Thoracic and Lumbar Spinal Mechanics

Question 1

What are the different spinal junctions?

Answer 1

Craniocervical, cervicothoracic, thoracolumbar, and lumbosacral

Question 2

Where does the gravitational line run through?

Answer 2

External auditory canal, head of the humerus, L3, anterior 1/3 of sacrum, lateral malleolus

Question 3

For T1-3, T12, what is the relationship between the spinous and transverse processes?

Answer 3

Spinous process located at the level of the corresponding transverse process

Question 4

For T4-6, T11, what is the relationship between the spinous and transverse processes?

Answer 4

Spinous process located 1/2 segment below the corresponding transverse process

Question 5

For T7-10, what is the relationship between the spinous and transverse processes?

Answer 5

Spinous process located at the level of the transverse process of the vertebra below

Question 6

What is the superior facet orientation of cervical vertebrae?

Answer 6

Backwards, upwards, medial

Question 7

What is the superior facet orientation of thoracic vertebrae?

Answer 7

Backwards, upwards, lateral

Question 8

What is the superior facet orientation of lumbar vertebrae?

Answer 8

Backwards, medial

Question 9

Define the anterior longitudinal ligament

Answer 9

Covers and connects the anterolateral aspects of the vertebral bodies and intervertebral discs; limits extension

Question 10

Define the posterior longitudinal ligament

Answer 10

Runs within the vertebral canal along the posterior aspect of the vertebral bodies; resists hyperflexion and prevents posterior herniation of nucleus pulposus

Question 11

What does the ligamentum flava connect?

Answer 11

Connects laminae of adjacent vertebrae

Question 12

What do interspinous ligaments connect?

Answer 12

Connects adjoining spinous processes

Question 13

What do intertransverse ligaments connect?

Answer 13

Connects adjoining transverse processes

Question 14

When were Fryette’s principles published? What portions of the spine do they apply to?

Answer 14

1918 (for 1 and 2) and 1948 (for 3 by Nelson); Thoracic and lumbar spine only for 1 and 2

Question 15

What is the 1st Fryette principle (Type 1 mechanics)?

Answer 15

In the neutral range (not flexed/extended), sidebending and rotation are coupled in opposite directions; rotation is towards the convexity of the spine; tends to be a group of vertebrae

Question 16

What is the 2nd Fryette principle (Type 2 mechanics)?

Answer 16

In sufficient flexion or extension, sidebending and rotation are coupled in the same direction; rotation is towards the concavity; tends to be a single vertebrae

Question 17

What is Fryette’s 3rd principle?

Answer 17

If motion is restricted in 1 direction, motion will also be restricted in other directions; if motion is improved in 1 direction, motion will improve in other directions

Question 18

The spine of the scapula is at the same level as what spinal landmark?

Answer 18

T3 spinous and transverse processes

Question 19

The inferior angle of the scapula is at the same level of what spinal landmarks?

Answer 19

Spinous process of T7 and transverse process of T8

Question 20

The iliac crest is at the same level of what spinal landmark?

Answer 20

L4 vertebra

Question 21

A patient presents with a scoliosis that obscures the heart. What is this called?

Answer 21

Levoscoliosis

Question 22

A patient presents with scoliosis that frames the heart. What is this called?

Answer 22

Dextroscoliosis

Question 23

What is the treatment for a patient with a Cobb angle of < 25 degrees?

Answer 23

Monitor with frequent radiographs

Question 24

What is the treatment for a patient with a Cobb angle between 25-45 degrees?

Answer 24

Non-operative bracing

Question 25

What is the treatment for a patient with a Cobb angle of > 50 degrees?

Answer 25

Surgical fusion - prevents progression

Question 26

A patient presents with a Cobb angle of 58 degrees. What complications can you expect?

Answer 26

Respiratory may be compromised *Respiratory compromised with a Cobb angle of > 50*

Question 27

A patient presents with a Cobb angle of 72 degrees. What complications can you expect?

Answer 27

Respiratory complications ONLY *Cardiac is compromised with a Cobb angle of > 75*

Question 28

Define radiculopathy

Answer 28

Pain with dermatomal distribution; lower extremity weakness and diminished reflexes; typically acute, but may become chronic; + straight leg test; MRI

Question 29

What is considered a + straight leg test and what does it indicate?

Answer 29

Pain is reproduced; pain from 15-30 degrees indicates a lumbar disc etiology

Question 30

Define spinal stenosis

Answer 30

Bilateral lower limb pain; neurogenic claudication; lower extremity weakness and diminished reflexes; typically chronic; + straight leg test; MRI

Question 31

Define cauda equina syndrome

Answer 31

Saddle anesthesia, lower extremity weakness, diminished reflexes, urinary retention; emergency, usually traumatic; MRI

Question 32

Define spina bifida occulta

Answer 32

Failure of neural tube to close without herniation

Question 33

Define meningocele

Answer 33

Failure of the neural tube to close with protrusions of the meninges through the defect

Question 34

Define myelomeningocele

Answer 34

Failure of the neural tube to close with protrusion of the meninges and spinal cord through the defect

Question 35

Define sacralization

Answer 35

1 or both transverse processes of L5 are long and articulate with the sacrum

Question 36

Define lumbarization

Answer 36

Failure of S1 to fuse with the rest of the sacrum

Question 37

Define spina bifida

Answer 37

Defect in the closure of the laminate

Question 38

Define spondylosis

Answer 38

Bony spurs

Question 39

Define spondylolesthesis

Answer 39

Slipping of one vertebra on another

Question 40

Define spondylolysis

Answer 40

Fracture or fractures