Back Clinical Notes FC

What is whiplash?

hyperextension

When does whiplash/hyperextension most commonly occur?

automobile accidents

What does hyperextension/whiplash result in?

excessive stretching and even tearing of the anterior longitudinal lig.

What is impacted during whiplash?

anterior longitudinal ligament.

A recoil affect during whiplash can often result in what additional injury?

hyperflexion

What is the role of the anterior longitudinal ligament when there is a fracture of the vertebral column?

It has a splinting action (except during fractures due to hyperextension)

When a fracture of the vertebral column occurs, what position should the patient be kept in?

hyperextension

When there is a fracture of the vertebral column, how are the fragments realigned and kept from further injury of the spinal cord?

The pull of the anterior longitudinal lig. helps.

Herniation of the nucleus pulposus through the annulus fibrosis is a common cause of what?

low back and lower limb pain

Where does herniation of the nucleus pulposus usually occur?

posterolatterally where the annulus fibrosis receives no support from the anterior and posterior longitudinal lig.

What does physiologically, does the herniation of the nucleus pulposus result in?

a bulge that compresses the spinal nerve roots, cauda equina, and spinal nerves in the vertebral canal and intervertebral foramen respectively.

Herniation of the nucleus pulposus is most common between what vertebra?

L4/L5 and L5/S1

Why does herniation of the nucleus pulposus more often occur at L4/L5 and L5/S1?

the discs are much larger and therefore more mobile

When the cervical vertebrae move from normal position (prolapse), what corresponding nerve is affected?

The spinal nerve with the second number designation

Ex: prolapse of C5/C6 affects nerve 6

When the lumbar vertebrae move from normal position (prolapse), what corresponding nerve is affected?

It will affect the second number.

Ex: L4/L5 prolapse affects spinal nerve 5

When the thoracic vertebrae move from normal position (prolapse), what corresponding nerve is affected?

first number

Ex: T2/T3 → T2 is affected

What is a Jefferson or Burst Fracture?

A fracture of both arches of the atlas due to a blow to the top of the head.

Describe how Jefferson fracture will impact the spinal cord?

The fracture alone will not typically injure the spinal cord, but if the transverse lig. is ruptured the odontoid process may injure the spinal chord.

What two places is the axis most susceptible to fracture?

1. odontoid process

2. vertebral arch

What is a Hangman’s Fracture?

Fracture of the vertebral arch

What does a hangman fracture usually result from?

hyperextension of the head on the neck (not both head and neck)

What does a fracture of the odontoid process usually result from?

Horizontal blow to the head

How does the transverse lig. impact an odontoid process fracture?

During a blow to the head, the transverse lig. is stronger than the odontoid process and breaks it.

How does the location of the odontoid process break, impact healing and why?

If it breaks at the base, it will usually not heal because the transverse lig. is holding it away from its blood supply.

If it breaks at the inferior to the inferior to the base, it is more likely to heal

What is spina bifida occulta?

Developmental abnormality in which the vertebral lamina fails to fuse and close off the vertebral canal

At what vertebral location does spina bifida occulta usually occur?

L5 and S1

What is a sign of spina bifida occulta?

tuft of hair over the defect

How does spina bifida occulta differ from spina bifida cystica?

Spina bifida cystica occurs when the condition incorporates neural tissue and meninges

Is less or more force required to dislocate the cervical vertebra?

Less force

Why is less force required to dislocate the cervical vertebrae?

Because the articulating facets of the cervical vertebrae are more horizontal

How does a dislocation of the cervical vertebrae affect the spinal cord?

It does not usually injure the spinal cord due the large vertebral foramen

What is spondylosis?

A degenerative joint disease which involves the calcification of the edges of the vertebral body and can cause localized pain and stiffness.

What is spondylosis?

Separation of the vertebral arch from the vertebral body.

What is spondylolisthesis?

anterior displacement of the vertebral body on the inferior vertebral segment.

Narrowing of the lumbar vertebral foramen is known as?

lumbar spinal stenosis

How does lumbar spinal stenosis impact the spinal nerve roots?

compresses one or more

When lumbar spinal stenosis is compounded with intervertebral disc bulging what occurs?

Arthritic proliferation and ligamentous degeneration of the vertebral canal is more compromised.

What is a lumbar puncture used for?

diagnostics of central nervous system disorders

Where is the needle for the lumbar puncture inserted?

Between L3/L4 or L4/L5 at the level of the iliac crest

Why is the needle for a lumbar puncture inserted between L4/5 or L3/4?

Avoid needle injuring the spinal cord by passing the ligamentum flavum and passes into the lumbar cistern deep to the spinal dura and arachnoid mater. Cerebrospinal fluid can then be drawn out and evaluated

What is sacrilization?

partial or complete incorporation of the L5 into the sacrum.

What is lumbarization?

S1 vertebra is separated from the sacrum

How can the coccyx be fractured, bruised, or dislocated?

abrupt falls on the lower back and difficult childbirth

What can follow coccygeal trauma?

coccygodynia, which is painful and difficult to treat

What is an injury to the ligamentous attachments between bone?

back sprain

What is the result of inadequate stretching before activity?

back sprain

What happens physiologically during back sprain?

excessive stretching and sometimes tearing of muscle fibers produced by an overly strong muscular contraction

What is a protective measure of muscle tissue?

spasm and involuntarily contract in response to injury and inflammation

What does complete transection of the spinal cord result in?

a loss of sensation and motor function below the lesion.

What happens when C1-3 is transected (cut/injured)?

no function below the head, respirator necessary for life)

What happens when C4-5 is transected (cut/injured)?

no function of limbs, respiration capable

What happens when C6-8 is injured/cut?

loss of hand and variable upper limb function (may be able to propel a wheel chair)

What happens when T1-9 is injured?

paralysis of both lower limbs

What happens when T10-L1 is injured?

some thigh muscle function (may allow walking with long leg braces)

What happens when L2-3 spinal nerves are damaged?

most lower limb functions present (may be able to walk with short leg braces)

What are the five categories of structures innervated by recurrent meningeal n. and posterior rami of psinal nerves?

1. fibroskeletal structures (recurrent meningeal)

2. Meninges (recurrent meningeal)

3. synovial joints (posterior rami)

4. intrinsic back muscles (posterior rami)

5. spinal nerves and roots (posterior rami)

What are the most common structures that contribute to back pain?

1. intrinsic back muscles

2. fibroskeletal

3. joints

Back muscular pain is usually the result of?

spasm in muscular tissue producing ischemia

Back joint pain is usually the result of?

osteoarthritis or disease arthritis

Fibroskeletal joint pain is usually a result of?

fractures and dislocations of ligamentous structures