosis combined
= Caused by assymetric weakening of para-spinal muscles (spunal muscular dystrophy)
- Leads to: Reduced lung capacity, pulmonary hyperenstion, spinal cord compression
Bent spine → deformed chest → poor breathing → low oxygen → lung blood vessels stressed → high pressure → possible nerve damage.
Normal MRI Spine
Where does the spinal cord end?
Why is lumbar puncture done at L3-L4?
Prolpase dic (herniated disc)
1) What are the 4 types of disc pathology?
- Disc degeneration: normal aging, loss of water content, disc weakens but stays in tact
- Proplapse: Nucleus pulposus bulges out but is still contained withi annulus fibrosis
- Extrusion: Nucleus pulposus breaks through annulus fibrosis, but remains connected to disc.
Sequestration: Free fragment of disc material escapes into spinal canal.
Pathophysiology of slipped disc
Pressure on:
1. Lower motor neurones, leads to weakness
2. Dorsal sensory roots, leads to numbness
3. Myotomal motor weakness (muscle weakness following specific nerve root supply)
The degree of symptoms depends on:
Level of compression
Side of compression (left/right)
Speed of compression onset
🟢 Common Site of Prolapsed Disc:
Q: Why do most lumbar disc herniations occur posterolaterally?
Most common at L4/5 or L5/S1 (lumbar region).
Cervical region also possible.
A) Posterior longitduinal ligament is strong centrallu.
However, it does not fully cover posterolateral part of disc
So, most disc herniations occur posteriolaterally
Because this area is less supported by the PLL
What is a radiculopathy?
How does cauda equina syndrome occur?
Compression of spinal nerve roots → radiculopathy.
Herniation (posteriorly) may compress spinal cord → can cause cauda equina syndrome (neurological emergency).
(if the disc herniates directly posteriorly, not jusy posterolaterally, it pushes into the central spinal canal. At L2, spinal cord has already ended, what is left is the cauda equina, horse’s tail, nerve roots)
What are the two types of nerve roots?
Exiting nerve root:
Traversing nerve root:
Sciatic stretch test
Cauda Equina Syndome
🔎 Cauda Equina Syndrome (CES) — Exam Notes
✅ Cause:
Massive posterior disc herniation. Usually at L4/5 or L5/S1. Compresses the sacral nerve roots (cauda equina).
✅ Clinical importance:
Neurosurgical emergency — urgent MRI & surgery needed. Often bilateral (both sides affected).
✅ What structures get affected?
Sacral nerve roots → control:
Bladder
Bowel
Perineum (S2–S4)
Sexual function
Leg motor/sensory function
Disc degeneration + marginal osteophytosis
✅ 1️⃣ Disc Degeneration Process
With age:
Nucleus pulposus dehydrates → loses water content.
Height of intervertebral (IV) disc decreases.
✅ 2️⃣ Effect of altered disc load
When disc height reduces → abnormal load on vertebral bodies.
Body reacts by forming marginal osteophytes (bony outgrowths at edge of joint).
Called marginal osteophytosis.
✅ 3️⃣ Secondary Facet Joint Stress
Loss of disc height → more stress on facet joints (posterior joints between vertebrae).
Leads to:
Facet joint osteoarthritis.
This joint is innervated by meningeal branch of spinal nerve → causes back pain.
🔑 Key Exam Pearls:
Osteophytes = bony growths at joint margins. Disc degeneration + facet joint osteoarthritis = common causes of chronic back pain in elderly. Osteoarthritis here can compress nerve roots → radiculopathy.
Cauda Equina Syndome Red Flags
✅ 🔑 SUPER EXAM PEARL:
If you see these red flags, think cauda equina → urgent MRI → neurosurgery.
🔎 Cervical Spondylosis
Cervical Spondylosis
✅ What is it?
Degenerative osteoarthritis of the intervertebral joints in the cervical spine (neck).
Basically: age-related wear-and-tear of:
Intervertebral discs
Facet joints
Vertebral bodies
🔎 Wedge Compression Fracture of Spine
CAUSE
FEATURES
✅ Cause:
Caused by vertical compression + flexion (bending forward force). Vertebral body gets crushed at the front → becomes wedge-shaped. -osteoperosis - trauma spunal metastases
FEATURES:
- Most are stable
- Can make spin curve abnormally, kyphosis
- Lose overall heivht
✅ One-line summary for you:
Wedge compression fracture = front of the vertebra squashed down → makes the spine curve forward.
Name 3 cancers that merasrasuse to bone
Red Flags for Cauda Equina Syndrome:
Red Flags for Cancer or Infection:
TUNAFISH Mnemonic (exam aid for cancer/infection red flags):
Red flags always require urgent imaging (usually MRI) to rule out serious spinal pathology.
✅ Red Flags for Cauda Equina Syndrome:
Bilateral sciatica Severe/progressive bilateral motor or sensory leg weakness Incontinence / retention of urine or faeces Saddle anaesthesia (S2–S4 dermatomes) Erectile dysfunction Reduced anal tone 🔑 ➔ Neurosurgical emergency → urgent MRI
✅ Red Flags for Cancer or Infection:
Gradual onset of symptoms Severe constant pain even at rest or lying down (supine) Night pain disturbing sleep Pain worse with straining Thoracic spine pain Local spinal tenderness No improvement after 4–6 weeks of conservative treatment Unexplained weight loss
1) What is lumbar puncture?
2) Why is it done in lumbar spine?
1) Put needle in lower back to get CSF for testing (meningitis, MS, subarachnoid haemorrhage)
2) Spinal cord ends at L1/L2. Below that is only the cauda equina (loose nevre roots floating in CS). If you put the needle in at L3LL4, OR L4/L5, you will not hit spinal cord, it is safe
✅ 🔑 Exam phrase to memorise:
"Lumbar puncture is performed below L2 to avoid spinal cord injury, entering subarachnoid space to collect CSF.
DIAGRAM ON LECTURE SLIDE.
