MSK Spine Flashcards Preview

Cuccurullo > MSK Spine > Flashcards

Flashcards in MSK Spine Deck (41):
1

Clinical course for neck/back pain
____ resolve by 1-2 weeks
____ resolve by 6-12 weeks

85% recur by:

50%
90%

1-2 years

2

____ constitutes the 2nd most common reason for primary care physician office visits

the 10% of patients with residual symptoms of neck/back pain

3

Red flags for back/neck pain:
Name the condition:

1. Gait ataxia/UMN changes
2. Bowel/bladder/sexual dysfunction
3. Night pain/weight loss
4. Fevers/Chills

1. Myelopathy
2. Cauda Equina syndrome
3. Tumor
4. Infection

4

In the work force, what are the top two reasons for absenteeism?

1. upper respiratory infections
2. low back pain

5

Regarding absenteeism and return-to-work expectations for low back pain

Time missed from work: (name RTW percentage)
1. ~6 months:
2. ~1 year:
3. ~ 2 years:

1. 50%
2. 25%
3. 0

6

Name the atypical C spine vertebrae
typical?

1. Atlas (C1) ring shaped with two lateral masses. No vertebral body or spinous process. Axis (C2) has odontoid process, bifid spinous process (like C2-6)
2. C3-7
Anterior region: cervical uncinate processes: raised margins along the lateral aspect of the superior surface of the cervical vertebral body.
Posterior region: pedicles, superior articular processes, inferior articular processes, laminae, TP, foramen transversarium, and SP

7

In cervical disc degenerative disease, the raised margins approximate with the body of the superior vertebra. The end result is the degenerative joint change called _____.

joint of luschka (unconvertebral joint)

the joints of luschka function to limit lateral translation.

8

Name the unique characteristics of thoracic vertebrae:
1. Anterior region
2. Posterior region

1. VB with articulations for ribs
2. Pedicles, SAP, IAP, laminae, transverse processes with articulations for rib tubercles and spinous processes.

9

____ is an anomalous fusion of the 5th lumbar vertebrae with the sacrum
Incidence: ____ complete, ____ incomplete

sacralization
1% complete
6% complete

10

a 3-joint complex is formed between 2 lumbar vertebrae:

1.
2.
3.

1. vertebral body endplate-disc-endlplate joint
2. zygapophyseal joint
3 zygapophyseal joint

11

____ is an anomalous partial or complete nonunion of the first and second segment of the sacrum. This forms an additional lumbar segment (L6) and leaves 4 remaining fused sacral segments.

Incidence:

Lumbarization

4%

12

Name the components of the zygapophyseal joint: 5

AKA: ZP-joint, apophyseal joint, facet joint

1. Superior articular process (SAP)
2. Inferior articular process (IAP)
3. Joint capsule
4 Articular cartilage
5. Meniscus

13

Name the sacral ligaments:

1. Superior iliolumbar
2. Anterior iliolumbar
3. Inferior Iliolumbar
4. Posterior sacroiliac ligament
5. Sacrospinous ligament
6. Sacrotuberous ligament
7. Anterior sacroiliac ligament.
8. Interosseous ligaments (at SI joint)

14

AA and OA joints have no true ___ joints due to their atypical anatomy.

ZP joints

15

Facet joints are positioned in a ___ plane in C3-7.
In a thoracic plane?
Lumbar?

Frontal (coronal)
Frontal (coronal)
Lumbar begins in sagittal plane, progresses to frontal plane at L5/S1.

16

Each ZP joint has ___ innervation.
Name them

dual - from medial branches of the dorsal primary ramus off that spinal nerve.

17

1 ZP joints in the cervical spine contain innervations from what level?

2. ZP joints in the thoracic and lumbar spine contain innervations from what levels?

1 same level and one level below
Example:
C5-6 ZP joint is supplied by C5 and C6 medial branches

2. Same level and one level below.
Example:
L4/5 ZP joint is supplied by medial branch of L4 and L3.

18

Name the three primary functions of ZP joints

1. Direct vertebral motion
2. Resist shearing and rotational forces
3. Weight bearing: increased with extension

19

Intervertebral discs are comprised of what three things?

1. Nucleus pulposus: A viscous muco-protein gel mixture of water and proteoglycans in a network of Type II collagen that braces the annulus to prevent buckling.

2. Annulus fibrosus: Type I collagen fibers arranged in obliquely running lamellae that encase the nucleus pulposus and are attached to the vertebral endplate plates. This orientation withstands distraction and bending but is relatively weaker for torsional stresses

3. Vertebral endplate - cartilaginous covering of the VB apophysis, forming the top and bottom of the disc.

20

what is the vascular supply of the intervertebral disc?

avascular by adulthood

21

Innervation of intervertebral disc
1. Outer 1/3 of disc
2. Nucleus pulposus
3. Anterolateral annulus fibrosis
4. Posterior part

1. outer 1/3 of the disc containing the annulus fibrosis: dual innervation from ventral rami
2. Nucleus pulposus lacks innervation
3. Anterolateral part of the annulus fibrosis: ventral rami and grey rami communicans
4. Posterior part of the annulus fibrosis: sinuvertebral nerves (recurrent branches off of the ventral rami)

22

name the two functions of the intervertebral disc:

1. allows for VB motion
2. Weight bearing

23

In relation to 100% at erect posture, what is the least amount of pressure (position) and the most pressure:

least: lying supine (25%)
Most: sitting slumped over in a chair 275%; next is bending over with a straightback and legs. 220%

24

Which positions apply the most pressure to the low back?

Lying supine with legs elevated (35%)
Doing a sit up 210%

if 100% is standing erect.

25

Aging effects of intervertebral discs
3 things decrease
3 things increase

decreases:
- nuclear water content
- ratio of chondroitin:keratin
- proteoglycan molecular weight

Increases
- Fibrous tissue
- cartilage cells
- amorphous tissue

26

The following nerves supply:
1. Ventral primary rami: (2)
2. Dorsal primary rami: (three branches)
3. Sinuvertebral nerve (4)

1. trunk musculature, plexus contributions

2. Lateral: iliocostalis, skin
- Intermedius: Longissimus
- Medial: multifidi, rotators, interspinalis, intertransversarii, posterior spinal ligaments, zygapophyseal joints

3. Posterior longitudinal ligament, posterior disc, anterior dura, vertebral body

27

____ runs the entire length of the spine, covering the anterior aspect of each vertebral body and disc.
Function: limits hyperextension and forward movement

Anterior longitudinal ligament

28

Posterior longitudinal ligament attaches to the posterior rim of the vertebral bodies and disc from ____ to ____. It continues superiorly with _____>

C2-sacrum
superiorly: tectorial membrane to occiput.

29

Function of Posterior longitudinal ligament:

prevents hyperflexion of the vertebral column.

30

____ is the superior continuation of the supraspinous ligament extending from the occipital protuberance to C7.
Function:

Ligamentum flavum

boundary of the deep muscle in the cervical region

31

____ connects adjacent vertebral arches longitudinally, attaching laminae to laminae

Function:

Ligamentum flavum

maintains constant disc tension and assists in straightening the column after flexion.

32

Supraspinous ligament runs from ___ to ___.

function:

runs spinous process to spinous process (so does interspinous ligament)

weakly resist both spinal separation and flexion

33

Intertransverse ligament runs:
Function:

runs transverse process to transverse process

resists lateral bending of the trunk.

34

Cervical region landmarks

Anterior
C2
C3
C4, C5
C6

Posterior
C2
C7
articular pillars

Anterior
C2 - TP palpated at the angle of the mandible
C3 hyoid bone
C4/5 thyroid cartilage
C6 first cricoid ring, carotid tubercle

posterior
C2 - first palpable midline spinous process (2 finger-breadths below the occiput)
C7 - Vertebral prominens (largest spinous process; nonbifid)
Articular pillars: lateral off the spinous process bilaterally

35

Thoracic region landmarks
T3
T8
T12

T3 spine of scap
T8 inferior angle of the scap
T12 lowest rib

36

Lumbar region
L4
S2

L4 iliac crests
S2 PSIS

37

Name the extrinsic back muscles:
Superficial layer
Intermediate layer:

Superficial layer
- trapezius
- lats

Intermediate
- serratus posterior superior and inferior

38

Name the intrinsic muscles of the back
1. Superficial layer
2. Intermediate layer (special group)
3. Deep layer

1. Superficial layer
- splenius capitis
- splenius cervices

2. Intermediate layer (erector spinae)
- Iliocostalis: lumborum, thoracis, cervices
- Longissimus: thoracis, cervicis, capitis
- Spinalis: thoracis, cervicis, capitis

3. Deep layer
- Transversospinal muscles (semispinalis: thoracis, cervicis, capitis). multifidus, rotators
- Interspinalis, intertransversarii muscles

39

The occipitoatlantal joint has ____ of flexion/extension of the entire cervical spine

50%

40

The atlantoaxial joint has ____ of rotation of the entire cervical spine

50%

41

What are the 3 phases of kirkaldy-willis: the degenerative cascade of spondylosis

1. dysfunction
2. instability
3. stabilization.
it is initiated by a rotational strain or compressive force to the spine during lumbar flexion.

Pathology of 1 component (disc or Z-joint) influences deterioration of the other components and adjacent vertebrae.