Monday 9th May MSK Vertebral Column

Monday 9th May PM Vertebral Column

By Oli Tame

Multiple Choice

Which part of the vertebral column is shown here in blue?

• Cervical

• Thoracic

• Lumbar

• Sacral

​Reference:

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https://teachmeanatomy.info/back/bones/vertebral-column/

Multiple Choice

What type of deformity of the spine is shown here?

(Reference: Lecture slides)

• Kyphosis

• Lordosis

• Scoliosis

• "Groovy hip syndrome"

​Reference:

​

https://teachmeanatomy.info/back/bones/vertebral-column/

Multiple Choice

What type of vertebra is shown here?

(Bonus question: can you name any of the structures that pass through the transverse foramen?)

• Cervical

• Thoracic

• Lumbar

• Sacral

Transverse foramen give passage to​ vertebral artery, vein and sympathetic nerves

​

Reference:

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https://teachmeanatomy.info/neck/bones/cervical-spine/

Multiple Choice

Left is a picture of an intervertebral disc. A "prolapsed disc" describes the protrusion of the central nucleus pulposus through the anulus fibrosis. In which direction does this typically occur?

• Posteriorly

• Anteriorly

• Posterio-laterally

• Anterio-laterally

Centre - posterio-lateral prolapse of intervertebral disc, causing compression of spinal nerve root (note far left shows posterior prolapse causing compression of spinal cord)

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Reference: Lecture slides​

Multiple Choice

Lastly... a clinical question:

Brian is a 75 year old man who has been brought to A&E by paramedics who say that he is "off his legs" (i.e. unable to walk to usual ability). When questioned, Brian says that he has had intense lower back pain for the past 24 hours which is shooting down his right leg, and his legs have felt progressively weaker. He feels a little numb when he wipes his bottom after going to the toilet, and has noticed some dribbling of urine from his penis. What do you want to do?

• Give painkillers, refer to outpatient physiotherapy, discharge

• Treat for probable UTI, admit for occupational health to assess Brian's property and mobility

• Give painkillers, perform PR exam, do a bladder scan, discuss with orthopaedics

​Think Cauda Equina!!​

• ​Lower back pain +/- sciatic irritation (if bilateral red flag)

• Bladder / bowel disturbance (always do a bladder scan)

• Saddle anaesthesia (always do a PR exam looking for loss of sensation, impaired anal tone / squeeze)​​​

​Also remember the red flags for back pain