OSTEOPOROSIS

Net demineralization of bones

Abnormal balance of calcium
Most affected areas: neck of femur, metacarpals, vertebra
Radiograph: diminished radiodensity of trabecular bone
thinned cortical bone
Horizontal stripping
Later stage: vertebral collapse and thoracic kyphosis

LAMINECTOMY
Surgical excision of spinous process
Removal of vertebral arch by transecting the pedicles
Relieve tumor, herniated IV disc, bony hypertrophy
DISLOCATION OF CERVICAL VERTEBRAE
Can be dislocated with less force: facets are more
horizontal
Facet jumping
FRACTURE AND DISLOCATION OF ATLAS
Jefferson/burst fracture- fracture of transverse ligament
FRACTURE AND DISLOCATION OF AXIS
Most common injury of cervical vertebrae
Pars interarticularis fracture due to hyperextension of head
on the neck- traumatic spondylolysis
Whiplash injury/ hangman's fracture- combined
hyperextension of head and neck
QUADRIPLEGIA/ DEATH
C2 displaced anteriorly to C3
Fracture of dens
Axis injury due to horizontal blows to head or osteopenia
LUMBAR LATERAL STENOSIS
Narrow vertebral foramen in one or more lumbar vertebrae
Compression of spinal nerve roots
CERVICAL RIBS
rst thoracic rib may elevate and place pressure on
structures that emerge from the superior thoracic aperture,
notably the subclavian artery or inferior trunk of the
brachial plexus
CAUDAL EPIDURAL ANESTHESIA OR CAUDAL ANALGESIA
local anesthetic agent is injected into the fat of the sacral
canal that surrounds the proximal portions of the sacral
nerves

INJURY OF COCCYX
abrupt fall onto the buttock
coccygodynia (or coccydynia), often follows coccygeal
trauma
Abnormal fusion of vertebrae
hemisacralization and sacralization of the L5 vertebra- L5
incorporated to sacrum
L4 L5 level degenerates
Lumbarization of S1- S1 fuses with L5
Effect of aging on vertebrae
Osteophyte (bony spicules) develop around the margins of
body
altered mechanics place greater stresses on the
zygapophysial joints
osteophytes develop along the attachments of the joint
capsules and accessory ligaments

ANOMALIES OF VERTEBRAE
associated with herniation of the meninges (meningocele, a
spina bida associated with a meningeal cyst) and/or the
spinal cord (meningomyelocele)
Severe forms of spina bida- neural tube defect
defective closure of the neural tube during the 4th week of
embryonic development

1/2

SPINA BIFIDA OCCULTA

neural arches of L5 and/or S1 fail to develop normally and
fuse posterior to the vertebral canal.
SPINA BIFIDA CYSTIC

vertebral arches may fail to develop completely

AGING OF IV DISCS
advancing age, the nuclei pulposi dehydrate and lose
elastin and proteoglycans while gaining collagen.
IV discs lose their turgor, becoming stiffer and more
resistant to deformation
nucleus becomes dry and granular and may disappear
altogether as a distinct formation
anulus brosis assumes an increasingly greater share of the
vertical load and the stresses and strains that come with it.
The lamellae of the anulus thicken and often develop
ssures and cavities.
HERNIATION OF NUCLEUS PULPOSUS
violent hyperexion of the vertebral column
nucleus pulposus further posteriorly toward the thinnest
part of the anulus brosus.
Compress nerve roots or cauda equina
nucleus pulposus usually extend posterolaterally--> anulus
brosus is relatively thin, and does not receive support
from either the posterior or the anterior longitudinal
ligaments
Most common: L4- L5,L5-S1
decrease in the radiographic intervertebral space
SCIATICA
pain in the lower back and hip radiating down the back of
the thigh into the leg- herniated lumbar IV disc that
compresses and compromises the L5 or S1 component of
the sciatic nerve
Straight leg test- pain
forcible hyperexion of the cervical region- rupture the IV
disc posteriorly without fracturing the vertebral body.
most commonly ruptured are those between C5C6 and
C6C7, compressing spinal nerve roots C6 and C7
FRACTURE OF DENS OF AXIS
Results in avascular necrosis
RUPTURE OF TRANSVERSE LIGAMENT
atlanto-axial subluxationincomplete dislocation of the
median atlanto-axial joint
Common among those with Down's syndrome
STEELES RULE OF THIRDS:
Approximately one third of the atlas ring is occupied by the
dens, one third by the spinal cord, and the remaining third
by the uid-lled space and tissues surrounding the cord
RUPTURE OF ALAR LIGAMENTS
combined exion and rotation of the head
FRACTURE AND DISLOCATION OF VERTEBRAE
crush or compression fracture of the body of one or more
vertebrae
hyperextension injury of the neck- injure posterior parts of
the vertebrae, fracturing by crush or compression of the
vertebral arches and their processes.
Severe hyperextension of the neck- occurs during rear-end
motor vehicle collisions; anterior longitudinal ligament is
severely stretched and may be torn
ZYGAPOPHYSIAL JOINTS
close to the IV foramina through which the spinal nerves
emerge from the vertebral canal.
When these joints 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
Denervation of lumbar zygapophysial joints- by
radiofrequency percutaneous rhizolysis
BACK PAIN
FIVE CATEGORIES OF STRUCTURES RECEIVE INNERVATION IN
THE BACK AND CAN BE SOURCES OF PAIN
Fibroskeletal structures: periosteum, ligaments, and anuli
brosi of IV discs.
Meninges: coverings of the spinal cord. Synovial joints:
capsules of the zygapophysial joints.
Muscles: intrinsic muscles of the back.
Nervous tissue: spinal nerves or nerve roots exiting the IV
foramina.
rst two are innervated by (recurrent) meningeal branches
of the spinal nerves and the next two are innervated by
posterior rami
REFERRED PAIN
Pain from nervous tissue; coming from the cutaneous or
subcutaneous area (dermatome) supplied by that nerve
LOCALIZED LOWER BACK PAIN (LBP
muscular, joint, or broskeletal pain.
Muscular pain is usually related to reexive cramping
(spasms)- produce ischemia
ZYGAPOPHYSIAL JOINT PAIN
associated with aging (osteoarthritis) or disease
(rheumatoid arthritis) of the joints.
ABNORMAL CURVATURE OF VERTEBRAL COLUMN
OSTEOPOROSIS
most prevalent metabolic disease of bone occurring in the
elderly
Humpback/hunchback
Excessive thoracic kyphosis
Dowagers hump
colloquial name for excessive thoracic kyphosis in older
women resulting from osteoporosis
EXCESSIVE LUMBAR LORDOSIS
hollow back or sway back
characterized by an anterior tilting of the pelvis (the upper
sacrum is exed or rotated antero-inferiorlynutation),
with increased extension of the lumbar vertebrae,
producing an abnormal increase in the lumbar kyphosis
Abnormal extension deformity
SCOLIOSIS
abnormal lateral curvature that is accompanied by rotation
of the vertebrae
spinous processes turn toward the cavity of the abnormal
curvature, and when the individual bends over, the ribs
rotate posteriorly (protrude) on the side of the increased
convexity
STRUCTURAL SCOLIOSIS
failure of half of a vertebra to develop (hemivertebra)
KYPHOSCOLIOSIS
structural scolioses is combined with excessive thoracic
kyphosis
IDIOPATHIC SCOLIOSIS
occurring without other associated health conditions or an
identiable cause
rst develops in girls between the ages of 10 and 14 and in
boys between the ages of 12 and 15
It is most common and severe among females

2/2

MYOPATHIC SCOLIOSIS
asymmetrical weakness of the intrinsic back muscles
FUNCTIONAL SCOLIOSIS
difference in the length of the lower limbs with a
compensatory pelvic tilt
Habit scoliosis- habitual standing or sitting in an improper
position
MUSCLES OF BACK
BACK SPRAIN
injury in which only ligamentous tissue, or the attachment
of ligament to bone, is involved, without dislocation or
fracture
from excessively strong contractions related to movements
of the vertebral column, such as excessive extension or
rotation.
BACK STRAIN
common injury in people who participate in sports
it results from overly strong muscular contraction.
The strain involves some degree of stretching or
microscopic tearing of muscle bers.
weight is not properly balanced on the vertebral column,
strain is exerted on the muscles
MYELOGRAPHY
Myelography is a radiopaque contrast procedure that allows
visualization of the spinal cord and spinal nerve roots
LUMBAR PUNCTURE
the withdrawal of CSF from the lumbar cistern
important diagnostic tool for evaluating a variety of central
nervous system (CNS) disorders.
Bet L3-L4 or L4-L5
ISCHEMIA
Deciency in blood supply
OBSTRUCTIVE ARTERIAL DISEASE
circulatory impairment if the segmental medullary arteries,
particularly the great anterior segmental medullary artery
(of Adamkiewicz)
PARAPLEGIA

lose all sensation and voluntary movement inferior to the

level of impaired blood supply to the spinal cord
SPINAL CORD INJURY

SPINAL CORD SHOCK

protrusion of a cervical IV disc into the vertebral canal after
a neck injury
TRANSECTION OF THE SPINAL CORD
results in loss of all sensation and voluntary movement
inferior to the lesion.
C1C3: no function below head level; a ventilator is
required to maintain respiration.
C4C5: quadriplegia (no function of upper and lower limbs);
respiration occurs.
C6C8: loss of lower limb function combined with a loss of
hand and a variable amount of upper limb function; the
individual may be able to self-feed or propel a wheelchair.
T1T9 paraplegia (paralysis of both lower limbs); the
amount of trunk control varies with the height of the
lesion.
T10L1: some thigh muscle function, which may allow
walking with long leg braces.
L2L3: retention of most leg muscle function; short leg
braces ma be required for walking