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95 Cards in this Set
- Front
- Back
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What are the 3 major components of the spine?
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1. the spinal column (bones and discs)
2. neural elements (spinal cord and nerve roots) 3. supporting structures (muscle and ligaments) |
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How many vertebrae are there and give the breakdown of each type?
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33 vertebrae
• cervical = 7 • thoracic = 12 • lumbar = 5 • sacrum = 5 • coccyx = 4 |
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How many spinal nerves are there?
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31 pairs of spinal nerves
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Which vertebrae are lordotic?
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cervical and lumbar vertebrae
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Which vertebrae are kyphotic?
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thoracic and sacral vertebrae
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What is the function of the spine/vertebrae?
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• 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) |
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What percentage of the population are seen for back pain per year?
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10%
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What percentage of people will experience back pain in their lifetime?
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80%
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What vertebrae does the spinal cord extend to?
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L1
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At what vertebrae does the spinal cord become the caudal equina?
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beyond L1
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What are the divisions of the peripheral nervous system?
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somatic and autonomic nervous system
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What are the two divisions of the autonomic nervous system?
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• sympathetic nervous system
• parasympathetic nervous system |
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What is the total volume of CSF in the average adult?
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150 ml
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What are the names of C1 and C2 vertebrae, respectively?
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• C1 is the atlas
• C2 is the axis |
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True/False: Intervertebral disc have their own blood supply
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• Intervertebral disc are not vascular and depend on the end plates to diffuse needed nutrients.
• The correct answer is: False |
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What is the function of intervertebral discs?
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• serve as the spine's shock absorbing system
• protect the vertebrae, brain and other structures • allow some vertebral motion (extension and flexion) |
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What are the 2 parts of the intervertebral disc?
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• annulus fibrosus - outer part
• nucleus pulposus - inner part |
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Which portion of the intervertebral disc contains more fluid?
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nucleus pulposus
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How many facet joints are on each vertebra?
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2 sets of facet joints of each vertebra
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What type of joints are facet joints?
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Synovial joints "hinge-like"
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What are the 3 important ligaments of the spine and where are they located?
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• 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 |
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What are some symptoms of spinal cord injury?
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- pains, numbness, weakness, and tingling
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Generally, what do the 8 cervical nerves control?
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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 |
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What goes through the transverse foramen?
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vertebral artery
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How do you see C1 and C2 in an anterior-posterior x-ray?
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the patient would have to open their mouth during the x-ray, because the mandible obscures the view of C1 and C2
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What is subluxation?
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partial dislocation of the spine
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What are the 3 parts of the cruciate ligament in C1 and C2? what are their function?
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• superior longitudinal band
• transverse ligament of atlas • inferior longitudinal band * the cruciate ligaments help hold the atlas in place |
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What is whiplash?
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a nonmedical term to describe hyperextension injury to the neck resulting from an indirect force, sually a rear-end automobile collision
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Injuries from whiplash can be seen on X-ray
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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
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What is the difference between sprain and strain?
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• strain is muscule-tendon tenderness
• sprain is ligament tenderness |
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What is the treatment for neck sprain/strain?
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NSAIDS, muscle relaxers, narcotics
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What are the 3 required radiographs to view a possible c-spine fracture?
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• anteroposterior view
• lateral view • odontoid view |
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What are the 5 steps of the Nexus study?
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• 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 |
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Describe to Canadian C-Spine rules
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• 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 |
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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
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• 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 |
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What would a high cervical lesion affect?
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A lesion on C3-C4 would affect all arm muscles and ventilation
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What would a midcervical lesion affect?
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would affect extension but not flexion at elbow
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What would a low cervical lesion affect?
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affects hand muscle function but may preserve elbow flexion and extension
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A thoracic lesions results in what?
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paraplegia
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What are some characteristics of partial spinal cord injury?
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• may be seen with acute neck extension
• typically get central spinal cord syndrome or anterior spinal artery syndrome |
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What are some characteristics of anterior cord syndrome?
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• involves the loss of motor function
• pain • temperature sensation distal to the level of injury • preservation of light touch, vibration, and proprioception |
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What are some characteristics of central cord syndrome?
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• associated with hyperextension injuries
• presents with motor weakness • more prominent in the arms than in the legs • variable sensory loss |
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What is the Brown-Sequard syndrome?
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• 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 |
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What are some characteristics of cauda equina syndrome?
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• 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" |
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How does an injury to the corticospinal tract present?
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• produces an ipsilateral upper motor neuron lesions that results in
1) increased deep tendon reflexes 2) spasticity 3) weakness 4) a positive Babinski sign |
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What is negative Babinski sign and a positive Babinski sign?
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• negative = toes curl down
• positive = toes fan out |
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How does an injury to the dorsal column present?
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loss of ipsilateral light touch sensation and proprioception
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How does an injury to the spinothalamic tract present?
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contralateral pain and temperature sensory losses
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How does an injury to the nerve roots present?
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• produces ipsilateral lower motor neuron lesions and radiculopathy
• results in decreased deep tendon reflexes, weakness, and sensory loss in that nerve distribution |
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What are characteristics of spinal shock?
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• 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) |
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When are extension and flexion radiographs done?
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• if xray is normal, but the patient still complains of pain
• checks for cervical spine stability |
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When is a CT scan used?
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• for subluxations or fractures
• when neuro abnormality is present |
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When should an MRI be done?
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• any suspected injury to the spinal cord
• to demonstrate spinal cord hemorrhage or contusion |
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Name 3 major C-spine fractures
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1. Hangman's fracture
2. Jefferson fracture 3. Extension "teardrop" fracture |
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Describe a Hangman's fracture
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an unstable fracture of the pedicles of the posterior arch of C2 caused by extension and distraction injury
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Describe a Jefferson fracture
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• 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) |
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What are the 3 classifications of odontoid fractures?
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• a piece of the odontoid is fractured
• a fracture at the base of the odontoid • a fracture including part of the vertebral body |
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Describe how a patient with acute brachial plexus neuritis presents
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• 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 |
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What are characteristics of torticollis?
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• 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 |
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Describe a extension "teardrop" fracture
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an unstable fracture where the anterior longitudinal ligament avulses the anterior-inferior corner of the vertebral body
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What is the conus medullaris?
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the area of the spinal cord below T12 and L1 where the cord transitions in to the cauda equina
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What are some characteristics of the sciatic nerve?
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• 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 |
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What is sciatica?
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• 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 |
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Describe the origin and location of the sciatic nerve
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• 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 |
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What is piriformis syndrome?
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an entrapment of the sciatic nerve as it exits the greater sciatic notch in the gluteal region
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What are some characteristics of spinal stenosis?
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• 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 |
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What is the treatment ofor spinal stenosis?
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1. NSAIDS
2. corticosteroid injecyions 3. rest or restricted activity 4. physical therapy 5. surgery |
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What is spondylolysis?
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a defect in the parts interarticularis
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What is the most common vertebra involved in spondylolysis?
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L5
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What is spondylolisthesis?
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• 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 |
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What is foot drop?
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• 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 |
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What occurs when you have a herniated disc?
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• the nucleus pulposus breaks through the anulus fibrosis of an intervertebral disc
• usually occurs in the L4-L5 and L5-S1 region |
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What are the four stages of disc herniation?
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1. disc protrusion
2. prolapsed disc 3. disc extrusion 4. sequestered disc |
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What is the test to evaluate for herniated disc?
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• 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 |
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What is best radiographic method to evaluated for a herniated disc?
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MRI is the best method
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What causes Cauda Equina Syndrome?
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occurs from a central disc herniation
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What are some symptoms of Cauda Equina Syndrome?
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• bilateral leg pain
• loss of perianal sensation • paralysis of the bladder • weakness of the anal sphincter |
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What is scoliosis?
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lateral curvature of the spine
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Which gender is more likely to develop scoliosis?
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girls
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What is the treatment of scoliosis?
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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 |
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What is Kyphosis?
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enhanced convex curvature of thoracic spine (hunchback)
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What is Pott's Disease?
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when TB of the spine causing progressive kyphosis
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What spinal deformity is often associated with respiratory distress?
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kyphosis
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What is Ankylosing Spondylitis?
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• inflammation with progressive fusion of the vertebrae
• a chronic, multisystem inflammatory disorder of the sacroilliac (SI) joints |
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What does Ankylosing Spondylitis look like on an X-ray?
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"bamboo-spine"
• spine looks like one piece instead of individually identifiable vertebrae |
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What blood test is associated with Ankylosing Spondylitis?
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HLA-B27
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Describe a wedge fracture
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a compression fracture in which a vertebra is crushed only in the front part of the spine, causing a wedge shape
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Describe a burst fracture
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the vertebra is crushed in all directions
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What are some characteristics of a Chance Fracture?
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• 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) |
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What should you be consider in a patient older than 55 y/o with non-traumatic back pain?
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always consider abdominal aortic aneurysm (AAA)
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What is Brudzinski sign?
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• passive neck or single hip flexion is accompanied by involuntary flexion of both hips
• when the neck is pulled forward, the knees are flexed |
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What is Kernig sign?
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• 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 |
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Positive Brudzinski and Kernig signs are symptoms for what illness?
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meningitis
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A lumbar puncture is usually done at what vertebral level?
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L3
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Name 2 causes of osteoporosis
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1. decreased sex hormones
2. Cushing's Syndrome (cortisol inhibits osteoblast activity) |
