Spinal Health and Imaging Techniques Quiz

OCCTH 583: Neck and Trunk

• Course name: OCCTH 583
• Course topic: Neck and Trunk
• Instructor: Jennifer Krysa, MSc, OT Reg (AB), OTR

Outline

• Structure and Function of the neck and back
  • Bones
  • Ligaments
  • Nerves
  • Muscles
• Conditions related to the neck and back

The Trunk: Osteology

• Skull
• Ribs
• Sternum
• Vertebral Column
• Pelvis (Ilium)

Vertebral Column

• 5 regions:
  • Cervical (C1-7)
  • Thoracic (T1-12)
  • Lumbar (L1-5)
  • Sacrum (5 fused segments)
  • Coccyx (4 fused segments)

Vertebra

• Vertebral body: structure & support; absorbs compressive forces
• Vertebral arch formed by pedicles & laminae; protects spinal cord
• Vertebral foramen: the bony canal for spinal cord; posterior to vertebral body
• Vertebra is singular, vertebrae is plural

Vertebra - Processes

• Spinous process: projects dorsal & inferior; the first palpable spinous process is C2
• Transverse process: projects laterally
• Superior facet
• Inferior facet

Vertebra - Lateral View

• Superior & inferior facets: joints between the vertebrae; thoracic vertebrae also have costal facets (ribs)

Cervical Spine

• C1 (atlas): no body
• C2 (axis): odontoid process (dens) evolved from body of C1; C-spine more mobile; Atlanto-axial facet joints quite shallow

C-spine Cont'd

• Transverse foramen on C1-C7
• Vert. a. travels thru C1-C6
• C3-C7 called the subaxial vertebra
• Bifid spinous process C2-C6
• C7 is a transitional vertebra with smaller (or absent) transverse foramen and usually not bifid

C-spine: Intervertebral Discs

• Approx 25% of the height in C-spine
• Nucleus pulposus distributes axial compressive forces
• Annulus fibrosus withstands tension in the disc
• No disc between occiput & C1 nor C1-C2
• Gives the lordotic shape to the C-spine

Function of the Vertebral Column

• Protection
• Support
• Provides an axis for the body and pivot for the head
• Posture and locomotion

Spine Ligaments

• Anterior Longitudinal Ligament (ALL): from occipital bone (&C1) to sacrum; Limits extension
• Posterior Longitudinal Ligament (PLL): within the vertebral canal from C2 to sacrum; mostly to IV discs

Intervertebral Jt Ligaments

• Ligamentum flavum: lamina to lamina of adjacent vertebral arches
• Supraspinous Ligament: thick; tips of spinous processes C7 to sacrum
• Interspinous Ligament: thin; adjoining spinous processes from root to apex
• Intertransverse ligaments: adjacent transverse processes

Spinal Nerves

• 31 pairs
• Dorsal roots - afferent (sensory) fibers
• Ventral roots - efferent (motor) fibers
• SAME: Sensory-Afferent, Motor-Efferent

Spinal nerve roots

• Named for the vertebra below it (C1 to C7)
• Rest of spine named for vertebra above starting with T1
• C8 spinal nerve root is between C7 and T1 vertebrae

Spine Musculature

• Spinal muscles surround and support spinal column
• Agonist and antagonist muscles act simultaneously
• Co-contraction: Exerts force in different directions to stabilize; Acts as synergists for movement

Muscles of the Neck

• Muscles listed with their specific functions for flexion, extension, lateral flexion, and rotation

Muscles of the Back

• Superficial (Extrinsic)/Intermediate - Responsible for movements of the scapulae and shoulder and respiratory movements
• Deep (Intrinsic) - Responsible for movements of the spine and maintaining posture
• Muscles listed with their specific functions for flexion, extension, lateral flexion, and rotation

Conditions of the Neck and Back

• Hyperextension Injury of Neck (Whiplash)
• Cervical Dystonia (Spasmodic Torticollis)
• Congenital Torticollis
• Common Conditions: Kyphosis, Lordosis, Scoliosis

Disc Conditions

• Degenerative Disc Disease
• Bulging Disc
• Herniated Disc
• Cervical discs mostly commonly ruptured are between C5-C6 and C6-C7; Spinal nerve roots are compressed causing pain & dysfxn

Vertebral Fracture

• MOI: Sudden, forceful flexion or extension of the vertebral column
• Atraumatic compression fracture (osteoporosis)
• T11 or T12 most commonly fractured non-cervical vertebrae due to trauma
• Thoracic spine most common place for compression fracture

Vertebral Fracture/Dislocation

• Cervical vertebrae more stacked, less interlocked so easier to dislocate
• Can spare spinal cord
• Hangman's fracture: fracture & dislocation of axis (C2)
• MOI: hyperextension of head ON neck
• Dens of axis fracture: MOI horizontal blow to head or osteopenia

Other Conditions

• Spondylosis - OA of the spine; Usually cervical or lumbar
• Spinal Stenosis - narrowing of the spinal canal

Other Spine Conditions Cont'd

• Spondylolysis - stress fracture of vertebra (pars interarticularis); Usually L5, sometimes L4; Unilateral or bilateral
• Spondylolisthesis - anterior displacement of vertebra due to above fracture

Common Conditions

• Muscle Strain
• Ligament Sprain

Signs, Symptoms, Sequelae

• Foot drop
• Sciatica
• Cauda Equina Syndrome
• Nerve root compression (herniated disc or injury)
• Medical emergency requiring Sx
• Pain, weakness, urinary retention or incontinence

Clinical Importance

• Back pain - most common cause of disability for those under age 45
• Majority of people can return to normal function after 4-6 weeks
• 7-10% of people will develop chronic back pain
• Many factors affect back health

Dermatomes

• Surface of the skin is divided into specific areas called dermatomes
• Useful in clinical practice for possible injury involving the spine by localizing neurological levels
• Weakness in extremities
• Absent deep tendon reflexes
• Reports of radiculopathy (symptoms related to irritation of a nerve root)

Diagnostic Tests

• X-rays - electromagnetic radiation
• Bone Scan - radioactive tracer injected; bony disruption uptakes the tracer
• CT Scan - computed tomography using x-ray
• MRI - magnetic resonance imaging using strong magnetic gradients and radio waves
• Nerve Conduction Studies (NCS) - flow of electrical current through a peripheral nerve
• Electromyography (EMG) - amount of electrical activity produced by a muscle contraction
• EMG & NCS usually performed together, but as separate tests

Reflex Testing

• Knee - L3/L4
• Ankle - S1/S2

Neck Special Tests

• Are beyond the scope of OT practice
• Refer to physiotherapist colleagues

Slump Test

• Impingement of dura and spinal cord or nerve roots
• Progressively provocative until symptoms reproduced
• Start: in sitting Patient flexes spine & sags shoulders forward (slumps)
• 1: examiner holds head chin too keep head erect
• 2. flex neck
• 3. extend knee
• 4. dorsiflex ankle

Surgical Interventions

• Spinal fusion - joining vertebrae together
• Laminectomy - removal of spinous process and lamina
• Foraminotomy - widen space where nerve root exits
• Discectomy - removal of all or part of vertebral disc

Conservative Interventions

• Treatment: Restore function of the muscles, ligaments and joints.
• Most back injuries are treated conservatively
• Conservative treatments include: Modalities- heat, ice, ultrasound, TENS machine, Proper posture and lifting techniques, Stretching, Strengthening
• Low Impact Aerobic Conditioning

Common OT Interventions

• Education
• Therapeutic exercise
• Mobility
• Strength
• Endurance
• Environmental modifications
• Adaptive equipment
• Prevention (ergonomics)

Resource

• Occupational Therapy: Body Postures During Daily Activity

Case Study 1

• Fredo (68 y.o.) experiencing back pain radiating down his left leg; diagnosed with spinal stenosis via MRI
• What is spinal stenosis?
• Why does it cause pain?
• Recommendations for Fredo's weekly golf game?

Case Study 2

• Bart recovering from laminectomy (10 weeks post-op)
• Bart wants to soak in his tub, recommendations?
• Tasks Bart can start to do?
• What limits Bart from fully engaging in ADLs & I-ADLs?

Test your knowledge on spinal health, imaging techniques such as CT scans and MRIs, and the anatomy of the vertebral column. This quiz covers important concepts including nerve conduction studies, spinal interventions, and specific vertebrae characteristics. Enhance your understanding of these critical topics for better overall health and wellness.