Spine

Question 1

What is the normal range of lumbar lordosis in the sagittal plane?

Answer 1

60 degrees, range 20-80 degrees

Question 2

Which part of the spine has the largest vertebral bodies?

Answer 2

The lumbar spine

Question 3

What supplies blood to lumbar vertebral bodies?

Answer 3

Segmental arteries

Question 4

What is complete spinal cord injury?

Answer 4

Where there is no motor or sensory function below the level of injury

Question 5

How long does spinal shock typically last?

Answer 5

24-72 hours

Question 6

What happens during spinal shock?

Answer 6

No motor, sensory or autonomic function

Question 7

What signifies the end of spinal shock?

Answer 7

The return of the bulbocavernosus reflex (innervated by sacral roots)- the most distal reflex

Question 8

What is the bulbocavernosus reflex?

Answer 8

Checked by squeezing the glans penis or clitoris or tugging a urinary catheter which elicits contraction of the anal sphincter

Question 9

What is the bulbocavernosus reflex?

Answer 9

Checked by squeezing the glans penis or clitoris or tugging a urinary catheter which elicits contraction of the anal sphincter

Question 10

What is incomplete spinal cord injury?

Answer 10

When spinal cord function is noted after spinal shock has ended and may manifest as sacral sparing or any distal sensory or motor function

Question 11

What is the name for the articulation with the ribs on thoracic vertebrae?

Answer 11

Superior and inferior articular facets

Question 12

What is the name for the part of the neural arch between the spinous process and the transverse process?

Answer 12

The lamina

Question 13

What is the name for the part of the neural arch between the transverse body and the pedicle?

Answer 13

The pedicles- these connect the rest of the arch to the body

Question 14

Why is the vertical extent of the pedicle less than that of the body?

Answer 14

Creates room for the spinal nerve to come out through the intervertebral foramen

Question 15

What is found at the junction of the lamina and pedicle?

Answer 15

The superior and inferior articular processes

Question 16

What determines the movement possible between adjacent vertebrae?

Answer 16

the direction of the facets

Question 17

How many parts does a vertebra ossify from?

Answer 17

Three; the centrum and right and left halves of the neural arch and these are the morphological parts of a vertebra

Question 18

What is an easy way to distinguish a cervical vertebrae?

Answer 18

A foramen in the transverse process- called the vertebrarterial foramen

Question 19

What are some radiological signs of cervical spine instability?

Answer 19

Interruption of cervical lordosis, interlaminar space widening, disc space reduction, avulsion of body fragment, spinous process malalignment

Question 20

What should be the first imaging step of the C-spine in major trauma?

Answer 20

CT

Question 21

What’s the first line of imaging in C-spine minor trauma?

Answer 21

XR

Question 22

What should you do if clinically you are suspicious of C-spine fracture or on the fence in the setting of minor trauma with negative XR?

Answer 22

MRI

Question 23

What is MRI helpful for in the setting of minor C-spine trauma?

Answer 23

Hidden fractures and fracture dating, spinal cord, ligaments and discs, muscle involvement

Question 24

If XR is positive in the setting of minor trauma of C-spine what is the next step?

Answer 24

CT to assess the fracture in more detail, assess for fragment displacement, microfracture and to assess the posterior elements

Question 25

What's the risk of false negative with XR in minor trauma?

Answer 25

Low

Question 26

What's the risk of false negative with XR in major trauma?

Answer 26

High

Question 27

What are the risks of false negative with CT in trauma?

Answer 27

Low for minor trauma and very low for major trauma

Question 28

What do you look for on C-spine AP XR in setting of trauma?

Answer 28

C3-T1 shape and alignment, alignment of the spinous processes

Question 29

What do you look for on C-Spine lateral XR in setting of trauma?

Answer 29

From C1-T1: check the lines, prevertebral soft tissues

Question 30

What do you look for with the transoral view XR of the C-spine in trauma?

Answer 30

Symmetry check- checking position of dens between the lateral masses of the atlas and symmetry of the joints between C1 and C2

Question 31

What can you see with a Swimmer's view?

Answer 31

C6-T3

Question 32

What do you use dynamic studies of the C-spine for in the setting of trauma?

Answer 32

Checking for instability

Question 33

What are the components of vertebral alignment that you're checking for on C-spine lateral XR?

Answer 33

Anterior profile, posterior profile, the spinolaminar line, and the posterior spinous line

Question 34

What is a Swimmer's view?

Answer 34

Used when you can't see C7-T1 on a standard view. Lateral XR taken supine with pt's arm above their head

Question 35

What do the costal elements develop into in the thoracic region?

Answer 35

The ribs which articulate with the neural arch by synovial joints

Question 36

What do the costal elements form in the cervical vertebrae?

Answer 36

The foramen in the transverse process. Anterior and posterior tubercles and intervening costal or intertubercular lamellar

Question 37

What is a cervical rib?

Answer 37

Elongation of the costal element of the C7 vertebra. Can be bony or fibrous passing from C7 to the first rib

Question 38

What type of cervical rib tends to be more irritating, bony or fibrous?

Answer 38

Fibrous

Question 39

What structures does a cervical rib put pressure on?

Answer 39

subclavian artery and lowest root (T1) of the brachial plexus

Question 40

When do symptoms from a cervical rib tend to appear?

Answer 40

Around puberty where the neck elongates and the shoulders droop

Question 41

What do the costal elements form in the lumbar vertebrae?

Answer 41

Transverse processes

Question 42

What grooves the lumbar transverse process?

Answer 42

The posterior ramus of the spinal nerve

Question 43

What lies above the groove in the transverse process of lumbar vertebrae?

Answer 43

The mamillary process (behind the superior articular facet

Question 44

Which has the better long term outcome haemorrhagic or non-haemorrhagic spinal cord injury?

Answer 44

Non-haemorrhagic- 69% had return of leg function va 8%