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Clinically applied MSK - Roshiva > Spine > Flashcards

Spine Flashcards

1
Q

What is the vertebral column/spine?

A
  • Central axis of human body
  • Composed of 33 vertebrae; 5 segments
  • Each segment is characterised by a different vertebral structure
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2
Q

What are the 5 different segments of the vertebra column?

A
  • 7 cervical vertebrae in the neck
  • 12 thoracic vertebrae articulating with a pair of ribs
  • 5 lumbar vertebrae (large to support weight of the body)
  • 5 sacral vertebrae (fused to form sacrum which transfers weight to lower body)
  • 4 coccygeal vertebrae (remnant of the embryonic tail). Co2-Co4 are fused
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3
Q

What is the function of the vertebra column?

A
  • Protect spinal cord (spinal cord is enclosed by vertebral canal)
  • Support by carrying weight of body above pelvis
  • Forms central axis of body
  • Role in movement and posture
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4
Q

What are the curvatures of the vertebral column?

A
  • Cervical = lordosis. Acquired as infant
  • Thoracic = Kyphosis. Present in fetus
  • Lumbar = lordosis. Acquired as infant
  • Sacrum = kyphosis. Present in fetus

These curvatures allow spring-like behaviours

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5
Q

What are the differences in vertebra in lordosis and kyphosis?

A
  • Lordosis = IV discs are larger anteriorly than posteriorly
  • Kyphosis = Posterior vertebral body is larger than anterior
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6
Q

What are the common features of a vertebrae?

A
  • Body = weight-bearing component (those in lower segments have larger bodies for greater weight support)
  • Superior and inferior parts of the body are lined with hyaline cartilage
  • Adjacent vertebral bodies are separated by fibrocartilaginous IV disc
  • Single spinous process (which may or may not be bifid)
  • 2 transverse processes (in thoracic vertebrae, they articulate with ribs)
  • Pedicles - connect vertebral body to transverse process
  • Lamina - connect the transverse process and spinous processes
  • Articular processes - form joints between one vertebra and the vertebra above and below it

-Intervertebral foramina

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7
Q

What is the vertebral canal?

A

Lining up of all the foramina for the vertebral canal

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8
Q

What are the characteristics of cervical vertebrae?

A
  • They have bifid spinous processes (except C1 and C7)
  • Transverse foramina - opening in transverse process where vertebral arteries travel to brain. Vertebral vein and sympathetic nerves pass through here as well.
  • Triangular vertebral foreman
  • C1 is atlas and C2 is axis. They are specialised for movement of head.
  • Cervical vertebrae are the smallest as they don’t have to bear much weight
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9
Q

What is the atlas (C1)?

A
  • Articulates with occiput to form altantoccipital joint (synovial joint) and the axis to form altantoaxial joint (3 synovial joints - 1 median and 2 lateral)
  • No spinous process and no vertebral body
  • Anterior arch contains facet for articulation with dens of C2 which is secured by transverse ligament of atlas
  • Anterior tubercle allows attachment for longus colli and longitudinal ligament

-Transverse ligament of atlas - attached to lateral masses

  • Has 2 lateral masses connected by the posterior arch
  • Each mass contains a superior articular facet (to articulate with occipital condyles) and an inferior articular facet (for articulation with axis)
  • Posterior arch has groove for vertebral artery and C1 spinal nerve
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10
Q

What is the axis (C2)?

A
  • Has bifid spinous process
  • Has 2 superior articular facets
  • Has 2 transverse foreman
  • Odontoid process (dens) extends superiorly from the anterior portion
  • Articulates with anterior arch of atlas creating the medial atlanto-axial joint
  • This allows rotation of the head independently of the torso

-Has superior articular facets which articulate with the inferior articulatar facets of the atlas to form the 2 lateral atlantoaxial joints.

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11
Q

What are the characteristics of C3-C7?

A
  • Has 2 transverse foreman (where vertebral artery, vein and sympathetic nerves can pass - except in C7, where the vertebral artery passes around the vertebra)
  • Bifid spinous process (C7 varies)
  • C6 and C7 have long spinous processes
  • Intervertebral foreman are narrow putting cervical spinal nerves at risk of impingement
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12
Q

How does the size of the intervertebral foreman vary?

A

It increases in size with flexion

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13
Q

What are the characteristics of the thoracic vertebrae?

A
  • Assist with rotation of column
  • Vertebral body is heart shaped and medium size
  • Intervertebral foreman is small and circular
  • Have superior and inferior costal facets (for articulation with head of ribs)
  • Costal facets on transverse processes (T1-T10 only)- articulate with tubercles of the ribs
  • Spinous processes are long and slant inferiorly - offers increased protection to spinal cord preventing objects such as knife entering spinal cord
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14
Q

What are the characteristics of lumbar vertebrae?

A
  • Kidney shaped large vertebral body
  • Body deeper anteriorly than posteriorly, producing lumbosacral angle
  • Intervertebral foreman is triangular
  • Long and slender transverse processes
  • Short and broad and spinous processes
  • Accessory processes on transverse process - attachment for deep back muscles
  • Mammillary processes on each articular process - attachment for deep back muscles
  • L5 is the biggest
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15
Q

What are the characteristics of the sacrum?

A
  • Inverted triangular shaped. Fusion of 5 vertebrae
  • Has facets on lateral walls for articulation with pelvis at sacroiliac joints
  • Wings of sacrum - supports psoas major and lumbosacral trunk
  • Base of sacrum (at the top) articulates with L5 (lumbosacral joint)
  • Sacral promontory
  • Apex of sacrum - articulates with coccyx
  • Sacrum usually doesn’t move.
  • The sacroiliac joints are different to each other
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16
Q

What are the key ligaments of the sacrum?

A
  • Sacrospinous = extends from sacrum to ischial spine
  • Sacrotuberous = extend from sacrum to ischial tuberosity
  • They stabilise the sacroiliac joint.
  • Prevent forward tilting of sacral promontory.
  • Transform greater and lesser sciatic notches into greater and lesser sciatic foramina
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17
Q

What is the sacral angle?

A
  • 30 degrees
  • Increasing sacral angle tilts pelvis anteriorly
  • Increases lumbar lordosis
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18
Q

What is the IV disc made up of?

A
  • Nucleus pulposus: contains collagen fibres organised randomly and elastin fibres are arranged radically. Fibres are embedded into hydrated gel, giving it jelly like consistency
  • Annulus fibrosis: made of 15-20 concentric layers with collagen fibres lying parallel to each lamella. It helps disc return to its original arrangement after flexion and extension. Withstands high bending and torsional loads
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19
Q

What are the anterior motion segments?

A
  • Vertebral bodies bear a lot of compressive loads and are thicker in lumbar regions to sustain higher loads
  • End plate is present which separates vertebral body from IV disc. It is made out of hyaline cartilage
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20
Q

What are the posterior motion segments?

A

Transverse and spinous process

-Allow muscle attachment. Movement of these muscles provide stability

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21
Q

What joints do we need to be be aware of?

A
  1. Uncovertable joint (Luschka’s joint)= Synovial joint. On each side of the 4 cervical discs between C3 and C7. Common location for spinal degradation
  2. Intervertebral joint = cartilaginous joint. by IV discs made of central nucleus pulposus surrounded by annulus fibrosis. Enhanced by anterior and posterior longitudinal ligament. Allows flexion, extension, lateral flexion and axial rotation
  3. Zygapophyseal joint = Synovial joint. Between superior and inferior articular processes of adjacent vertebrae
  4. Costovertebral joint = Synovial joint. Between head of rib and transverse process and vertebral body
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22
Q

What is the uncovertable joint?

A
  • Synovial plane joint
  • Between uncinate processes C3-C7 and inferior aspect of respective vertebra above
  • No ligaments
  • Allows slight movement of cervical spine
  • Common location for spinal degeneration
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23
Q

What is the zygapophyseal joint/facet joint?

A
  • Synovial plane joint
  • Between superior and inferior articular process of adjacent vertebrae
  • Each joint is surrounded by a joint capsule - thin in cervical region allowing greater range of movement
  • Ligaments = longitudinal ligaments (anterior and posterior), ligament in flavum
  • Allows flexion, extension, lateral flexion, axial rotation of vertebral column
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24
Q

What is the costovertebral joint?

A
  • Synovial joint
  • Between costal demifacets on T1-T10, full costal facets on vertebrae T1, T11 and T12
  • Allows internal rotation and elevation of head of rib
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25
Q

What are intervertebral discs?

A
  • Indirect articulation between vertebral bodies
  • Contributes up to 30% of vertebral column height
  • Covers the entire surface of vertebral body
  • 2 parts: annulus fibrosis (fibrocartilage) and nucleus pulposus
  • IV discs are thinnest in the upper thoracic region
  • Annulus fibrosis: 15-20 concentric layers of collagen fibres lying parallel to each other. Helps disc return to its original arrangement following extension/flexion. When relaxed, it is stiff. Withstands high bending and torsional loads
  • Nucleus pulposos: contains collagen fibres organised randomly and elastin fibres arranged radically. Fibres embedded into hydrated gel.
26
Q

What are the anterior and posterior longitudinal ligaments?

A

Anterior longitudinal ligaments:

  • Run full length of vertebral column
  • Fibrous band that connects anterolateral aspects of vertebral bodies and IV discs
  • Prevents hyperflexion and limits extension of vertebral column
  • Maintains stability of joint
  • only ligament that limits extension

Posterior longitudinal ligament:

  • Runs full length of vertebral column
  • weaker than anterior longitudinal ligament
  • runs along posterior aspect of vertebral bodies
  • mainly attached to IV discs
  • Runs from C2 to sacrum
  • Resist hyperflexion
  • Helps prevent herniation of nucleus pulposus
  • Well provided with nociceptive nerve endings
27
Q

What are the accessory ligaments?

A

-They unite the laminate, transverse processes and spinous processes to stabilise the joints

These are:

  • Ligamentum flava
  • Interspinous and supraspinous ligament
  • nuchal ligament
  • intertransverse ligament = connecting adjacent transverse processes
28
Q

What is ligamentum flavum?

A
  • Extend vertically between lamina of adjacent vertebrae
  • contains elastin fibres
  • under constant tension
29
Q

What is the nuchal ligament?

A
  • Equivalent to supraspinal ligaments in the neck

- from nuchal line to C7

30
Q

What is the interspinous ligament and supraspinous ligament?

A

Joins spinous processes of adjacent vertebrae
Limit flexion

  • Interspinous = attach between the processes
  • supraspinous = ligaments attach to the tips of the process
31
Q

What ligaments are involved in lateral flexion of vertebral column?

A
  • Contralateral intertransverse ligament

- Ligament flavum

32
Q

What ligaments are involved in rotation?

A

-Capsular ligaments of zygophyseal joints (they withstand the most strain)

33
Q

What are the craniovertebral joints?

A
  • Between cranium and vertebral column
  • Synovial joint

Atlanto-occipital joints:

  • Between C1 and occipital bone condyles
  • Allows flexion, lateral flexion and rotation

Atlanto-axial joints (there are 3):

  • 2 lateral and 1 median
  • Lateral joints allow gliding
  • Median one allows pivoting
34
Q

What is the atlantoaxial joint?

A
  • Synovial joint (there are 3)
  • Articulation between inferior articular surface of lateral mass of axis and superior articular facet of axis
  • Ligaments: cruciform ligament, alar ligaments and apical ligament of dens
  • Allows axial rotation, limited flexion, extension and lateral flexion
  • Lateral ones allow gliding
  • Medial one allows pivoting
35
Q

What are alar ligaments?

A
  • Extend from sides of dens to lateral margins of foramen magnum
  • Attaches cranium to C1
  • prevents excessive rotation at the joints/limits side to side rotation
36
Q

What are cruciform ligaments?

A
  • Vertical ligamentous band
  • Holds C2 to median atlantoaxial joint
  • Allowing pivoting between atlas and axis
37
Q

What muscles flex the trunk (shoulder to butt)?

A
  • Rectus abdominis
  • External and internal obliques
  • Psoas major and minor
38
Q

What muscles extend the trunk?

A
  • Erector spinae (iliocostalis, longissimus cervis, spinalis thoracis)= allows flexion, extension and rotation of spine
  • Multifidus = extension, lateral flexion and rotation of spine
  • Quadratus lumborum = lateral flexion and extension of trunk
  • Semispinalis (thoracis) = flexes cervical and thoracic vertebrae; allows contralateral rotatio
  • Interspinalis = extension of spine and maintains posture
  • Rotatores major and rotatores minor = stabilises, extends and rotates spine
39
Q

What muscles move the head and neck?

A
  • Sternocleidomastoid
  • Longus capitis
  • Splenius capitis
  • Trapezius
  • Erector spinae
  • Rectus capitis anterior
  • Rectus capitis lateralis
  • Rectus capitis major
  • Rectus capitis minor
  • Superior oblique
40
Q

What muscles move the neck only?

A
  • Longus coli
  • Scalene anterior
  • Scalene medius
  • Scale posterior
  • Splenius cervicis
  • Multifidus
  • Semispinalis cervicis
41
Q

What is the arterial supply to the spinal cord?

A

-Vertebral arteries are the main source of blood to the spinal cord

  • 1 Anterior spinal artery (branches of vertebral arteries)
  • 2 Posterior spinal artery (branches of vertebral arteries)
  • Anterior and posterior segmental medullary arteries (artery of Adamkiewicz is the anterior segmental medullary artery)
  • Arterial vasocorona (supplies pia mater of spine)

-The anterior and posterior 2 spinal arteries are direct branches of the 2 vertebral arteries and they merge to form the basilar artery of the Circle of Willis (primary source of blood supply to brain and spinal cord)

42
Q

What is the venous drainage of the spinal cord?

A
  • 3 anterior spinal veins
  • 3 posterior spinal veins

These drain into the internal and external vertebral plexuses

44
Q

What is atlantoaxial instability?

A
  • Characterised by excessive movement at the junction between C1 and C2 as a result of a bony or ligamentous abnormality
  • Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved
  • This instability can originate from congenital conditions but in adults it can be caused by acute trauma or degenerative changes or inflammatory process of rheumatoid arthritis.
  • Can also occur in Down’s Syndrome due to loose ligaments

Symptoms:

  • Ranges from mild axial pain to death
  • Neck movement restriction
  • Respiratory distress

Treatment:

  • Directly stabilise C1-C2 fusion using screws and rods. Ensures the atlantoaxial joint doesn’t move
  • Or occipital-cervical fusion (from base of skull to base of spine)
45
Q

What is an atlas fracture?

A
  • Fracture of atlas
  • Extension/rotation and axial load injury by hitting head on ground
  • Can cause severe disruption of C1-C2 complex
  • Can also involve axis fracture

Type 1: caused by axial load and flexion/extension. There is isolated fracture of anterior or posterior arch
Type 2: caused by axial load. Bilateral fractures of anterior and posterior arch
Type 3: caused by axial load and rotation. Lateral mass fracture

Symptoms:

  • Pain and stiffness
  • Death

Diagnosis:
-CT and MRI allow complete assessment of bone and ligament injury

Treatment:

  • Halo brace - holds head and neck still so that bones and ligaments in the neck can heal
  • C1-C2 fusion
  • occipital-cervical fusion
46
Q

What is axis fracture?

A
  • 3 categories: odontoid fractures, hangman’s fracture injuries and fractures of the axis body
  • Can be caused by high energy mechanisms in younger patients but low energy trauma with the elderly

Hangman’s fracture:

  • fracture of both pedicles and pars interarticularis
  • caused by hyperextension of upper cervical spine

Odontoid fracture:
Type1 = oblique fracture through the Odontoid tip. Has ligamentous injury. Stable
Type2 = fracture through the base of the dens. Unstable. Higher risk of nonunion with comminuted fracture. Poor healing
Type 3 = fracture through the body of C2. Will heal with mobilisation but may have residual spinal stenosis

Presentation:

  • Hyperflexion = anterior displacement
  • Hyperextension = posterior displacement

Treatment:

  • Odontoid fractures can be stabilised by inserting a screw up into the C2 and this can be done accessing the neck
  • You can also stabilise C2 fracture by C1-C2 stabilisation
  • Halo vest (brace that immobilises cervical spine). Attached to outer portion of skull

-Imaging: X-rays, CT

47
Q

What is subaxial cervical spine injury?

A
  • C3-C7
  • Can be injury to the bone, soft tissue or combination
  • Can be burst fractures
  • Can cause height loss
  • Can be caused by forward flexion
  • Can be facet injuries
48
Q

What is the difference between neurogenic shock and spinal shock?

A
  • Neurogenic shock = haemodynamic changes caused by sudden loss of autonomic tone due to spinal cord injury. Seen when level of injury is above T6
  • Spinal shock = loss of all sensation below the level of injury and isn’t circulatory in nature
49
Q

What are the differences in spinal shock and neurogenic shock in detail?

A

Spinal shock:

  • Immediate temporary loss of total power, sensation and reflexes below the level of injury
  • Hypotension
  • Bradycardia
  • Absent bulbocavernosus reflex is absent
  • Flaccid paralysis
  • Peripheral neurones become temporarily unresponsive to brain stimuli

Neurogenic shock:

  • Sudden loss of the sympathetic nervous system
  • Hypotension
  • Bradycardia
  • Variable bulbocavernosus reflex
  • Disruption of autonomic pathways. Loss of sympathetic tone and vasodilation
50
Q

What are the spinal cord syndromes?

A
  1. Central cord syndrome
    - incomplete spinal cord injury
    - common in elderly with history of cervical spondylosis and spinal stenosis
    - (cervical spondylosis - age related wear and tear affecting spinal discs)
    - (cervical stenosis - neck’s spinal canal narrowing due to degenerative changes
    - affects central part of spinal cord
    - central part of spinal cord contains large nerve fibres that exchange information between spinal cord and cerebral cortex (which is involved in personality, feeling and motor function, hand and arm function).
    - lower body may also be affected like bladder
    - Caused by forced extension
  2. Brown Sequard syndrome
    - occurs in patients who suffered penetrating traumatic spinal cord injury e.g bullet or knife wounds
    - affects either left of right side of spinal cord but symptoms can affect both sides
    - characterised by partial loss of function or impaired function, vibrating sensation on the same side of the injury, pain and temperature loss on the opposite side of the injury
  3. Anterior and posterior cord syndromes
    - most common in people with non traumatic spinal cord injury
    - anterior cord syndrome causes complete loss of movement, pain and temperature; preserves light touch sensations (retains propioception). Caused by forced flexion
    - posterior cord syndrome causes loss of light touch sensation; preserves movement pain and temperature sensation.
51
Q

What are motor neurone lesions?

A
  • Motor neurones are cells of the brain and spinal cord that allow us to speak, move and breathe that send commands to muscles that carry out these functions
  • Motor neurones have the longest fibres and have single axon that can stretch from the base of the spinal cord all the way to the toes
  • There are upper (first order) and lower motor neurones
  • Upper motor neurones originate in cerebral cortex and travel down to the brain stem or spinal cord. Use glutamate
  • Lower motor neurones begin in spinal cord and inner age muscles and glands. Use acetylcholine
  • An upper motor neuron lesion = lesion of the neural pathway above anterior horn of spinal cord or motor nuclei of cranial nerves
  • A lower motor neuron lesion = lesion which affects nerve fibres travelling from anterior horn of spinal cord to associated muscle
  • Prevents signals travelling from brain and spinal cord to muscles. Without these signals, your muscles become weak and stiff
  • Causes of lower motor neurone lesions are motor neuron disease, peripheral neuropathy, poliomyelitis, spinal cord injury and nerve root compression
  • Mixed upper and lower motor neuron disease include multiple sclerosis
52
Q

What are the signs of upper motor neuron lesions?

A
  • Weakness: extensors are weaker than flexors in the arm but flexors are weaker than extensors in the leg
  • Muscle wasting is absent (or present slightly)
  • Hyperreflexia with clonus (overreactive reflexes and involuntary muscle contractions
  • Spasticity (tightening of muscles/stiffness)
  • No fasciculation (muscle twitch)
  • Babinski sign positive (where toe bends up and back to the top of the foot and the other toes fan out. This can mean you have an underlying nervous system or brain condition that’s causing your reflexes to react abnormally)
  • Hoffman’s sign positive (if flexion and sudden release of terminal phalanx of middle finger result in reflex flexion of all the digits)
  • Pronator drift
  • Absent abdominal reflexes
53
Q

What are the signs of the lower motor neurone lesions?

A
  • Weakness - limited to focal or root innervated pattern
  • Muscle wasting
  • Reflexes
  • Fasciculation
  • Absent Babinski sign
  • Absent abdominal reflexes
54
Q

What are the types of thoracolumbar fractures?

A
  • compression fractures
  • rotational injuries
  • distraction injuries with posterior ligament disruption
  • split fractures
  • sheer injuries
55
Q

What are the injuries of the thoracolumbar spine?

A

A= compression injuries

  • anterior portion of vertebral column is affected
  • intact posterior tension band (the group of muscles, ligaments and processes/pedicles)
  • A0: no or clinically insignificant fractures of spinous or transverse processes
  • A1: known as compression wedge injury. Involves a single anterior or middle endplate of vertebral body; no involvement of posterior aspect
  • A2: known as split of pincer type injuries. Involve both end plates without involvement of posterior wall
  • A3: known as incomplete burst injuries; involve single end plate along posterior vertebral wall; laminar fracture could also be present
  • A4: known as complete burst injuries. They involve both end plates along posterior vertebral walls. Also associated with laminar fractures

B= distraction injuries

  • B1: known as Chance fractures; they disrupt the pedicles and spinous process in a single vertebral level
  • B2: involve an intervertebral body level with disruption to posterior tension band ligaments
  • B3: known as hyperextension injuries; they disrupt anterior tension band and extend through IV disc or vertebral body

C= translation injuries
-Displacement in any direction

56
Q

What is ankylosing spondylitis?

A
  • Type of arthritis
  • Long term inflammation of joints of spine
  • Joints of pelvis may also be affected
  • Cause back pain, hip pain, butt pain
  • Eye and bowel problems may arise

-Idiopathic aetiology

  • Treatment goals is to relief pain and stiffness, maintaining spine functions
  • Treatment with NSAIDs
  • TNFI
57
Q

What is scoliosis?

A
  • Abnormal lateral curvature of spine
  • Spinal curvature in the coronal plane
  • Scoliosis is defined by ‘Cobbs angle’ of spinal curvature (greater than 25 or 30 degrees is significant) in coronal plane
  • Hypokyphosis in Sagittal plane
58
Q

What are the different types of scoliosis?

A
  1. Idiopathic scoliosis
    - without known cause
  2. Congenital scoliosis
    - baby’s back develops before birth. Problems with the vertebrae cause the spine to curve as they may be incomplete or fail to divide properly
  3. Neuromuscular scoliosis
    - caused by disorder such as spina bifida, cerebral palsy or spinal cord injury
    - they can damage your muscles so that your spine isn’t supported
  4. Degenerative scoliosis
    - affects adults
    - develops in lower back as IV discs and joints begin to wear out with age

Treatment:

  • spinal fusion = 2 or more vertebrae are fused together so that they don’t move independently. Pieces of bone or bone-like material are placed between the vertebrae. Metals, rods and hooks hold that part of spine straight while the old and new bone materials fuse together
  • complications= bleeding, infection
59
Q

What is thoracic disc herniation?

A
  • Herniated disc occurs where annulus fibrosis ruptures and the nucleus pulposus squeezes out
  • herniation can compress a nerve nearby, it results in a pinched nerve
  • can be caused by degenerative disc disease or injury
  • pinched nerve can cause pain, numbness and tingling in the legs and arms
  • A bulging disc occurs when the annulus fibrosis weakens but doesn’t rupture. It bulges outwards
  • A herniated disc may start out as bulging disc
  • Disc herniation can occur in the cervical, thoracic or lumbar spine
  • location of pain depends on site of disc herniation
  • if herniation occurs in the neck, it can cause pain in the shoulder and arm
  • if herniation occurs in lower back, it can radiate down into hip and leg

Symptoms

  • can cause pinched nerve of cervical spinal nerves
  • cause pain, pins and needles, weakness

-a cervical large disc herniation may compress spinal cord within the vertebral canal and cause numbness, weakness and stiffness in legs and possibly some difficulty with bowel and bladder control

  • Thoracic herniated disc can cause pain in the mid back and around the level of disc herniation
  • compresses thoracic spinal nerve which can cause pain around the rib cage and upper abdomen
  • large disc herniation may compress spinal cord within spinal canal and cause numbness, stiffness and weakness in legs. Maybe some difficulty with bowel and bladder control
  • Lumbar herniated disc can cause continuous back pain, back muscle spasms
  • can cause sciatica
  • muscle weakness of legs
  • numbness of leg or foot
60
Q

What is cauda equina syndrome?

A
  • Neurological condition affecting bundle of nerve roots at lower end of spinal cord
  • Cauda equina provides innervation to the lower limbs, sphincter and controls bladder function and distal bowel and sensation to skin around the butt
  • Cauda equina syndrome occurs when nerves below the spinal cord are compressed compromising bowel and bladder
  • Most common cause is prolapse of lumbar disc (herniation)

Symptoms

  • acute back pain or leg pain
  • disturbance of bowel or bladder function

There are 4 classifications for Cauda equina syndrome:

  1. Suspected
  2. Incomplete - patients suffering with urinary difficulties
  3. Retention - painless urinary retention and overflow incontinence
  4. Complete - objective loss of Cauda equina function, absent perineal sensation, a loose anus, paralysed bowel and bladder
61
Q

What is the Cauda equina?

A
  • Spinal cord ends around L1-L2
  • The Caudal roots below L1 form the Cauda equina
  • Cauda equina have ventral and dorsal roots
  • Ventral root provides motor fibres for efferent pathway along sympathetic fibres
  • Dorsal roots is composed of afferent fibres for transmission of sensation. The functions are sensory and motor fibres to the lower limbs, voluntary control of external anal and urinary sphincters
62
Q

What are dermatomes?

A
  • Sensory
  • Skin areas that feed back sensation into a specific spinal root
  • Area of skin supplied by a single spinal nerve
  • Dermatomes correspond to nerve roots, indicating a nerve foot tissue
63
Q

What are myotomes?

A
  • Muscle group innervated by a particular nerve root

- Feed forward, allow movement

Clinically applied MSK - Roshiva (8 decks)

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