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61 Cards in this Set

  • Front
  • Back
What vertebrae does the spinal cord extend to?
Which vertebrae are lordotic?
cervical and lumbar vertebrae
Which vertebrae are kyphotic?
thoracic and sacral vertebrae
How many spinal nerves are there?
31 pairs of spinal nerves
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)
Where are there no intervertebral discs?
• between C1 and C2
• sacrum
Upon flexion of the neck, which spinous process is felt on the posterior part of the neck?
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 are physical exam findings of an upper motor neuron lesion?
• hyperreflexia
• muscle spasticity
• spasms
What are physical exam findings of lower motor neuron lesion?
• decreased DTRs
• flaccid muscle tone
• flaccid paralysis
Intervertebral discs make up what percentages of the spinal column's length?
True/False: Intervertebral disc have their own blood supply
• Intervertebral discs are not vascular and depend on the end plates to diffuse needed nutrients
• The correct answer is: False
What are the 2 parts of the intervertebral disc?
• annulus fibrosus - outer part
• nucleus pulposus - inner part
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 is the conus medullaris?
the area of the spinal cord below T12 and L1 where the cord transitions in to the cauda equina
What is the longest and largest nerve in the body?
sciatic nerve (measures ¾ inch in diameter)
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)
What are symptoms of sciatica?
• loss of reflexes
• numbness
• severe pain
• weakness
What are conditions that can cause sciatica?
• bulging or herniated disc
• Isthmic Spondylolisthesis
• spinal stenosis
• tumor (rare),
What is Piriformis Syndrome?
caused by entrapment of the sciatic nerve as it exits the greater sciatic notch in the gluteal region
What is a sensory march?
• pain, that starts in the legs, and moves upward to the buttocks
• pain the begins higher in the body and moves downward
• seen in cervical spinal stenosis
What are treatment options for spinal stenosis?
• corticosteroid injections
• rest or restricted activity
• physical therapy
• surgical
What is spondylolysis?
a defect in the parts interarticularis
What is the most common vertebra involved in spondylolysis?
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 are causes of foot drop?
• peroneal nerve injury (ex. herniation, trauma, spondylolisthesis, etc.)
• MS
• Parkinson's
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 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 causes Cauda Equina Syndrome?
occurs from a central disc herniation compressing the cauda equina
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 whiplash?
a nonmedical term to describe hyperextension injury to the neck resulting from an indirect force, sually a rear-end automobile collision
What is the treatment for neck sprain/strain?
• muscle relaxers
• narcotics
What is scoliosis?
lateral curvature of the spine
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 spinal deformity is often associated with respiratory distress?
What is Kyphosis?
enhanced convex curvature of thoracic spine (hunchback)
What is Pott's Disease?
when TB of the spine causing progressive scoliosis
What is the treatment for kyphosis?
• 45-60º curve: observe 3-4 months w/ physical therapy
• > 60º curve or persistent pain: brace; possible surgery
What is Ankylosing Spondylitis?
• inflammation with progressive fusion of the vertebrae
• a chronic, multisystem inflammatory disorder of the sacroilliac (SI) joints
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 would a high cervical lesion affect?
A lesion on C3-C5 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
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
How does an injury to the corticospinal tract present?
• produces an ipsilateral upper motor neuron lesions
• results in:
- increased deep tendon reflexes
- spasticity
- weakness
- 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?
• warm, pink, dry skin
• adequate urine output
• relative bradycardia
• signs of autonomic dysfunction (ex. ileus, urinary retention, fecal incontinence, priapism)
When are extension and flexion radiographs done?
• if xray is normal, but the patient still complains of pain
• checks for cervical spine stability
What are the Nexus C-spine rules?
plain film Xray of the spine when one of the following is present:
• midline pain or bony tenderness, crepitus, or step-off
• presence of distracting injuries
• altered mental status (including intoxication)
• compliant of paresthesia or numbness; neurologic deficit
Describe a Hangman's fracture
an unstable fracture of the pedicles of the posterior arch of C2 caused by extension and distraction injury
Describe an extension "teardrop" fracture
an unstable fracture where the anterior longitudinal ligament avulses the anterior-inferior corner of the vertebral body
What is a clay shoveler's fracture?
• an oblique fracture of the lower cervical spinous process (usually C7)
• results from hyperflexion
What are 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?
What is the Brown-Sequard syndrome?
What is the Brown-Sequard syndrome?
• most often results from penetrating trauma
• caused 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 should you be consider in a patient older than 55 y/o with non-traumatic back pain?
always consider abdominal aortic aneurysm (AAA)