Unit 3, Lecture 1 Moorified

What is a functional causation of scoliosis? A. weakened intrinsic musculature on a unilateral side of the body B. infection of the thoracic spine C. consistent sitting or standing inappropriately D. leg lengths are different and the pelvis tilts during standing

D. leg lengths are different and the pelvis tilts during standing slide 13 "Abnormal lateral curve: -Lumbar in nature but can affect thoracic region as well -80% idiopathic-no cause -Myopathic: weakened intrinsic muscles on one side -**Functional: difference in leg lengths causing to stand causing pelvic tilt** -Habitual: standing or sitting inappropriately Moore 482 "Problems extrinsic to a structurally normal vertebral column, such as asymmetrical weakness of the intrinsic back muscles (myopathic scoliosis), or a difference in the length of the lower limbs with a compensatory pelvic tilt, may lead to a functional scoliosis."

How many vertebrae are in the vertebral column of an adult after fusion occurs? a. 26 b. 27 c. 32 d. 33

a. 26 Slide 5

Upon performing a sports physical exam on your 18 year old patient, you have them flex at the waist and try to touch their toes. You note a lateral curve of the lumbar and thoracic vertebrae, revealing a visibly crooked spine. Upon further questioning, the patient reveals that they have noticed a difference in the length of their legs, causing a pelvic tilt. What is the disorder? a. Myopathic scoliosis b. Functional scoliosis c. Functional Kyphosis d. Myopathic lordosis e. Habitual scoliosis

b. Functional scoliosis 482 "Problems extrinsic to a structurally normal vertebral column, such as asymmetrical weakness of the intrinsic back muscles (myopathic scoliosis), or a difference in the length of the lower limbs with a compensatory pelvic tilt, may lead to a functional scoliosis."

Which of the following is a unique characteristic of the cervical vertebrae? A) Bifid spinous process B) Costal facets C) Small processes for muscle attachment D) Triangular shape

A) Bifid spinous process pic 447

A 10 year old child presents to the ED with complaints of severe neck pain. He admits to you that he was not following the rules and tried to dive into the shallow end of the pool and hit his head on the bottom. On exam you do not find any evidence of spinal cord injury, but you do notice that the child's upper neck is tender and painful. What will an Xray most likely show? a. Fracture of atlas b. Fracture of Axis c. Slipped disc d. Compression fracture of C4

a. Fracture of atlas (Moore pg. 458) "The atlas (vertebra C1) is a bony ring, with two wedgeshaped lateral masses, connected by relatively thin anterior and posterior arches and a transverse ligament (Fig. 4.4A). Because the taller side of the lateral mass is directed laterally, vertical forces (as would result from striking the bottom of a pool in a diving accident) compressing the lateral masses between the occipital condyles and the axis drive them apart, fracturing one or both of the anterior or posterior arches (Fig. B4.4B)."

Kyphosis and scoliosis, respectively, are a. anterior compression of the thoracic vertebra body, abnormal lateral curvature b. abnormal lateral curvature, anterior compression of the thoracic vertebra body c. posterior compression of the thoracic vertebra body, abnormal posterior curvature d. abnormal posterior curvature, posterior compression of the thoracic vertebra body

a. anterior compression of the thoracic vertebra body, abnormal lateral curvature

How many vertebrae are in the vertebral column? a. 32 b. 33 c. 35 d. 37

b. 33

How many bones are in the vertebral column of infants and adults, respectively? a. 26, 33 b. 33, 26 c. 23, 36 d. 36, 23 e. 24, 24

b. 33, 26 Slide 5

The spine forms the main part of which of the following? a. Appendicular Skeleton b. Axial Skeleton c. Exoskeleton d. Endoskeleton

b. Axial Skeleton (Slide 4) moore 440 "The vertebrae and IV discs collectively make up the vertebral column (spine), the skeleton of the neck and back that is the main part of the **axial skeleton** (i.e., articulated bones of the cranium, vertebral column, ribs, and sternum) (Fig. 4.1D)."

Mrs. Edith Lotzakatz is a 64 year old retired librarian presenting to her primary care PA for her annual exam, today she is also endorsing back pain that has gradually worsened over the past few months and is worried it be arthritis. The patient is post-menopause, and labs reveal low calcium levels. A radiograph of the spine shows demineralization in the spine. The PA informs Mrs. Lotzakatz that she has osteoporosis in the most common area of the spine for this to develop, which area would this be? a. pedicles of the lumbar vertebrae b. bodies of the thoracic vertebrae c. bodies of the atlas and axis d. transverse processes of the lumbar vertebrae e. pedicles of the thoracic vertebrae

b. bodies of the thoracic vertebrae page 456 vertebral body osteoporosis blue box "Although osteoporosis affects the entire skeleton, the most affected areas are the neck of the femur, the bodies of vertebrae, the metacarpals (bones of the hand), and the radius. These bones become weakened and brittle, and are subject to fracture." pic 456 "Early to moderate osteoporosis, characterized by vertical striation in the vertebral bodies."

A 67-year old female patient presents to the clinic for lower back pain that radiates down the lateral side of her thighs. During your history taking the patient discloses that the pain has really been slowing her down from all of her activities, but she has still been able to maintain her own grocery shopping as the pain subsides when pushing a shopping cart. You remember that a positive shopping cart sign is suggestive of lumbar spinal stenosis. What is the most likely surgical option that will be considered for this patient? a) Fusion of the L1-:L5 vertebrae b) Fusion of the sacrum to the coccyx c) Laminectomy of the lumbar vertebrae d) Laminectomy of the thoracic vertebrae

c) Laminectomy of the lumbar vertebrae BB 457 "The surgical excision of one or more spinous processes and the adjacent supporting vertebral laminae in a particular region of the vertebral column is called a laminectomy (*#1 in Fig. B4.2A*). The term is also commonly used to denote removal of most of the vertebral arch by transecting the pedicles (*#2 in Fig. B4.2A*)." BB 460 "Lumbar spinal stenosis describes a stenotic (narrow) vertebral foramen in one or more lumbar vertebrae (Fig. B4.6B). This condition may be a hereditary anomaly that can make a person more vulnerable to age-related degenerative changes such as IV disc bulging. Lumbar spinal nerves increase in size as the vertebral column descends, but paradoxically, the IV foramina decrease in size."

Which of the following is a classical finding for only cervical vertebrae? a. Transverse Process b. Costal Facet c. Foramen Transversarium d. Pedicle

c. Foramen Transversarium (Moore p. 447) 444 "The most distinctive feature of each cervical vertebra is the oval foramen transversarium (transverse foramen) in the transverse process. The vertebral arteries and their accompanying veins pass through the transverse foramina, except those in C7, which transmit only small accessory veins. Thus the foramina are smaller in C7 than those in other cervical vertebrae, and occasionally they are absent." moore yellow 463 "The chief regional characteristics of vertebrae are: foramina trans versarii for cervical vertebrae, costal facets for thoracic vertebrae, the absence of foramina transversarii and costal facets for lumbar vertebrae, the fusion of adjacent sacral vertebrae, and the rudimentary nature of coccygeal vertebrae."

While examining a patient on your preceptorship, you notice an abnormal curvature to the patients spine. When asking them to bend over, one side of their back raises higher in the air than the other. You remember while looking through this patients chart seeing a diagnosis of hemiplegia early on in their life. What is the most likely cause of the patients Scoliosis? a. Functional b. Habitual c. Myopathic d. Vertebral degradation

c. Myopathic The back - slide 13

Severe forms of spina bifida result from what? a. Drinking during the third trimester b. Smoking during the third trimester c. Neural tube defects d. Umbilical cord compression during labor

c. Neural tube defects Pg 463 Abnormalities of Vertebrae "A common birth defect of the vertebral column is spina bifida occulta, in which the neural arches of L5 and/or S1 fail to develop normally and fuse posterior to the vertebral canal. This bony defect, present in up to 24% of the population (Greer, 2009), usually occurs in the vertebral arch of L5 and/or S1. The defect is concealed by the overlying skin, but its location is often indicated by a tuft of hair. Most people with spina bifida occulta have no back problems."

A 65 year old women comes to the ER after falling while roller-blading down the street in her neighborhood. Knowing that post-menopausal women are more prone to fractures due to osteoporosis, you are concerned about what component of the back that is especially sensitive to demineralization? a. Spinous processes b. Vertebral foramen c. Vertebral body d. Vertebral arch

c. Vertebral body Blue box #456-457 "Vertebral body osteoporosis is a common metabolic bone disease that is often detected during routine radiographic studies. Osteoporosis results from a net demineralization of the bones caused by a disruption of the normal balance of calcium deposition and resorption. As a result, the quality of bone is reduced and atrophy of skeletal tissue occurs. Although osteoporosis affects the entire skeleton, the most affected areas are the neck of the femur, the **bodies of vertebrae**, the metacarpals (bones of the hand), and the radius. These bones become weakened and brittle, and are subject to fracture."

The vertebral column combines with what other aspects of the skeleton to form the main part of the axial skeleton? a. cranium, ribs, and os coxae b. ribs, sternum, and scapulae c. cranium, ribs, and sternum d. ribs, scapulae, and sternum

c. cranium, ribs, and sternum slide 4

8 year old boy chief complaint of gradual onset back pain. Pain is worse after activity and at the end of the day and improves with rest. Physical exam reveals rigid kyphosis with a relatively sharp angulation when he bends over. The curvature does not flatten with forward bending, extension, or lying supine. Standing lateral spine radiograph shows wedging of 8º in the thoracic vertebral bodies as well as degeneration of the end plates and Schmorl nodes to the lumbar spine. Treatment for Scheuermann's disease is conservative: strengthening and stretching exercises, analgesics, and avoidance of precipitants. Schmorl nodes are a. degeneration of the vertebral body b. anterior degeneration of the vertebral body causing increased convexity of the lumbar spine c. herniation of the disc into the vertebral end plate d. Lateral curvature of the spine

c. herniation of the disc into the vertebral end plate slide 44

While enjoying the sun at the community pool, you see a man doing the back stroke doing laps. Unfortinately he wasn't paying attention and hit his head on the side of the pool with a head on collision. What may result from this type of injury? a. Compression of the lateral masses between occipital condyles b. Fracture of anterior or posterior arches c. Rupture of the transverse ligament d. Spinal cord damage e. All of the above

e. All of the above

The axial skeleton is comprised of: a. Vertebrae only b. Vertebrae and cranium c. Vertebrae, cranium and pelvis d. Vertebrae, cranium, ribs and pelvis e. Vertebrae, cranium, ribs and sternum

e. Vertebrae, cranium, ribs and sternum Slide #4

A 14 year old girl named Emma comes in for a well-child visit. Although USPTF's newest guidelines recommend against screening all adolescents for scoliosis, Emma's mother says she is concerned because she has noticed a curve in daughter's spine and that one shoulder seems higher than the other. You do an exam and confirm a minor scoliosis. You recommend PT to start, but Emma's mother asks what is causing this and if they can fix it. You tell her: A. It is most likely idiopathic. B. It is definitely caused by intrinsic back muscle weakness. C. It's most likely caused by the way Emma stands D. It's definitely from having different leg lenths. E. It is most likely due to a previous injury.

A. It is most likely idiopathic. **p7/slide 13 and page 482 of Moore "Approximately 80% of all structural scolioses are idiopathic, occurring without other associated health conditions or an identifiable cause. Idiopathic scoliosis first 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."

Violet, a 70-year-old Caucasian woman diagnosed with osteoporosis, presents to your office with a chief complaint of back pain. Upon general inspection, you note that Violet appears alert and oriented, is well and appropriately dressed, and sits hunched forward in her chair with her purse in her lap. As you assist her to the exam table, you notice that she is slightly unbalanced and remains hunched forward. Other than a tender vertebral column, you notice nothing unusual during the physical exam. An x-ray is ordered and shows abnormal curvature of the vertebrae. What abnormal curvature is commonly seen in post-menopausal women with osteoporosis? A. Kyphosis: increased convexity of thoracic vertebrae B. Kyphosis: increased concavity of the thoracic vertebrae C. Lordosis: increased convexity of the neck or lumbar vertebrae D. Lordosis: increased concavity of the neck or lumbar vertebrae E. Scoliosis: increased lateral curvature that is lumbar in nature, but can affect the thoracic region as well

A. Kyphosis: increased convexity of thoracic vertebrae Vertebral Column Powerpoint Slides 10-14. Moore Pgs. 456-457 pic 481 BB 480 "Excessive thoracic kyphosis (clinically shortened to kyphosis, although this term actually applies to the normal curvature, and colloquially known as humpback or hunchback) is characterized by an abnormal increase in the thoracic curvature; the vertebral column curves posteriorly (Fig. B4.17B & F). This abnormality can result from erosion (due to osteoporosis) of the anterior part of one or more vertebrae. *Dowager's hump is a colloquial name for excessive thoracic kyphosis in older women* resulting from osteoporosis. However, this type of kyphosis also occurs in elderly men (Swartz, 2009)."

A 36 year old woman who is 12 weeks post-partum presents in your clinic complaining of lower back pain and abdominal weakness. As part of the physical exam, you inspect the patient's back to see an increased concave curvature of the lower back giving her a "swayback" appearance. What hyperextension compensatory abnormality would most likely be seen on spinal xray? A. Lordosis B. Kyphosis C. Scoliosis D. Spinal Dysraphism E. Osteoporosis

A. Lordosis pic 481

An 85 year old female patient comes to the clinic with severe pain in her lower back. Her former doctor once told her that she has an extra thoracic vertebrae, which she thinks is causing this pain. She says the pain is oddly relieved when she walks up the stairs to her room, but really hurts when she is sleeping. What do you think is the cause of this pain? A) T13 is stretching the nerve receptors in her neural canal B) Stenosis of the lumbar vertebra leading to impingement of the neural canal C) Lordosis of the spine from aging leading to strained and weakened trunk muscles D) Idiopathic scoliosis leading to a pinched nerve

B) Stenosis of the lumbar vertebra leading to impingement of the neural canal pic 460

Which portion of the vertebrae is larger as moving superior to inferior due to the weight bearing characteristics? A) Vertebral arch B) Vertebral body C) Spinous Process D) Lamina

B) Vertebral body

Which set of vertebrae is the least tightly interlocked? A. Lumbar B. Cervical C. Thoracic D. Sacral E. Coccygeal

B. Cervical (page 457. Reasoning: due to more horizontal articular facets) "Because of their more horizontally oriented articular facets, the cervical vertebrae are less tightly interlocked than other vertebrae. The cervical vertebrae, "stacked like coins," can be dislocated in neck injuries with less force than is required to fracture them (Fig. B4.3A-F)."

What answer includes the correct number of vertebra found in the human vertebral column? A. Cervical: 10, Thoracic: 7, Lumbar: 3, Sacral: 5, Coccygeal:4 B. Cervical: 7, Thoracic: 12, Lumbar: 5, Sacral: 5, Coccygeal: 4 C. Cervical: 8, Thoracic: 10, Lumbar: 4, Sacral: 4, Coccygeal:4 D. Cervical: 5, Thoracic: 12, Lumbar: 7, Sacral: 4, Coccygeal:5

B. Cervical: 7, Thoracic: 12, Lumbar: 5, Sacral: 5, Coccygeal: 4 pic slide 5

A 26 year old male presents to the clinic following injury from a stunt to become Youtube famous. The patient reports a hard fall to his buttocks. Imaging shows a break in the tailbone. What is a potential long-term effect of the patient's failed attempt at his stunt? A. Lumbar stenosis B. Coccygodynia C. Cauda Equina Syndrome D. Sacrodynia

B. Coccygodynia P. 461 "An abrupt fall onto the buttocks may cause a painful subperiosteal bruising or fracture of the coccyx, or a fracture—dislocation of the sacrococcygeal joint. Displacement is common, and surgical removal of the fractured bone may be required to relieve pain. An especially difficult childbirth occasionally injures the mother's coccyx. A troublesome syndrome, coccygodynia (or coccydynia), often follows coccygeal trauma; pain relief is commonly difficult."

After being admitted for anorexia nervosa, a 16 yo female is having a physical assessment to determine the extent of damage to her body. Exam shows a frail female who appears younger than her stated age and stands hunched over. A vertebral x-ray shows radiolucent vertebral bodies with striations. Her labs show an elevated PTH and low Ca level. Which of the following needs to be added to her diagnosis list? A. Hyperparathyroidism B. Osteoporosis C. Scoliosis D. Lumbar Spinal Stenosis

B. Osteoporosis Vertebral Body Osteoporosis pg 456 BB 456 "Vertebral body osteoporosis is a common metabolic bone disease that is often detected during routine radiographic studies. Osteoporosis results from a net demineralization of the bones caused by a disruption of the normal balance of calcium deposition and resorption. As a result, the quality of bone is reduced and atrophy of skeletal tissue occurs. Although osteoporosis affects the entire skeleton, *the most affected areas are* the neck of the femur, the bodies of vertebrae, the metacarpals (bones of the hand), and the radius. These bones become weakened and brittle, and are subject to fracture."

A 13 year-old female is in for her annual well check exam. During her visit you have her stand up straight and then bend at the waist. You notice some unevenness in her upper back and note that her right scapula protrudes and is elevated higher than her left scapula. What do you suspect this patient may have? A. Thoracic nerve damage B. Scoliosis C. Compression of thoracic vertebrae D. Spina bifida

B. Scoliosis Slide 15 pic 481

A 12 year-old female presents to the clinic with her mom and reports worsening lower back pain over the last 3 months, both with standing and sitting. After ruling out several possible causes of the pain, you order an x-ray of the lumbar/sacral regions of her back and notice that the girl's L5 has become partially fused with S1, resulting in the L4-L5 relationship to become degenerative and weakened. You immediately recall a congenital condition in which the lumbar vertebra fuses completely or partially with the sacrum on either or both sides, resulting in pain. What is this congenital defect commonly referred to as? A: Lumbar Spinal Stenosis B: Hemisacralization C: Lumbarization D: Osteopenia

B: Hemisacralization -Blue Box on pg. 462 in Moore "Abnormal Fusion of Vertebrae: In approximately 5% of people, L5 is partly or completely incorporated into the sacrum—conditions known as *hemisacralization* and sacralization of the L5 vertebra (Fig. B4.8A), respectively. In others, S1 is more or less separated from the sacrum and is partly or completely fused with L5 vertebra, which is called *lumbarization* of the S1 vertebra (Fig. B4.8B). When L5 is sacralized, the L5-S1 level is strong and the L4-L5 level degenerates, often producing painful symptoms.

Which curvature becomes more obvious as the infant starts walking? A) Cervical B) Thoracic C) Lumbar D) Sacral E) Coccygeal

C) Lumbar 471 "The cervical lordosis becomes fully evident when an infant begins to raise (extend) the head while prone and to hold the head erect while sitting. The lumbar lordosis becomes apparent when toddlers begin to assume the upright posture, standing and walking."

A 63 year old female nurse comes to your office with complaints of back pain worsening in the last month. She is concerned that she cannot continue working with this severe pain. She reports the pain is worst while standing or laying down in bed, but seems to be relieved while hunching over the nurses's station. MRI reveals a complete impingement of the neural canal in the lumbar region. What is this condition for which a decompressive laminectomy may be performed? A) Herniated disc B) Jefferson impingement C) Lumbar spinal stenosis D) Neural canal decay

C) Lumbar spinal stenosis

A 29-year-old female was giving birth to her first child. As she anticipated much of the pain often associated with childbirth, she requested a caudal epidural anesthesia to help make her experience less traumatic. Which of the following nerves are blocked by the anesthetic to inhibit sensation inferior to the epidural block? A) T12-L1 spinal nerves B) L1-L5 spinal nerves C) S2- Co1 spinal nerves D) S3-Co4 spinal nerves

C) S2- Co1 spinal nerves BB 461 "In living persons, the sacral hiatus is closed by the membranous sacrococcygeal ligament, which is pierced by the filum terminale (a connective tissue strand extending from the tip of the spinal cord to the coccyx). ... In caudal epidural anesthesia or caudal analgesia, a local anesthetic agent is injected into the fat of the sacral canal that surrounds the proximal portions of the sacral nerves. ... The height to which the anesthetic ascends is controlled by the amount injected and the position of the patient."

When looking at the spine posteriorly there are areas of the spine that are concave and areas that are convex. The term that refers to areas of convexity is A. Lordosis B. Scoliosis C. Kyphosis D. Plasdosis

C. Kyphosis Slide 6

A 62-year-old male presents to the clinic complaining of back and lower limb pain that is worse when standing and relieved with leaning forward or sitting. Patient also notes leg paresthesias. The patient recalls his father and grandfather complaining of similar symptoms. On imagine you note a narrow L3 vertebral foramen. What is your diagnosis? A. Occult spina bifida B. Arthritis of lumbar vertebrae C. Lumbar spinal stenosis D. Traumatic spondylolysis of L3 E. Hangman's fracture of L3

C. Lumbar spinal stenosis (pg 460)

Which type of vertebrae is best described as having a heart shaped body, a non-bifid spinous process, and costal facets? A. Coccygeal B. Cervical C. Thoracic D. Lumbar E. Sacral

C. Thoracic P 17, slide 34 of power point pic 444

Which ligament of the atlas prevents posterior displacement of Dens and anterior displacement of Atlas? A. Anterior longitudinal B. Denticulate C. Transverse D. Posterior longitudinal E. Supraspinous

C. Transverse Answers found on lecture slide 26 "Transverse Ligament of the Atlas: Extends from one lateral mass to other. Passes between Dens and spinal cord. Prevents Posterior displacement of Dens and Anterior displacement of Atlas"

Which of the following correctly matches the vertebrae with its defining characteristic? A. Costal facets on cervical vertebrae B. Bifid spinous process on lumbar vertebrae C. Foramina trasversarii on thoracic vertebrae D. Costal facets on thoracic vertebrae

D. Costal facets on thoracic vertebrae Summary pg 463/Slide 27 Moore pg 463 Yellow Box: "The chief regional characteristics of vertebrae are: foramina transversarii for cervical vertebrae, **costal facets for thoracic vertebrae**, the absence of foramina transversarii and costal facets for lumbar vertebrae, the fusion of adjacent sacral vertebrae, and the rudimentary nature of coccygeal vertebrae."

All of the following are true except: A. There are 7 cervical vertebrae,12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae, and 4 coccygeal vertebrae. B. The number of thoracic vertebrae can vary along with the number of lumbar and sacral vertebrae. Cervical Vertebrae remain constant. C. Infants have 33 bones of the spine, while adults have 26 due to fusion. D. The curvature of cervical and lumbar vertebrae are primary curves, forming during fetal development, while the curvature of thoracic and sacral vertebrae are secondary curves, and become accentuated as an infant develops.

D. The curvature of cervical and lumbar vertebrae are primary curves, forming during fetal development, while the curvature of thoracic and sacral vertebrae are secondary curves, and become accentuated as an infant develops. Vertebral Column Powerpoint Slides 5-8. Thoracic and Sacral curves of the spine are Primary Curves, forming during fetal development. Lumbar and Cervical curves are Secondary Curves, which become accentuated during infant development. pic 471

From the following choices, choose the type of back muscles that are correctly paired with the corresponding type of skeleton it works on and the function of the muscles themselves. A: Superficial Back Muscles; Axial Skeleton and Movement B: Superficial Back Muscles; Appendicular Skeleton and Positioning C: Deep Back Muscles; Appendicular Skeleton and Positioning D: Deep Back Muscles; Axial Skeleton and Positioning

D: Deep Back Muscles; Axial Skeleton and Positioning -"The Back: Vertebral Column"; Slide 3 moore 482 "The intrinsic (deep) back muscles include muscles that specifically act on the vertebral column, producing its movements and maintaining posture." 443 "The spinous and transverse processes provide attachment for deep back muscles and serve as levers, facilitating the muscles that fix or change the position of the vertebrae."

A G2P1 pregnant female, 37 weeks pregnant, presents to your clinic complaining of back pain and you notice her exaggerated posture due to the patient trying to balance her gravid uterus over her normally slight 5 foot frame. What is the name for this abnormal curvature of the spine? A. Lordosis B. Swayback C. Kyphosis D. Scoliosis E. A and B

E. A and B moore 480-481 "Excessive lumbar lordosis (clinically shortened to lordosis, although once again this term actually describes the normal curvature; colloquially, excessive lumbar lordosis is known as hollow back or sway back) is characterized by an anterior tilting of the pelvis (the upper sacrum is flexed or rotated antero-inferiorly—nutation), with increased extension of the lumbar vertebrae, producing an abnormal increase in the lumbar kyphosis (Fig. B4.17C).

What does the transverse ligament of the Atlas prevent from occurring? A. Posterior displacement of Dens B. Posterior displacement of Atlas C. Anterior displacement of Atlas D. Anterior displacement of Dens E. A and C

E. A and C combo pic 469 and 477 moore 477 "When the transverse ligament of the atlas ruptures, the dens of the axis is set free, resulting in atlantoaxial sub luxation—incomplete dislocation of the median atlanto-axial joint (Fig. B4.14A)." Bottom Pic pg 477 "*A*. This left lateral view demonstrates that subluxation of the median atlanto-axial joint results from rupture of the transverse ligament. The atlas moves but the dens is fixed. C, spinal cord; D, dens of axis. *B*. This left lateral view of a fracture of the dens shows that the dens and atlas move together as a unit because the transverse ligament holds the dens to the anterior arch of the atlas."

An 80-year-old female presents to your clinic to establish care and receive her preventative health exam for the year. She has a history significant for hypertension, osteoporosis, GERD, and seasonal allergies. Her vitals are within normal limits. As she stands up to move over to the exam table for her physical exam, you notice that she is moderately hunched forward with a curve to her spine. What is this finding consistent with? Lecture slide 10 a. Lordosis b. Kyphosis c. Scoliosis d. Spinal stenosis

b. Kyphosis

Increased thoracic curvature is referred to as what? a. Lordosis b. Kyphosis c. Scoliosis d. Sacrosis

b. Kyphosis pic 481

A 70-year old stoic male, who does not like medical appointments or anything to do with the clinic, presents complaining of ongoing significant low back pain. A complete workup was done, and the patient was found to have lumbar spinal stenosis. The PA explains that in lumbar spinal stenosis, the vertebral foramen narrow in one or more lumbar vertebrae, leading to higher risk of compression of spinal nerve roots. What happens to the size of lumbar spinal nerves and IV foramina as the vertebral column descends? a. Lumbar spinal nerves decrease in size and foramina increase in size b. Lumbar spinal nerves increase in size and IV foramina decrease in size c. Lumbar spinal nerves decrease in size and IV foramina decrease in size d. Lumbar spinal nerves increase in size and IV foramina increase in size

b. Lumbar spinal nerves increase in size and IV foramina decrease in size Pg 460: Lumbar Spinal Stenosis "Lumbar spinal nerves increase in size as the vertebral column descends, but paradoxically, the IV foramina decrease in size. Narrowing is usually maximal at the level of the IV discs."

A 73-year-old female patient is brought into the emergency department after utilizing her Life Alert medical response device. She states she fell when getting out of bed that morning and couldn't get up. She endorses severe back pain. On x-ray several vertebral compression fractures are noted. When reviewing her medical record you see that she had been previously diagnosed with vertebral kyphosis. What is the most likely vertebral region that they compression fractures occurred in? a. Cervical b. Thoracic c. Lumbar d. Sacral e. Coccygeal

b. Thoracic

While assessing a mature woman's spine, you note that there is abnormal curvature. While reading her medical record, you note that she has osteoporosis and see that at a previous visit, someone noted that this patient has Kyphosis. Which region of the spine did you note the abnormal curvature? a. Cervical b. Thoracic c. Lumbar d. Sacral e. Coccygeal

b. Thoracic Lecture slide 10 "Increased Thoracic Curvature: increased convexity. Usually associated with osteoporosis especially in aging females. Weakness of vertebral body bony matrix allows for compression on anterior body"

Which ligament separates the dens from the spinal cord in the cervical spine, preventing posterior displacement of the dens and anterior displacement of the axis? a. Transverse ligament of the Axis b. Transverse ligament of the Atlas c. Longitudinal ligament of the Axis d. Longitudinal ligament of the Atlas

b. Transverse ligament of the Atlas (Slide 26 - Lecture 1) pic 447 Moore 476 "The transverse ligament of the atlas is stronger than the dens of the C2 vertebra. Fractures of the dens make up about 40% of fractures of the axis. The most common dens fracture occurs at its base—that is, at its junction with the body of the axis (Fig. B4.13A)."

After being involved in a car accident where a man was rear ended, he suffered an un-displaced fracture of the dens. What ligament prevented the posterior displacement of the dens and anterior displacement of the atlas? a. Alar ligament b. Transverse ligament of the atlas c. Posterior atlanto-occipital d. Apical ligament

b. Transverse ligament of the atlas

You are treating a 32 year old female in the emergency department following a car accident where the patient was an unbelted passenger. She is conscious, but reports severe neck pain. A CT of the cervical spine and head is performed and she is found to have a Jefferson fracture of the Atlas (C1), with an intact transverse ligament. Which of the following is true regarding this injury? a. Spinal cord injury is more likely if the transverse ligament is intact b. Dimensions of the Atlas are decreased in a Jefferson fracture, almost always resulting in spinal cord injury c. Spinal cord injury is more likely if the transverse ligament has also been ruptured d. Spinal cord injuries only happen below the level of C2

c. Spinal cord injury is more likely if the transverse ligament has also been ruptured combo pic 458 - 459 (Blue box pg 458 "Fracture and Dislocation of Atlas") "If the [vertical force (as would result from striking the bottom of a pool in a diving accident)] is sufficient, rupture of the transverse ligament that links them will also occur (Fig. B4.4C). The resulting Jefferson or burst fracture (Fig. B4.4C-E) in itself does not necessarily result in spinal cord injury, because the dimensions of the bony ring actually increase. Spinal cord injury is more likely, however, if the transverse ligament has also been ruptured (see the blue box "Rupture of Transverse Ligament of Atlas" on p. 477) indicated radiographically by widely spread lateral masses."

A 47 year-old woman presents to the clinic. She is complaining of low back pain and difficulty finding a comfortable sleeping position at night. You notice she has poor posture during the interview. After the H&P and determining that she has an office job for a living, you decide that an x-ray of the vertebral column is warranted. When reading the x-ray, you notice an incomplete fusion of L5. What is this diagnostic of? a. Closed spinal dysraphism b. Occult spina bifida c. Sacralization of L5 vertebra d. A&B e. A&C

d. A&B Slide 43

Numerical variations in the number of vertebrae occur in all types EXCEPT: a. Thoracic b. Lumbar c. Sacral d. Cervical

d. Cervical ***Answer found on lecture slide 8***

All of these regarding the Cervical Vertebrae C1, aka the Atlas, are true, EXCEPT: a. It does not have spinous processes b. It has paired lateral masses that articulate with the occipital condyles of the foramen magnum c. The transverse processes of the Atlas (C1) contain foramen transversarium d. It contains a blunt-like tooth protruding from its anterior arch, called the Odontoid Process

d. It contains a blunt-like tooth protruding from its anterior arch, called the Odontoid Process **The axis contains the odontoid process** slide 25

Which of the following statements is false regarding the spinal column? a. There are always 7 cervical vertebrae b. The atlas and the axis are also called C1 and C2 respectively c. There are typically 12 thoracic vertebrae but this number may be variable d. The 5 vertebrae of the coccyx are fused e. The variable number of vertebrae typically does not cause pain

d. The 5 vertebrae of the coccyx are fused Slide 5 of "The Back" slide 40: "• Made up of *four* fused rudimentary vertebra from the embryological tail • Coccygeal vertebra *1 may not fuse* • All nerves exit spinal column before coccyx" pic 452

Which of the following is true about the cervical spine? a. There are variations in the number of vertabra b. The dens is located posteriorly on the axis c. The atlas holds up the axis d. The transverse processes of the atlas are more lateral than other vertebrae

d. The transverse processes of the atlas are more lateral than other vertebrae (Lecture slide 24) moore 446 "The two superior-most cervical vertebrae are atypical. Vertebra C1, also called the atlas, is unique in that it has neither a body nor a spinous process (Figs. 4.5A and 4.6B). This ring-shaped bone has paired lateral masses that serve the place of a body by bearing the weight of the globe-like cranium in a manner similar to the way that Atlas of Greek mythology bore the weight of the world on his shoulders (Fig. 4.6E). The transverse processes of the atlas arise from the lateral masses, causing them to be more laterally placed than those of the inferior vertebrae."

What piece of the Atlas holds the Dens of the Axis in place? a. Posterior arch b. Transverse foramen c. Superior articular facet d. Transverse ligament

d. Transverse ligament The back - slide 26 pic 469