Session 8-Lumbar Spine Structure, Function And Common Disorders

Question 1

How many:

1) cervical
2) thoracic
3) lumbar
4) sacral
5) coccygeal vertebrae are there?

Answer 1

1) 7
2) 12
3) 5
4) 5
5) 4

Question 2

How many separable single vertebrae are there?

Answer 2

24

Question 3

Which are the most mobile areas of the spine?

Answer 3

Cervical

Lumbar

Question 4

Which area of the spine is relatively immobile and why is this?

Answer 4

Thoracic

Ribs attached limits movement

Question 5

Which two parts of the spine are fusions of vertebrae?

Answer 5

Sacrum

Coccyx

Question 6

What are the functions of the vertebral column?

Answer 6

• supports skull, pelvis, upper limbs and thoracic cage
• protection of spinal cord and cauda equina
• movement: highly flexible structure of bones, intervertebral discs and ligaments
• haemopoiesis: red marrow

Question 7

True or false: vertebral bodies decrease in size inferiorly

Answer 7

FALSE - increase in size as compression forces increase

Question 8

Why are the sacral vertebrae fused, widened and concave anteriorly?

Answer 8

To transmit weight of body through pelvis to legs

Question 9

Which movements does the lumbar spine allow?

Answer 9

Flexion and extension
Lateral flexion
Rotation

Question 10

What is the largest part of the vertebra?

Answer 10

Vertebral body

Question 11

What is the vertebral body made up of?

Answer 11

10% cortical bone

90% cancellous bone

Question 12

What are the advantages of having a higher proportion of cancellous bone in the vertebral body?

Answer 12

1) lighter

2) other functions ie haemopoiesis

Question 13

What are end plates?

Answer 13

Articular surfaces covered with hyaline cartilage on superior and inferior parts of vertebral column

Question 14

What connects transverse process to spinous process?

Answer 14

Lamina

Question 15

What connects transverse process to body?

Answer 15

Pedicle

Question 16

What is the lamina and pedicle called collectively?

Answer 16

Vertebral arch

Question 17

What emerges through intervertebral foramina?

Answer 17

Spinal nerves

Question 18

What is the articulation of superior and inferior articular processes called?

Answer 18

Facet joint (synovial)

Question 19

What does the interlocking design of facet joints prevent?

Answer 19

Anterior displacement of vertebrae

Question 20

What is the composition of intervertebral discs?

Answer 20

70% water
20% collagen
10% proteoglycans

Question 21

Why do we lose height with age?

Answer 21

Repair of proteoglycans is less with age so chains get shorter so less hydrophilic and lose water and discs lose height

Question 22

What is the role of proteoglycans in intervertebral discs?

Answer 22

Binds water (hydrophilic)

Question 23

What are the two regions of intervertebral discs?

Answer 23

Nucleus pulposus (central)
Annulus fibrosus (peripheral)

Question 24

What is annulus fibrosus made of?

Answer 24

Type I collagen

Question 25

What is the major role of annulus fibrosus?

Answer 25

Shock absorber

Question 26

True or false: intervertebral discs are avascular

Answer 26

TRUE

Question 27

What is the nucleus pulposus a remnant of?

Answer 27

Notochord

Question 28

What is nucleus pulposus made of?

Answer 28

Type II collagen

Question 29

When are intervertebral discs very strong?

Answer 29

Axial compression

Question 30

What do the ligaments of the vertebral column provide?

Answer 30

Stability

Question 31

What are the major ligaments of the vertebral column and which is stronger?

Answer 31

Anterior longitudinal and posterior longitudinal ligament Anterior is stronger

Question 32

What is the function of the anterior longitudinal ligament?

Answer 32

Prevents hyperextension

Question 33

What does the posterior longitudinal ligament prevent?

Answer 33

Hyperflexion

Question 34

What makes ligamentum flavum yellow?

Answer 34

Elastic fibres

Question 35

What is the role of ligamentum flavum?

Answer 35

Limits hyperflexion

Question 36

What do interspinous ligaments do?

Answer 36

Unite spinous processes

Question 37

Where are the supraspinous ligaments?

Answer 37

Tips of adjacent spinous processes

Question 38

Describe the curvatures of the vertebral column

Answer 38

``` Cervical - lordosis (curves backward) Thoracic - kyphosis (curves forward) Lumbar - lordosis Sacral - kyphosis Coccyx - kyphosis ```

Question 39

What is the primary curvature?

Answer 39

Curve we're born with-kyphosis

Question 40

What are the 'weak points' of the vertebral column?

Answer 40

Where the centre of gravity pass through the vertebral column (C1, C2, C7, T1, T12, L1, L5, S1)

Question 41

Where is there an exaggeration of lordosis during pregnancy?

Answer 41

Lumbar region

Question 42

What is mechanical back pain?

Answer 42

Pain when spine is loaded

Question 43

When is mechanical back pain: 1) worse 2) relieved?

Answer 43

1) exercise | 2) rest

Question 44

What are the predisposing factors of mechanical back pain?

Answer 44

Overweight Unhealthy lifestyle Deconditioned core muscles

Question 45

How does decreased disc height lead to pain?

Answer 45

Decreased height -> increased stress on facet joints -> osteoarthritis -> pain

Question 46

What are the four stages to disc herniation?

Answer 46

1) degeneration (ageing) 2) prolapse (protrusion of nucleus pulposus into spinal canal) 3) extrusion (nucleus pulposus breaks through annulus fibrosus) 4) sequestration (nucleus pulposus breaks through annulus fibrosus and separates from main body of disc in spinal canal)

Question 47

Where is the most common location of slipped discs?

Answer 47

L4/5 or L5/S1

Question 48

What is sciatica?

Answer 48

Compression of nerve roots which contribute to sciatic nerve

Question 49

Which nerve roots contribute towards sciatic nerve?

Answer 49

``` L4 L5 S1 S2 S3 ```

Question 50

What are the types of sciatica?

Answer 50

L4 sciatica - anterior thigh, anterior knee and medial shin L5 sciatica - lateral thigh, lateral calf and dorsum of foot S1 sciatica - posterior thigh, posterior calf, heel and sole of foot

Question 51

What is cauda equina syndrome?

Answer 51

Compression of cauda equina

Question 52

What are the symptoms of cauda equina syndrome?

Answer 52

Bilateral sciatica Perianal numbness Painless retention of urine Urinary/foecal incontinence

Question 53

What is lumbar canal stenosis?

Answer 53

Narrowing of spinal canal in elderly due to: - Disc bulge - Arthritis in synovial facet joints - Ligamentum flavum expands and restricts space for nerves

Question 54

What is claudication?

Answer 54

Pain in legs when walking

Question 55

What is spondylolisthesis?

Answer 55

Slip forwards of vertebra above on vertebra below

Question 56

What are the types of spondylolisthesis?

Answer 56

- dysplastic: abnormality in shape of facet joints - isthmic: defect in pars interarticularis - degenerative - iatrogenic - pathological (tumours)

Question 57

What does a patient with isthmic spondylolisthesis present with?

Answer 57

Back pain and L5 sciatica

Question 58

What does a patient with degenerative spondylolisthesis present with?

Answer 58

Claudication