Spinal orthopaedics 1 - Clinically relevant anatomy of the spine

Question 1

what is mechanical back pain?

Answer 1

Back pain related to joints, ligament and muscles with no sinister features

Question 2

What is spondylosis?

Answer 2

Degeneration of intervertebral discs (lose water content with age = less cushioning and increased pressure on facet joints) leading to secondary OA

Question 3

What is a radiculopathy?

Answer 3

One or more nerves are compressed/ irritated = does not work properly

Question 4

What is spondylolisthesis?

Answer 4

Vertebrae bone slips out of position

Question 5

Benign tumour seen on the spine?

Answer 5

Osteoid osteoma

Question 6

Malignant tumours seen in the spine? (2)

Answer 6

Metastatic disease

Multiple myeloma

Question 7

How many vertebrae are there?

Answer 7

33

Question 8

5 sections of the spine?

Answer 8

Cervical
Thoracic
Lumbar
Sacral (fused)
Coccygeal (fused)

Question 9

How many cervical vertebrae?

Answer 9

7

Question 10

How many thoracic vertebrae?

Answer 10

12

Question 11

How many lumbar vertebrae?

Answer 11

5

Question 12

How many sacral vertebrae?

Answer 12

5

Question 13

How many coccygeal vertebrae?

Answer 13

4

Question 14

Which 2 areas of the spine are naturally lordotic?

Answer 14

Cervical and lumbar

Question 15

Which 2 areas of the spine are naturally kyphotic?

Answer 15

Thoracic and sacral

Question 16

Name of C1?

Answer 16

Atlas

Question 17

Name of C2?

Answer 17

Axis

Question 18

Name of C7?

Answer 18

Vertebra prominens

Question 19

How is vertebra prominens (C7) different?

Answer 19

Larger and longer spinous process

Question 20

Name of centre of vertebral disc?

Answer 20

Nucleus pulposus

Question 21

Name of periphery of vertebral disc?

Answer 21

Anulus fibrosus

Question 22

What type of joints are intervertebral joints?

Answer 22

Secondary cartilagenous (made from fibrocartilage)

Question 23

Why is lumbar rotation less than thoracic rotation?

Answer 23

Due to more vertically orientated facet joins

Question 24

Why does the cervical spine allow the greatest amount of movement?

Answer 24

Due to more horizontal facet joints

Question 25

Other name for facet joint?

Answer 25

Apophyseal joint

Question 26

What is spondylosis often used synonymously for?

Answer 26

OA

Question 27

Give 2 treatments for facet joint OA at one level of the spine?

Answer 27

Facet joint injections under fluoroscopy | Localised fusion

Question 28

What is a disc bulge?

Answer 28

Disc is compressed evenly leading to it bulging out equally on all sides

Question 29

2 other names for disc herniation?

Answer 29

Prolapsed or slipped disc

Question 30

What does disc herniation involve?

Answer 30

Tearing of the cartilage rings

Question 31

2 types of disc herniation/ slip/ prolapse?

Answer 31

Protrusion (only a few cartilage rings are torn = no leakage of entire) Extrusion (all rings in a small area are torn = jelly like material flows out of a disc)

Question 32

At what level is disc bulge/ prolapse most likely to occur?

Answer 32

L4/5 and L5/S1

Question 33

Why is MRI not diagnostic of a disc bulge/ prolapse?

Answer 33

Many people will have these but be asymptomatic

Question 34

Do motor neurones originate anteriorly or dorsally? | Where are their bodies located?

Answer 34

Anteriorly | Anterior grey horn

Question 35

Do sensory neurones originate anteriorly or dorsally? | Where are their bodies located?

Answer 35

Dorsally | dorsal root ganglion

Question 36

What is the name for the bundle of nerves at the lower end of the spinal column/ distal continuation of nerves after the spinal cord?

Answer 36

Cauda equina

Question 37

At what vertebral level does the spinal cord end?

Answer 37

L1

Question 38

Where does the upper motor neurone synapse to the lower motor neurone?

Answer 38

In the spinal cord

Question 39

Does the following symptoms/ signs signal an upper or lower motor neurone pathology? - weakness, spasticity, increased tone, hyperreflexia

Answer 39

Upper

Question 40

Does the following symptoms/ signs signal an upper or lower motor neurone pathology? - weakness, flaccidity, loss of reflexes

Answer 40

Lower

Question 41

What is the name of the membranous sheath of dura matter that surrounds the spinal cord and the cauda equina?

Answer 41

Thecal sac

Question 42

What are the 2 nerve roots that are susceptible to being compressed? e.g. in disc prolapse

Answer 42

Transversing Exiting (outside thecal sac passing under the pedicle) Transversing (anteriorly in the thecal sac, preparing to the next exiting nerve root)

Question 43

What does compression of a nerve root cause?

Answer 43

Radiculopathy

Question 44

Name of the sensory distribution of a nerve root?

Answer 44

Dermatome

Question 45

Name for the group of muscles that a single nerve root supplies?

Answer 45

Myotome

Question 46

Name for the ligaments of the spine?

Answer 46

Ligamentum flavum

Question 47

What is myelopathy another name for?

Answer 47

Spinal cord compression e.g. tumour, disc prolapse

Question 48

Signs of myelopathy? (3)

Answer 48

Upper motor neurone signs Patient will walk with a large gait Babinski sign

Question 49

Describe babinski sign?

Answer 49

When plantar of foot is scratched, the big toe will go up rather than down

Question 50

3 erector spinae muscles?

Answer 50

Iliocosalis Longissimus thoracis spinalis thoracis

Question 51

Name the 5 ligaments of the spinal column?

Answer 51

``` Anterior longitudinal ligament Posterior longitudinal ligmanet ligamentum falvum supraspinous ligmanet interspinous ligament ```

Question 52

At what level are lumbar punctures or spinal anaesthesia given?

Answer 52

Posterior iliac crest (L4) | Posterior superior iliac spine (S2)

Question 53

When is spinal discectomy or decompression good?

Answer 53

Sciatica/ leg pain which doesn't settle within 3 months with conservative management