Blue Boxes: Back

Question 1

Vertebral Body Osteoporosis

Answer 1

Common metabolic bone disease that is often detected during routine radiographic studies

• characterized by vertical striations in vertebral body
• can lead to continued loss of trabecular bone (bone becomes less white)
• If osteoporosis becomes se ver, can lead to excessive thoracic kyphosis

Question 2

What is a laminectomy?

Answer 2

Surgical excision of one or more spinous processes and adjacent supporting vertebral laminae

Often performed to relieve pressure on the spinal cord or nerve roots caused by a tumor, herniated IV disc, or bony hypertrophy (excess growth)

Question 3

Dislocation of Cervical Vertebrae

Answer 3

• Cervical vertebrae are more likely to be dislocated due to more horizontally oriented articular facets
• However, large vertebral canal means less chance of damaging spinal cord

Question 4

Jefferson Fracture

Answer 4

Fracture of both arches of the atlas

• Usually from a diving accident or large object falling onto the head
• Does not typically injure spinal cord (Larger vertebral foramen)

Question 5

Hangman’s Fracture

Answer 5

Fracture of the vertebral arch of the axis

• Results from hyperextension of the head on the neck (not whiplash)
• One of the most common cervical vertebrae injuries

Question 6

Fracture of Odontoid Process

Answer 6

Due to horizontal blow to the head

• Transverse ligament is stronger than the odontoid process.
• These breaks are typically harder to heal b/because of the lack of blood supply to the odontoid process (transverse ligament limits its blood supply)
• Can also results as a complication of ostopenia

Question 7

Lumbar Spinal Stenosis

Answer 7

Narrowing of the Lumbar Vertebral Foramen

• Lumbar spinal nerves increase in size as the vertebral column descends, but paradoxically, the IV foramina decrease in size
• Compression of one or more spinal nerve roots occupying the inferior vertebral canal
• Complication: If IV Disc protrusion occurs along with stenosis, further compromises vertebral canal

(along w/ Arthritic Proliferation and Ligamentous Degeneration)

Question 8

Cervical Ribs

Answer 8

Developmental costal element of C7 becomes abnormally enlarged, which can become a supernumerary (extra) rib

-Can place pressure on structures that emerge from superior thoracic aperture (notablly brachial plexus and sublcavian artery), which can thoracic outlet syndrome

Question 9

Caudal Epidural Anesthesia

Answer 9

Anesthetic agents are injected into the fat of the sacral canal that surrounds the proximal portions of the sacral nerves

-accomplished via sacral hiatus or posterior sacral foramina

Question 10

Coccygodynia

Answer 10

Painful bruisng or fracture of the coccyx (tailbone)

• hard to treat and pain relief is difficult
• dislocation common
• can happen as a result of difficult childbirth

Question 11

Hemisacralization

Answer 11

Partial or complete incorporation of L5 into sacrum

-can produce painful symptoms

Question 12

Lumbarization

Answer 12

Separation of S1 from sacrum and fusion with L5 vertebra

Question 13

Effect of Aging on Vertebrae

Answer 13

Birth to Age 5: lumbar vertebra grows 3x in height

Age 5-13: lumbar vertebra grows 50% in height

Ages 13-25: Minimual longitiduinal growth until completion

Older Age: Overall decrease in bone density, causing changes in the shape of vertebral bodies (why there is slight height loss in aging)

-can see production of osteophytes (bony spurs) and osteoarthritis

Question 14

Spina Bifida Occulta

Answer 14

Vertebral lamina fail to fuse and close off the vertebral canal

• Most common in L5-S1
• Possible to have tuft of hair over this area as well

Question 15

Spina Bifida Cystica

Answer 15

One or more vertebral arches may fail to develop completely

-Associated with herniation of meninges (meningocele) or spinal cord (meningomyelocele)

Question 16

Aging of Intervertebral Discs

Answer 16

Nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen, leading to IV discs becoming stiffer and more resistant to deformation

-Can lead to degenerative disc disease

Question 17

Back Pain

Answer 17

Second most common reason to visit doctor (after cold)

Sources of Pain:

1. Fibroskeletal structures: periosteum, ligaments, and anuli fibrosi of IV discs.
2. Meninges: coverings of the spinal cord.
3. Synovial joints: capsules of the zygapophysial joints.
4. Muscles: intrinsic muscles of the back.
5. Nervous tissue: spinal nerves or nerve roots exiting the IV foramina.

Question 18

Herniation of Nucleus Pulposus

Answer 18

Protrusion of nucleus pulposis through the annular fibrosis

• Most common in L4/L5 and L5/S1
• Typically occurs posterolaterally where anterior and posterior longitudinal ligaments do not support the annular fibrosis

Question 19

Sciatica

Answer 19

Pain radiating from lower back into buttock down the posterior or lateral aspect of thigh into leg

-often caused by herniated lumbar IV disc that compresses L5 or S1 component of sciatic nerve

Question 20

Zygapophysial Joints

Answer 20

If they are injured or develop osteophytes (osteoarthritis), the spinal nerves are often affected

• Pain along the distribution patterns of the dermatomes and spasm in the muscles derived from the associated myotomes
• Myotome: consists of all muscles or parts of muscles receiving innervation from one spinal nerve*

Question 21

Hyperextension/Whiplash

Answer 21

Overstretching of anterior longitudinal ligament (at front of vertebral body)

-most often in rear-end motor vehicle collisions

Question 22

What do you do for a patient who has had a fracture of the vertebral column?

Answer 22

Keep them in hyperextension. Pull of the anterior longitudinal ligament.

Question 23

Spondylosis

Answer 23

Calcification of edges of the vertebral bodies

-Causes joint pain and stiffness

Question 24

Spondylolysis

Answer 24

Separation of vertebral arch from vertebral body

-Fracture of the column of bones connecting the superior and inferior articular processes (pars interarticularis)

Question 25

Spondylolisthesis

Answer 25

Anterior displacement of vertebral body on inferior vertebral segment

Question 26

Rupture of Alar Ligament

Answer 26

Alar ligaments of Axis are weaker than transverse ligaments -Can cause increase of approximately 30% in the range of movement to the _contralateral side_

Question 27

Primary Curvature of Spine

Answer 27

Cervical Lordosis Thoracic Kyphosis Lumbar Lordosis Sacral Kyphosis

Question 28

Excess Thoracic Kyphosis (Kyphosis)

Answer 28

_Humpback_ of thoracic vertebrae

Question 29

Excessive Lumbar Lordosis (Lordosis)

Answer 29

_Swayback_ of lumbar vertebrae

Question 30

Scoliosis

Answer 30

Lateral curvature in spine (cervical, thoracic, or lumbar)

Question 31

What is the difference between back sprain, strain, and spasms?

Answer 31

**Back Sprain:** Injury to _ligamentous tissue_ w/o dislocation or fracture -Involves excessive stretching of fibers from overly strong muscle contraction **Back Strain:** Common injury from overly strong musclar contraction -Some degree of stretching or microscopic tearing of muscle fibers **Back Spasm:** Protective mechanism after an injury or in response to inflammation -Sudden involuntary contraction of one or more muscle groups

Question 32

Reduced Blood Supply to Brainstem

Answer 32

**Arteriosclerosis:** Blood flow reduced due to hardening of arteries -Affects vertebral arteries that go through transverse foramina of cervical vertebrae

Question 33

Lumbar puncture

Answer 33

Peform at L3/L4 or L4/L5 to avoid puncturing spinal cord - Pop occurs when needle passes through ligamentum flavum - CSF drawn from the arachnoid space/lumbar cistern

Question 34

Spinal cord injuries

Answer 34

* C1-C3: no function below head, respirator needed for life * C4-C5: no function of ribs, can breath on their own (quadraplegia) * C6-C8: Loss of function in hands and upper limbs) * T1-9: Paralysis of both lower limbs * T10-L1: Some thigh muscle function; walking with long leg braces * L2-L3: most lower limb function present; can walk with short leg braces

Question 35

Joint of Luschka

Answer 35

Joint between _unicate process of inferior vertebra_ and the inferior surface of the superior vertebra

Question 36

Second Number Rule

Answer 36

Cervical and lumbar regions: vertebral level at which the prolapse occurs will affect the spinal nerve with the second number designation Example: Injury to L4/L5 will affect spinal nerve L5. Example: Injury C5/6 will affect spinal nerve C6