spinal trauma Flashcards
(38 cards)
what are the 5 ligaments of the spine
ligamentum flavum
ant / post longitudinal ligament
supra spinous ligament
interspinous ligament
know where each the 5 ligaments are
what is lumbar stenosis and what is this disorder often associated with
narrowing of spinal canal
- spinal claudication
what is spinal claudication, what causes it
clinical term describing weakness of legs that get worse specifically on walking but then eases after sitting for mins
- narrowing of blood vessels from due to bone overgrowth causing reduction in space for spinal nerves
specific lumbar stenosis causes neurogenic claudication by narrowing spinal canal and intervertebral foramen = compression on spinal cord and nerves
but you can have general claudication happen due to stenosis in either cervical, thoracic or lumbar stenosis
what imaging modality best for spinal stenosis
MRI
what are the 3 potential causes for lumbar stenosis
herniated intervertebral disk
bone spur
thickened spinal ligaments
there are 2 types of lumbar stenosis, lateral and medial lumbar stenosis.
what is the difference between/ what it is, what its caused by and what they can impact
lateral = narrowing of intervertebral foramen , can compress nerve root (causing numbness, pain, weakness)
- caused secondary to SUPERIOR ARTICULATING PROCESS (SAP) HYPERTROPHY
medial (aka central) = narrowing of spinal canal itself, compressing the thecal sac (which contains spinal cord and nerve roots), variety of impacts e.g neurogenic claudication, back pain, bowel/bladder dysfunction
- caused by secondary to INFERIOR ARTICULATING PROCESS (IAP) HYPERTROPHY (thickening of ligamentous flavum)
(know where the superior/inferior articulating process is)
what is a common sign of central lumbar stenosis seen on imaging?
fleur de lis (clover sign) seen from axial view of vertebral with (expression of thickened ligament flava)
(know what this looks like on scan)
what is the most common method of treatment for lumbar stenosis
decompressive laminectomy
(can also do foraminotomy, lumbar microdisection, interspinous process distractors
describe what lumbar laminectomy is to relieve lumbar stenosis
open surgical approach
- removal of both lamina and spinous process
what are the 3 columns of the spine and what do they include
anterior = anterior longitudinal lig, 1/2 vertebral body, anterior disc
middle = 2nd Half vertebral body, posterior disc, posterior longitudinal body
posterior = rest of vertebral bony anatomy, ligaments flavum, interspinous and supra spinous ligament
difference between stable and unstable fracture
stable = only one vertebral column involved UNLESS both pedicles fractures
- dont cause spinal deformity/neruological issues
unstable = 2+ vertebral column involved
- cause spinal deformity/neruological issues
what are the 3 types of spinal fractures, describe each of them
wedge /compression = loss of height due to trauma/pathological fracture (typically only affects vertebral body)
burst = fracture of vertebra in multiple locations (often having pieces retropulsed into spinal cord)
fracture dislocation = fractured vertebra and disrupted ligaments, instability may cause spinal cord compression
(know what each of these look like on imaging)
what is spondylolithesis
condition where one vertebra slides forward over the vertebra below it
how many grades are there to spondylolithesis, describe them
4
grade 1 = less than 25% slipping
grade 2= 25-50% slipping
3= 50-75% slipping
4= more than 75% slipping
(know what different grade spondylolithesis looks like)
what is whiplash
soft tissue injury when head is forcibly hyperEXTENDED
what ligament of spine may be damaged due to whiplash/hyperextension
anterior longitudinal ligament
what spinal ligament can be damaged due to hyperflexion
nuchal ligament
what 2 materials are intervertebral discs made out of, what is the purpose of them
annulus fibrosus (fibrocartilaginous ring that surrounds the nucleus pulposus, which keeps the nucleus pulposus intact when forces are applied to the spinal column_
nucleus pulposus (soft core of an intervertebral disc. shock absorption, flexibility, stability, and prevents bone-to-bone contact.)
(know what it looks like)
what is disc herniation
when nucleus pulposus breaks thru annual fibrosus and presses on spinal cord/nerve
what are 2 main causes for disc termination between younger and older ppl
excessive force in youngers
dehydration, elastin loss and collagen gain in olders
how many and what are the characterised stages of disk herniation? whats the differences
4
1= degenerative disc (weakened annulus fibrosus = nucleus pulposus unable to retain as much fluid = decrease in thickness of disk)
2= prolapse/bulging (nucleus pulposus bulge into annulus fibrosus due to it being weakened from injury. may have slight impingement into spinal canal or spinal nerves)
3= extrusion (nucleus pulposus breaks thru annulus fibrosus but remains in disc)
4 = sequestration (nucleus pulposus breaks thru annulus fibrosis and can move outside intervertebral disc and into spinal canal)
KNOW WHAT EACH LOOKS LIKE
disk herniation happens in direction it receives least support from surrounding ligaments, which would this be
posterolaterally, (no support from ant/post longitudinal ligament)
- longitudinal ligament and annulus fiborsus relatively thin
