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Spinal Anatomy & Pathology Flashcards

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1
Q

What are the 4 levels of the spine?

A

Cervical, thoracic, lumbar and sacral

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2
Q

How many vertebrae are in each spinal region?

A

Cervical: 7
Thoracic: 12
Lumbar: 5
Sacral: 5
Coccyx: 4

33 total

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3
Q

Two adjacent vertebrae and an intervertebral disc is called:

A

Functional spinal unit

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4
Q

Which spinal region allows the greatest range of motion?

A

Cervical

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5
Q

Which vertebrae are limited in rotation due to rib attachments?

A

Thoracic

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6
Q

Which vertebrae are designed to bear more weight than other regions of the spine?

A

Lumbar

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7
Q

Lateral flexion & Rotation of the cervical spine musculature is known as:

A

Torticolis

Unilateral contracture of the SCM; bilateral contraction of SCM is neck flexion.

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8
Q

Degeneration of the vertebrae at the weakest point; pars interarticularis.

A

Spondylolysis;

Lumbar: L4-L5, L5-S1 (also thoracic)

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9
Q

Stress fracture, which results in “Scotty dog w/decapitation”:

A

Spondylolysis

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10
Q

Autoimmune disorder w/progressive bone fusion:

Marie-Strumpell/Bekhterev’s Disease

A

Ankylosing Spondylitis (AS)

Onset: 22-40yrs

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11
Q

Spondyloarthropathy OR Spondyloarthritis

A

Spondylitis, inflammation of 1+ vertebra; non-degenerative

Onset: 15-45yrs

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12
Q

Anterior slippage of a vertebra on the one below:

A

Spondylolithesis

MC: L4-L5, L5-S1

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13
Q

What are the subtypes of Spondylolisthesis?

A

Type I: Spondylolytic (Isthmic)
Type II: Degenerative
Type III: Congenital
Type IV: Traumatic
Type V: Pathological

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14
Q

Grading of Spondylolisthesis

A

Grade 1: 0 - 25%
Grade 2: 25 - 49%
Grade 3: 50 - 74%
Grade 4: 75 - 99%
Grade 5: 100%, complete slippage: spondyloptosis

Orthoses indicated for 1 & 2

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15
Q

Spinal osteoarthritis; mechanical, degenerative arthritis of the spine:

A

Spondylosis

formation of osteophytes

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16
Q

Pathological Fractures

What is the precursor to osteoporosis?

A

Osteopenia

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17
Q

What conditions result in pathological fractures?

A
  1. Osteopenia
  2. Osteoporosis
  3. Osteogenesis Imperfecta
  4. Osteosarcoma
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18
Q

MOI: Axial load at the top of the head.

A

Jefferson Fracture

Unstable; C1 (atlas) split in multiple fragments.

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19
Q

What orthotic device is used to treat a Jefferson fracture?

A

Halo

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20
Q

MOI: Hyperextension followed by distraction

A

Hangman Fracture
Fracture through pedicles of C2 that separates posterior neural arch from the vertebral body.

Unstable in 3 planes; traumatic spondylolisthesis

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21
Q

MOI: Hyperextension or hyperflexion

A

Fracture of Odontoid

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22
Q

Fracture through the base of odontoid; unstable

A

Type II

Tx: Halo

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23
Q

Fracture into the body of vertebra; unstable

A

Type III

Better prognosis compared to Type II because of increased surface contact and blood supply to promote healing. Tx: Halo

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24
Q

Rare fracture through the tip of odontoid; stable

Study These Flashcards
A

Type I

No halo required; tx with Philadelphia collar

25
# Compression fracture MOI: **Flexion** followed by **compression** ## Footnote Stable
Denis Type I ## Footnote Anterior column; **CASH, Jewett** Knight-Taylor (in hyperextension)
26
Why is Denis Type I a stable fracture?
Anterior & posterior longitudinal ligaments, and posterior ligamentous complex are intact; spinous processes are not separated. ## Footnote Osteoporosis; thoracic
27
Vertebroplasty:
Injection of bone cement into fractured vertebra to relieve pain and restore mobility ## Footnote Tx: compression fracture
28
Burst fracture of the **anterior** and **middle** spinal columns: ## Footnote Stable fracture
Denis Type II ## Footnote Ruptured ligaments: supra/interspinous; fragments may enter spinal canal
29
MOI: **Compression** followed by **flexion**
Denis Type II ## Footnote Stable: Rigid Orthosis Unstable: ORIF & Rigid Orthosis
30
MOI: **Flexion** followed by **distraction**
Denis Type III ## Footnote Posterior & Mddle Columns
31
What is a **Chance** fracture?
A subtype of Denis Type III; fracture through bone ## Footnote Mild: Jewett Moderatre++: Body Jacket (Bivalve TLSO)
32
What is a **Slice** fracture?
A subtype of Denis Type III; fracture through soft tissue that typically requires surgical repair. ## Footnote More severe compared to Chance fracture.
33
Fracture & dislocation of the ant, mid, post columns:
Denis Type IV ## Footnote Fracture through vertebral body; rupture of post. ligaments; **articular facets**
34
MOI: Excessive translatory, flexion & rotatory forces
Denis Type IV ## Footnote Surgery with post-op TLSO; may result in **complete spinal cord transection**
35
Holdsworth Fracture is also known as:
Denis Type IV
36
MOI: Axial load & flexion
Teardrop Fracture Spinal cord injury & spinous process fx; highly unstable. MC in cervical spine due to high mobility. ## Footnote **Tx: ORIF + Halo**
37
What landmarks are used for brace measurements?
1. Sternal Notch 2. Xiphoid Process 3. Iliac Crests 4. ASIS 5. Greater Trochanter 6. Pubis
38
Internal & External Obliques Rectus Abdominus
Spinal flexion muscles
39
What are the spinal flexion muscles?
Psoas major Iliacus (Iliopsoas)
40
What are the layers of spinal extension muscles?
Deep Intermediate Superficial
41
Transversospinalis
Deep extensor muscles; ## Footnote Semispinalis, multifidus, rotatores
42
Erector Spinae
Intermediate extensor muscles ## Footnote Longissimus thoracis, spinalis thoracis, iliocostalis lumborum
43
Trapezius & Latissiumus Dorsi
Superficial extensor muscles of the spine
44
Which ligament attaches the ilium to lumbar vertebrae like **guy** wires?
Iliolumbar Ligament
45
Which structure attaches vertebra to vertebra on the posterior spine?
Ligamentum flavum ## Footnote Flexibility: for vertebral distraction and movement, in a controlled speed to maintain stability
46
Large ligementous structure which stabilizes spine from C7 to sacrum:
Supraspinous Ligament ## Footnote Superiorly, it is the nuchal ligament (above C7)
47
Resists flexion; narrow & weak compared to other spinal ligaments:
Posterior Longitudinal Ligament
48
Resists **hyperextension**; originates from cranium; longest ligament in body; broadest of all spinal ligaments:
Anterior Longitudinal Ligament
49
Which ligament prevents anterior displacement of C1 over C2
Transverse Ligament ## Footnote Also stabilizes the odontoid; allows rotation, limiting displacement.
50
What is the purpose of spinal ligaments?
1. Protection 2. Stability 3. Posture
51
**23**, 3-9mm thick, 25% of spinal column hgt and provides shock absorption:
Intervertebral Discs ## Footnote Contribute to spinal curves - thicker on one side in cervical & thoracic regions.
52
What material allows IVD to resist tension and compression?
Collagen ## Footnote Also made up of proteoglycans, which attract water.
53
What is the mode of nutrition for IVDs?
Osmosis ## Footnote Nutrients received from cartilage end plate; **imbibition** - process in which spinal discs absorb nutrients & fluids.
54
How do IVDs change with aging?
1. Decreased fluid w/age 2. Degeneration begins ~20yrs of age ## Footnote gradual loss of water in nucleus, progressive fibrosis.
55
What are the components of the IVD?
1. Nucleus pulposus - gel-like center 2. Annulus fibrosus - crisscrossing outer fibers
56
What are the joints btwn the ribs and thoracic vertebrae?
1. Costovertebral joint - body of vertebra & head of rib 2. Costotransverse joint - transverse process of vertebra & rib notch
57
How does facet orientation affect movement in the thoracic region?
1. Limits flexion & extension in upper area 2. Allows free lateral flexion 3. Rotation in superior area that decreases caudally
58
Primary Curve
* Long "C" curve at birth; * Thoracic & Sacral curves * Kyphotic (convex posteriorly)
59
Secondary
* Cervical & lumbar curves * Lordotic (convex anteriorly)

Spinal Orthotics (3 decks)

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