MSK Spine

Question 1

Clinical course for neck/back pain
____ resolve by 1-2 weeks
____ resolve by 6-12 weeks

85% recur by:

Answer 1

50%
90%

1-2 years

Question 2

____ constitutes the 2nd most common reason for primary care physician office visits

Answer 2

the 10% of patients with residual symptoms of neck/back pain

Question 3

Red flags for back/neck pain:
Name the condition:

1. Gait ataxia/UMN changes
2. Bowel/bladder/sexual dysfunction
3. Night pain/weight loss
4. Fevers/Chills

Answer 3

1. Myelopathy
2. Cauda Equina syndrome
3. Tumor
4. Infection

Question 4

In the work force, what are the top two reasons for absenteeism?

Answer 4

1. upper respiratory infections

2. low back pain

Question 5

Regarding absenteeism and return-to-work expectations for low back pain

Time missed from work: (name RTW percentage)

1. ~6 months:
2. ~1 year:
3. ~ 2 years:

Answer 5

1. 50%
2. 25%
3. 0

Question 6

Name the atypical C spine vertebrae

typical?

Answer 6

1. Atlas (C1) ring shaped with two lateral masses. No vertebral body or spinous process. Axis (C2) has odontoid process, bifid spinous process (like C2-6)
2. C3-7
   Anterior region: cervical uncinate processes: raised margins along the lateral aspect of the superior surface of the cervical vertebral body.
   Posterior region: pedicles, superior articular processes, inferior articular processes, laminae, TP, foramen transversarium, and SP

Question 7

In cervical disc degenerative disease, the raised margins approximate with the body of the superior vertebra. The end result is the degenerative joint change called _____.

Answer 7

joint of luschka (unconvertebral joint)

the joints of luschka function to limit lateral translation.

Question 8

Name the unique characteristics of thoracic vertebrae:

1. Anterior region
2. Posterior region

Answer 8

1. VB with articulations for ribs

2. Pedicles, SAP, IAP, laminae, transverse processes with articulations for rib tubercles and spinous processes.

Question 9

____ is an anomalous fusion of the 5th lumbar vertebrae with the sacrum
Incidence: ____ complete, ____ incomplete

Answer 9

sacralization
1% complete
6% complete

Question 10

a 3-joint complex is formed between 2 lumbar vertebrae:

2. 3.

Answer 10

1. vertebral body endplate-disc-endlplate joint
2. zygapophyseal joint
   3 zygapophyseal joint

Question 11

____ is an anomalous partial or complete nonunion of the first and second segment of the sacrum. This forms an additional lumbar segment (L6) and leaves 4 remaining fused sacral segments.

Incidence:

Answer 11

Lumbarization

4%

Question 12

Name the components of the zygapophyseal joint: 5

Answer 12

AKA: ZP-joint, apophyseal joint, facet joint

1. Superior articular process (SAP)
2. Inferior articular process (IAP)
3. Joint capsule
   4 Articular cartilage
4. Meniscus

Question 13

Name the sacral ligaments:

Answer 13

1. Superior iliolumbar
2. Anterior iliolumbar
3. Inferior Iliolumbar
4. Posterior sacroiliac ligament
5. Sacrospinous ligament
6. Sacrotuberous ligament
7. Anterior sacroiliac ligament.
8. Interosseous ligaments (at SI joint)

Question 14

AA and OA joints have no true ___ joints due to their atypical anatomy.

Answer 14

ZP joints

Question 15

Facet joints are positioned in a ___ plane in C3-7.
In a thoracic plane?
Lumbar?

Answer 15

Frontal (coronal)
Frontal (coronal)
Lumbar begins in sagittal plane, progresses to frontal plane at L5/S1.

Question 16

Each ZP joint has ___ innervation.

Name them

Answer 16

dual - from medial branches of the dorsal primary ramus off that spinal nerve.

Question 17

1 ZP joints in the cervical spine contain innervations from what level?

2. ZP joints in the thoracic and lumbar spine contain innervations from what levels?

Answer 17

1 same level and one level below
Example:
C5-6 ZP joint is supplied by C5 and C6 medial branches

2. Same level and one level below.
   Example:
   L4/5 ZP joint is supplied by medial branch of L4 and L3.

Question 18

Name the three primary functions of ZP joints

Answer 18

1. Direct vertebral motion
2. Resist shearing and rotational forces
3. Weight bearing: increased with extension

Question 19

Intervertebral discs are comprised of what three things?

Answer 19

1. Nucleus pulposus: A viscous muco-protein gel mixture of water and proteoglycans in a network of Type II collagen that braces the annulus to prevent buckling.
2. Annulus fibrosus: Type I collagen fibers arranged in obliquely running lamellae that encase the nucleus pulposus and are attached to the vertebral endplate plates. This orientation withstands distraction and bending but is relatively weaker for torsional stresses
3. Vertebral endplate - cartilaginous covering of the VB apophysis, forming the top and bottom of the disc.

Question 20

what is the vascular supply of the intervertebral disc?

Answer 20

avascular by adulthood

Question 21

Innervation of intervertebral disc

1. Outer 1/3 of disc
2. Nucleus pulposus
3. Anterolateral annulus fibrosis
4. Posterior part

Answer 21

1. outer 1/3 of the disc containing the annulus fibrosis: dual innervation from ventral rami
2. Nucleus pulposus lacks innervation
3. Anterolateral part of the annulus fibrosis: ventral rami and grey rami communicans
4. Posterior part of the annulus fibrosis: sinuvertebral nerves (recurrent branches off of the ventral rami)

Question 22

name the two functions of the intervertebral disc:

Answer 22

1. allows for VB motion

2. Weight bearing

Question 23

In relation to 100% at erect posture, what is the least amount of pressure (position) and the most pressure:

Answer 23

least: lying supine (25%)
Most: sitting slumped over in a chair 275%; next is bending over with a straightback and legs. 220%

Question 24

Which positions apply the most pressure to the low back?

Answer 24

Lying supine with legs elevated (35%)
Doing a sit up 210%

if 100% is standing erect.

Question 25

Aging effects of intervertebral discs 3 things decrease 3 things increase

Answer 25

decreases: - nuclear water content - ratio of chondroitin:keratin - proteoglycan molecular weight Increases - Fibrous tissue - cartilage cells - amorphous tissue

Question 26

The following nerves supply: 1. Ventral primary rami: (2) 2. Dorsal primary rami: (three branches) 3. Sinuvertebral nerve (4)

Answer 26

1. trunk musculature, plexus contributions 2. Lateral: iliocostalis, skin - Intermedius: Longissimus - Medial: multifidi, rotators, interspinalis, intertransversarii, posterior spinal ligaments, zygapophyseal joints 3. Posterior longitudinal ligament, posterior disc, anterior dura, vertebral body

Question 27

____ runs the entire length of the spine, covering the anterior aspect of each vertebral body and disc. Function: limits hyperextension and forward movement

Answer 27

Anterior longitudinal ligament

Question 28

Posterior longitudinal ligament attaches to the posterior rim of the vertebral bodies and disc from ____ to ____. It continues superiorly with _____>

Answer 28

C2-sacrum | superiorly: tectorial membrane to occiput.

Question 29

Function of Posterior longitudinal ligament:

Answer 29

prevents hyperflexion of the vertebral column.

Question 30

____ is the superior continuation of the supraspinous ligament extending from the occipital protuberance to C7. Function:

Answer 30

Ligamentum flavum boundary of the deep muscle in the cervical region

Question 31

____ connects adjacent vertebral arches longitudinally, attaching laminae to laminae Function:

Answer 31

Ligamentum flavum maintains constant disc tension and assists in straightening the column after flexion.

Question 32

Supraspinous ligament runs from ___ to ___. function:

Answer 32

runs spinous process to spinous process (so does interspinous ligament) weakly resist both spinal separation and flexion

Question 33

Intertransverse ligament runs: | Function:

Answer 33

runs transverse process to transverse process resists lateral bending of the trunk.

Question 34

Cervical region landmarks ``` Anterior C2 C3 C4, C5 C6 ``` Posterior C2 C7 articular pillars

Answer 34

``` Anterior C2 - TP palpated at the angle of the mandible C3 hyoid bone C4/5 thyroid cartilage C6 first cricoid ring, carotid tubercle ``` posterior C2 - first palpable midline spinous process (2 finger-breadths below the occiput) C7 - Vertebral prominens (largest spinous process; nonbifid) Articular pillars: lateral off the spinous process bilaterally

Question 35

Thoracic region landmarks T3 T8 T12

Answer 35

T3 spine of scap T8 inferior angle of the scap T12 lowest rib

Question 36

Lumbar region L4 S2

Answer 36

L4 iliac crests | S2 PSIS

Question 37

Name the extrinsic back muscles: Superficial layer Intermediate layer:

Answer 37

Superficial layer - trapezius - lats Intermediate - serratus posterior superior and inferior

Question 38

Name the intrinsic muscles of the back 1. Superficial layer 2. Intermediate layer (special group) 3. Deep layer

Answer 38

1. Superficial layer - splenius capitis - splenius cervices 2. Intermediate layer (erector spinae) - Iliocostalis: lumborum, thoracis, cervices - Longissimus: thoracis, cervicis, capitis - Spinalis: thoracis, cervicis, capitis 3. Deep layer - Transversospinal muscles (semispinalis: thoracis, cervicis, capitis). multifidus, rotators - Interspinalis, intertransversarii muscles

Question 39

The occipitoatlantal joint has ____ of flexion/extension of the entire cervical spine

Answer 39

50%

Question 40

The atlantoaxial joint has ____ of rotation of the entire cervical spine

Answer 40

50%

Question 41

What are the 3 phases of kirkaldy-willis: the degenerative cascade of spondylosis

Answer 41

1. dysfunction 2. instability 3. stabilization. it is initiated by a rotational strain or compressive force to the spine during lumbar flexion. Pathology of 1 component (disc or Z-joint) influences deterioration of the other components and adjacent vertebrae.