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95 Cards in this Set

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  • Back
What are the 3 major components of the spine?
1. the spinal column (bones and discs)
2. neural elements (spinal cord and nerve roots)
3. supporting structures (muscle and ligaments)
How many vertebrae are there and give the breakdown of each type?
33 vertebrae
• cervical = 7
• thoracic = 12
• lumbar = 5
• sacrum = 5
• coccyx = 4
How many spinal nerves are there?
31 pairs of spinal nerves
Which vertebrae are lordotic?
cervical and lumbar vertebrae
Which vertebrae are kyphotic?
thoracic and sacral vertebrae
What is the function of the spine/vertebrae?
• protection (of spinal cord and nerve roots)
• base for attachment (for ligaments, tendons, and muscles)
• structural support
• flexibility and mobility
• other (produce RBCs and mineral storage)
What percentage of the population are seen for back pain per year?
10%
What percentage of people will experience back pain in their lifetime?
80%
What vertebrae does the spinal cord extend to?
L1
At what vertebrae does the spinal cord become the caudal equina?
beyond L1
What are the divisions of the peripheral nervous system?
somatic and autonomic nervous system
What are the two divisions of the autonomic nervous system?
• sympathetic nervous system
• parasympathetic nervous system
What is the total volume of CSF in the average adult?
150 ml
What are the names of C1 and C2 vertebrae, respectively?
• C1 is the atlas
• C2 is the axis
True/False: Intervertebral disc have their own blood supply
• Intervertebral disc are not vascular and depend on the end plates to diffuse needed nutrients.
• The correct answer is: False
What is the function of intervertebral discs?
• serve as the spine's shock absorbing system
• protect the vertebrae, brain and other structures
• allow some vertebral motion (extension and flexion)
What are the 2 parts of the intervertebral disc?
• annulus fibrosus - outer part
• nucleus pulposus - inner part
Which portion of the intervertebral disc contains more fluid?
nucleus pulposus
How many facet joints are on each vertebra?
2 sets of facet joints of each vertebra
What type of joints are facet joints?
Synovial joints "hinge-like"
What are the 3 important ligaments of the spine and where are they located?
• ligamentum flavum - forms over the dura mater, inside the spinal canal
• posterior longitudinal ligament - runs in the spinal canal but posterior to the vertebra body
• anterior longitudinal ligament - runs up and down the spine; attaches to the front of each vertebra
What are some symptoms of spinal cord injury?
- pains, numbness, weakness, and tingling
Generally, what do the 8 cervical nerves control?
C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles (e.g. Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands
What goes through the transverse foramen?
vertebral artery
How do you see C1 and C2 in an anterior-posterior x-ray?
the patient would have to open their mouth during the x-ray, because the mandible obscures the view of C1 and C2
What is subluxation?
partial dislocation of the spine
What are the 3 parts of the cruciate ligament in C1 and C2? what are their function?
• superior longitudinal band
• transverse ligament of atlas
• inferior longitudinal band

* the cruciate ligaments
help hold the atlas in place
What is whiplash?
a nonmedical term to describe hyperextension injury to the neck resulting from an indirect force, sually a rear-end automobile collision
Injuries from whiplash can be seen on X-ray
Most injuries are to soft tissues such as the discs, muscles, and ligaments and cannot be seen on standard X-rays The correct answer is: False
What is the difference between sprain and strain?
• strain is muscule-tendon tenderness
• sprain is ligament tenderness
What is the treatment for neck sprain/strain?
NSAIDS, muscle relaxers, narcotics
What are the 3 required radiographs to view a possible c-spine fracture?
• anteroposterior view
• lateral view
• odontoid view
What are the 5 steps of the Nexus study?
• midline pain or bony tenderness, crepitus, or step-off
• neurologic deficit
• presence of distracting injuries
• altered mental status (including intoxication)
• compliant of paresthesia or numbness
Describe to Canadian C-Spine rules
• 1st question - any high-risk factor that mandate radiography (such as age > 65, dangerous mechanism, or paresthesias in extremities); if yes » Xray, if no » go to 2nd question

• 2nd question - any low-risk factor that allows safe assessment of range of motion (simple rear-end MVC, sitting positio in the ER, ambulatory at any time, delayed onset of neck pain, or absence of midline c-spine tenderness); if no » Xray, if yes » go to 3rd question

• 3rd question - able to rotate neck actively; if unable to rotate » Xray, if yes » no Xray
True/False: A 70 year-old male with a head injury and is negative for all 5 points of the Nexus study does not need an Xray
• The Nexus study rules apply to ages 18-55 years old. Therefore, a 70 year-old patient will get an Xray
• The correct answer is: False
What would a high cervical lesion affect?
A lesion on C3-C4 would affect all arm muscles and ventilation
What would a midcervical lesion affect?
would affect extension but not flexion at elbow
What would a low cervical lesion affect?
affects hand muscle function but may preserve elbow flexion and extension
A thoracic lesions results in what?
paraplegia
What are some characteristics of partial spinal cord injury?
• may be seen with acute neck extension
• typically get central spinal cord syndrome or anterior spinal artery syndrome
What are some characteristics of anterior cord syndrome?
• involves the loss of motor function
• pain
• temperature sensation distal to the level of injury
• preservation of light touch, vibration, and proprioception
What are some characteristics of central cord syndrome?
• associated with hyperextension injuries
• presents with motor weakness
• more prominent in the arms than in the legs
• variable sensory loss
What is the Brown-Sequard syndrome?
• most often results from penetrating trauma
• causes by a hemisetion of the spinal cord
• loss of ipsilateral motor function, proprioception, light touch sensation, and loss of contralateral pain and temperature sensation
What are some characteristics of cauda equina syndrome?
• more a peripheral nerve injury than a spinal cord lesion
• presents with variable motor and sensory loss in the lower extremities, sciatic, bowel or bladder dysfunction, and "saddle anesthesia"
How does an injury to the corticospinal tract present?
• produces an ipsilateral upper motor neuron lesions that results in
1) increased deep tendon reflexes
2) spasticity
3) weakness
4) a positive Babinski sign
What is negative Babinski sign and a positive Babinski sign?
• negative = toes curl down
• positive = toes fan out
How does an injury to the dorsal column present?
loss of ipsilateral light touch sensation and proprioception
How does an injury to the spinothalamic tract present?
contralateral pain and temperature sensory losses
How does an injury to the nerve roots present?
• produces ipsilateral lower motor neuron lesions and radiculopathy
• results in decreased deep tendon reflexes, weakness, and sensory loss in that nerve distribution
What are characteristics of spinal shock?
• characterized by warm, pink, dry skin
• adequate urine output
• relative bradycardia
• other signs of autonomic dysfunction (ileus or paralyzed paristalis, urinary retention, fecal incontinence, and priaprism)
When are extension and flexion radiographs done?
• if xray is normal, but the patient still complains of pain
• checks for cervical spine stability
When is a CT scan used?
• for subluxations or fractures
• when neuro abnormality is present
When should an MRI be done?
• any suspected injury to the spinal cord
• to demonstrate spinal cord hemorrhage or contusion
Name 3 major C-spine fractures
1. Hangman's fracture
2. Jefferson fracture
3. Extension "teardrop" fracture
Describe a Hangman's fracture
an unstable fracture of the pedicles of the posterior arch of C2 caused by extension and distraction injury
Describe a Jefferson fracture
• an axial load compression fracture of the anterior and posterior arches of C1
• an unstable fracture
• lateral masses of C1 lying lateral to the lateral masses of C2 (results as a spread of the ring of C1)
What are the 3 classifications of odontoid fractures?
• a piece of the odontoid is fractured
• a fracture at the base of the odontoid
• a fracture including part of the vertebral body
Describe how a patient with acute brachial plexus neuritis presents
• a characteristic pattern of acute or subacute onset of pain
• followed by profound weakness of the upper arm and amyotrophic changes affecting the shoulder girdle and upper extremity
What are characteristics of torticollis?
• refers to presentation of the neck in a twisted or bent position
• manifests in involuntary contraction of the neck muscles, leading o abnormal postures and movements of the head
Describe a extension "teardrop" fracture
an unstable fracture where the anterior longitudinal ligament avulses the anterior-inferior corner of the vertebral body
What is the conus medullaris?
the area of the spinal cord below T12 and L1 where the cord transitions in to the cauda equina
What are some characteristics of the sciatic nerve?
• the longest and largest nerve in the body (measuring ¾ inch in diameter)
• originates in the sacral plexus
• enables movement and feeling (motor & sensory) in the thigh, knee, calf, ankle, foot and toes
What is sciatica?
• injury or inflammation of the sciatic nerve
• can cause intense pain along any part of the sciatica nerve pathway (from the buttocks to the toes)
• symptoms include a loss of reflexes, weakness, numbness, severe pain
• makes everydat activities (walking, sitting, and standing) difficult
Describe the origin and location of the sciatic nerve
• sciatic nerve fibers originate at the 4th and 5th lumbar vertebra
• passes through the sciatic foramen just below the Piriformis muscles
• goes to the back of the extension of the hip and to the lower part of the Gluteus Maximus
• runs verically downward into the back of the thigh
• behind the knee, it braches into the hamstring muscles, calf, and further downward into the feet
What is piriformis syndrome?
an entrapment of the sciatic nerve as it exits the greater sciatic notch in the gluteal region
What are some characteristics of spinal stenosis?
• a narrowing of the spinal canal, which places pressure on the spinal cord
• inflammation of the nerves on a narrow canal causes usually causes symptoms
• lumbar spinal stenosis » pain, weakness, or numbness in the legs, calves, or buttocks
• cervical spinal stenosis » similar symptoms in the shoulders, arms, and legs
What is the treatment ofor spinal stenosis?
1. NSAIDS
2. corticosteroid injecyions
3. rest or restricted activity
4. physical therapy
5. surgery
What is spondylolysis?
a defect in the parts interarticularis
What is the most common vertebra involved in spondylolysis?
L5
What is spondylolisthesis?
• anterior slipping of L5 over the saccrum
• usually a result of chronic stress
• symptoms include pain in the low back, thighs, legs, muscle spasms, weakness, and/or tight hamstring muscles
What is foot drop?
• an abnormal neuromuscular disorder that affects the patient's ability to raise their foot at the ankle
• inability to dorsiflex (point toe to the body)
• patients exhibit Steppage Gait or Footdrop Gait
What occurs when you have a herniated disc?
• the nucleus pulposus breaks through the anulus fibrosis of an intervertebral disc
• usually occurs in the L4-L5 and L5-S1 region
What are the four stages of disc herniation?
1. disc protrusion
2. prolapsed disc
3. disc extrusion
4. sequestered disc
What is the test to evaluate for herniated disc?
• the straight-leg raise test (or Lasegue Test)
• the patient lies down, the knee is extended and the hip is flexed
• pain at 15° is a positive straight-leg raise test
What is best radiographic method to evaluated for a herniated disc?
MRI is the best method
What causes Cauda Equina Syndrome?
occurs from a central disc herniation
What are some symptoms of Cauda Equina Syndrome?
• bilateral leg pain
• loss of perianal sensation
• paralysis of the bladder
• weakness of the anal sphincter
What is scoliosis?
lateral curvature of the spine
Which gender is more likely to develop scoliosis?
girls
What is the treatment of scoliosis?
treatment is dependant on the degree of curvature
• 10-15° » follow-up in 6 months
• 15-20° » serial xrays every 3-4 months
• >20° » ortho referral for possible bracing
What is Kyphosis?
enhanced convex curvature of thoracic spine (hunchback)
What is Pott's Disease?
when TB of the spine causing progressive kyphosis
What spinal deformity is often associated with respiratory distress?
kyphosis
What is Ankylosing Spondylitis?
• inflammation with progressive fusion of the vertebrae
• a chronic, multisystem inflammatory disorder of the sacroilliac (SI) joints
What does Ankylosing Spondylitis look like on an X-ray?
"bamboo-spine"

• spine looks like one piece instead of individually identifiable vertebrae
What blood test is associated with Ankylosing Spondylitis?
HLA-B27
Describe a wedge fracture
a compression fracture in which a vertebra is crushed only in the front part of the spine, causing a wedge shape
Describe a burst fracture
the vertebra is crushed in all directions
What are some characteristics of a Chance Fracture?
• seen in passengers restrained by lap belts
• commonly found in the upper lumbar spine
• represents a pure bony injury extending from posterior to anterior (through the spinous process, pedicles, and vertebral body)
What should you be consider in a patient older than 55 y/o with non-traumatic back pain?
always consider abdominal aortic aneurysm (AAA)
What is Brudzinski sign?
• passive neck or single hip flexion is accompanied by involuntary flexion of both hips
• when the neck is pulled forward, the knees are flexed
What is Kernig sign?
• passive knee extension in supine patient elicits neck pain and hamstring resistance
• When the patient is lying flat and you try to straighten the knee, the patient brings their head up
Positive Brudzinski and Kernig signs are symptoms for what illness?
meningitis
A lumbar puncture is usually done at what vertebral level?
L3
Name 2 causes of osteoporosis
1. decreased sex hormones
2. Cushing's Syndrome (cortisol inhibits osteoblast activity)