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Regional Anesthesia > 2.2 Anatomy and Sono-Anatomy of the Spine > Flashcards

2.2 Anatomy and Sono-Anatomy of the Spine Flashcards

1
Q

how many cervical vertebrae in the human spine?

A

7 cervical

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2
Q

how many thoracic vertebrae in the human spine?

A

12 thoracic

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3
Q

how many lumbar vertebrae in the human spine?

A

5 lumbar

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4
Q

how many sacral vertebrae in the human spine?

A

5 FUSED sacral

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5
Q

how many coccygeal vertebrae in the human spine?

A

4 FUSED coccygeal

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6
Q

purpose of the 33 vertebrae in the human spine

A

serve to protect the spinal cord and support weight

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7
Q

which nerve root controls motor (vroom vroom) function?

A

ventral

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8
Q

which nerve root controls sensory function?

A

dorsal

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9
Q

the primary curvature of the vertebral column is concave ___________

A

anteriorly

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10
Q

what two regions of the spine are primary curvatures?

A

thoracic and sacral
(concave anteriorly)

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11
Q

the secondary curvature of the vertebral column is concave ___________

A

posteriorly

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12
Q

what two regions of the spine are secondary curvatures?

A

cervical and lumbar
(concave posteriorly)

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13
Q

the most prominent vertebra in the neck is at level:

A

C7

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14
Q

the inferior angles of the scapula are at level:

A

T7

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15
Q

the line that connects the two iliac crests is:

A

L4

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16
Q

the posterior superior iliac spine is at level:

A

S2

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17
Q

when viewed laterally, the cervical and lumbar curves are _______ anteriorly

A

convex

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18
Q

when viewed laterally, the thoracic and sacral curves are _______ anteriorly

A

concave

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19
Q

spinal curves play a significant role in:

A

the distribution of local anesthetics (especially during a spinal)

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20
Q

each vertebra consists of a vertebral _______ and a vertebral _______

A

body; arch

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21
Q

the vertebral ______ is anterior (the major weight-bearing component of the bone)

A

body

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22
Q

the vertebral ______ is anchored to the POSTERIOR SURFACE of the vertebral body by 2 pedicles and forms what two walls of the vertebral canal?

A

arch; lateral and posterior

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23
Q

the _________ ________ is created by joining the PEDICLES and LAMINAE

A

transverse process

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24
Q

the __________ _________ is formed by the FUSING of the LAMINAE

A

posterior spinous process

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25
Q

what two sites are the safest for spinals and epidurals? why?

A

L2/3 and L3/4
largest aperture and least neural tissue

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26
Q

the posterior spaces between vertebral arches becomes WIDER by _______ of the vertebral column

A

flexion

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27
Q

what are interlaminar foramen? (hint: triangle-shaped)

A

space between the spinous processes of the proximate lumbar vertebrae

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28
Q

what is the sacral hiatus?

A

failure of the 5th sacral laminae to fuse at the midline, creating an inverted “V” shaped defect in the sacrum

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29
Q

what is the sacral hiatus covered by? (hint: easy to palpate in children)

A

(thick) sacrococcygeal ligament

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30
Q

which ligament lines the anterior surface of the vertebral column?

A

posterior longitudinal ligament

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31
Q

this ligament connects the cervical, thoracic, and lumbar SPINOUS PROCESSES from C7 to the sacrum

A

supraspinous ligament

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32
Q

which ligament is fused between the supraspinous ligament and ligamentum flavum? (hint: it passes between adjacent vertebral spinous processes and “anchors” our needle)

A

interspinous ligament

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33
Q

this ligament anchors the laminae and limits forward flexion of the spine

A

ligamentum flavum

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34
Q

small vessels from the ______ _____ penetrate the ligamentum flavum to supply blood

A

vertebral plexus

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35
Q

why might the supraspinous ligament and ligamentum flavum have limited flexion in older patients?

A

calcification

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36
Q

the spinal cord is surrounded by what 5 things (in order?)

A

pia mater
subarachnoid space
arachnoid mater
subdural space
dura mater

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37
Q

where do we deposit local anesthetic for spinals?

A

subarachnoid space

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38
Q

between the pia and arachnoid matter, this space is filled with ~150 mLs of CSF

A

subarachnoid space

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39
Q

the pia matter ends at the ____ ______ which anchors the spinal cord to the coccyx

A

filum terminale

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40
Q

where is the epidural space located?

A

between the periosteal lining of the canal and the dura

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41
Q

the epidural space is limited anteriorly and posteriorly by the:

A

posterior longitudinal ligament (anteriorly) and ligamentum flavum (posteriorly)

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42
Q

distance from the skin to the anterior surface of the ligamentum flabum

A

4-5 cm (normal body habitus)

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42
Q

size of the epidural space

A

5-7 mm

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43
Q

before exiting the foramens, the nerve roots:

A

leave the cord and traverse the epidural space

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44
Q

what does the epidural space contain? (name 3)

A

lymphatic vessels
small arteries
valveless veins

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45
Q

epidurals and spinals are done below ___ so there is no risk of hitting the spinal cord

A

L1

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46
Q

in what two regions is the spinal cord thickest?

A

cervical (C5 to T1) = innervates upper limbs
and lumbar (L1 to S3) = innervates lower limbs

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47
Q

in adults, the spinal cord extends from the foramen magnum and terminates at the: (adults and children)

A

conus medullaris, L1-L2

(at birth, continuous from brain to L3)

48
Q

collection of nerve roots in the lower lumbar, sacral, and coccygeal region

A

cauda equina

49
Q

two sources of spinal cord blood supply

A

1) longitudinal oriented vessels
2) feeder arteries

50
Q

longitudinal oriented vessels

A

arise superior to cervical portion of cord

51
Q

feeder arteries AKA segmental spinal arteries

A

enter the canal through the intervertebral foramina at every level

52
Q

what is the main artery of the spinal cord, branching from the segmental spinal artery?

A

artery of adamkiewicz

53
Q

the segmental spinal arteries give rise to the ________ and _______ ___________ arteries and ___________ __________ arteries

A

anterior and posterior radicular arteries
(at every vertebral level)

segmental medullary arteries

54
Q

this artery is the sole source of blood supply to the anterior spinal cord

A

anterior spinal artery

55
Q

these two arteries originate from the cerebellar arteries and are located on each side of the spinal cord

A

posterior spinal arteries

56
Q

interruption to blood supply of the anterior spinal artery will cause ________
(hint: supplies motor)

A

paraplegia

57
Q

this artery is at the level of T10-L2 and supplies the lower anterior 2/3 of the spinal cord

A

artery of adamkiewicz

58
Q

damage to the artery of adamkiewicz causes:

A

motor weakness
(anterior = motor)

59
Q

the central area supplied by the anterior spinal artery is predominantly a _______ area

A

motor

60
Q

contains processes of sensory neurons carrying information TO the CNS

A

posterior root

61
Q

contains motor nerve fibers and carries signals AWAY from the CNS

A

anterior root

62
Q

2 major branches of each spinal nerve:

A

posterior rami
anterior rami

63
Q

all major _____ _____ are formed by the anterior rami

A

somatic plexus

64
Q

innervate only intrinsic back muscles and a narrow strip of skin on the back

A

posterior rami

65
Q

innervate other skeletal muscles of the body, including limbs and trunks, and most of the skin (except certain regions of the head)

A

anterior rami

66
Q

supply the dura, ligaments, intervertebral discs, and blood vessels of the spinal cord

A

recurrent meningeal nerves

67
Q

major somatic plexus (4):

A

cervical
BRACHIAL
lumbar
sacral

68
Q

there are approximately ___ pairs of spinal nerves

A

31

69
Q

number of cervical nerves

A

8

70
Q

number of thoracic nerves

A

12

71
Q

number of lumbar nerves

A

5

72
Q

number of sacral nerves

A

5

73
Q

number of coccygeal nerves

A

1

74
Q

area of skin supplied by a single spinal cord level by a single spinal nerve

A

dermatome

75
Q

autonomous region

A

where overlap of dermatomes is likely

76
Q

level of umbilicus

A

T10

77
Q

nipple level

A

T4

78
Q

dermatome coincides with vertebral level at which:

A

spinal nerve originates

79
Q

level of little finger

A

C8

80
Q

procedure dermatome level: upper abdominal surgery

A

T4

81
Q

procedure dermatome level: intestinal, gynecologic, and urologic surgery

A

T6

82
Q

procedure dermatome level: vaginal delivery of a fetus, hip surgery

A

T10

83
Q

procedure dermatome level: thigh surgery and lower leg amputations

A

L1

84
Q

procedure dermatome level: foot and ankle surgery

A

L2

85
Q

procedure dermatome level: perineal and anal surgery

A

S2 to S5 (SADDLE BLOCK)

86
Q

(procedure dermatome level) Ex: C-section

A

T4 (intraabdominal)

87
Q

(procedure dermatome level)
Ex: Inguinal hernia

A

T10 (lower abdomen)

88
Q

(procedure dermatome level): surgery in the perineum

A

S2-S4

89
Q

With central neuraxis analgesia/anesthesia techniques, sympathetic nerve conduction (vasomotor) is blocked. Why is the PNS spared?

A

nerve fibers (visceral afferent) lay outside the canal and are not exposed to LA

90
Q

ATP PT MVP Motor

A

Autonomic temperature pain pressure touch motion vibration proprioception motor

91
Q

a fibers

A

myelinated, large fibers with faster speed of impulse conduction

92
Q

the larger the fiber the _____ to block

A

harder

93
Q

a-alpha fibers are harder or easier to block than a-delta?

A

harder

94
Q

the larger the fibers the faster or slower the speed of conduction?

A

faster

95
Q

a-alpha fibers (hint: last to block)

A

motor & proprioception

96
Q

a-beta fibers (hint: PT; M)

A

touch, pressure, small motor

97
Q

a-gamma fibers (hint: PT)

A

pressure, touch

98
Q

a-delta (hint: _TP)

A

sharp pain, heat/cold

99
Q

B fibers

A

myelinated autonomic fibers in the preganglionic SNS
smallest and easiest to block

100
Q

unmyelinated, postganglionic sympathetic fibers

A

c fibers

101
Q

c fibers

A

smallest = first to get blocked
small, slow conduction
dull pain, temperature, touch

102
Q

which fibers do you test to see if your block is working? how?

A

c fibers; pinprick (dull pain) or an alcohol swab (temperature)

103
Q

level of sympathetic block is _____ dermatomes above the sensory level

A

2-3

104
Q

blockade of ____ ______ _______ causes a VAGAL response

A

cardiac accelerator fibers

105
Q

where are postganglionic fibers found?

A

in their target organs

106
Q

where are preganglionic fibers found?

A

CNS

107
Q

why are PNS nerve fibers RARELY affected by spinal or epidural blockade?

A

located OUTSIDE the subarachnoid space

108
Q

paramedian sagittal TRANSVERSE view

A

“trident sign”
finger-like shadowing behind transverse processes

109
Q

paramedian sagittal ARTICULAR process view

A

“camel humps”

110
Q

paramedian sagittal LAMINAR view

A

“sawtooth” or “horse heads”

111
Q

paramedian sagittal OBLIQUE view

A

slight medial tilt
optimizes view of posterior and anterior complexes

112
Q

transverse INTERLAMINAR view

A

bat sign
articular processes/facet joints and transverse processes are visible

113
Q

key ultrasonographic structures in the parasagittal TRANSVERSE process view (“trident sign”

A

erector spinae muscle, psoas muscle, transverse process

114
Q

key ultrasonographic structures in the parasagittal ARTICULAR process view (“camel humps”

A

erector spinae muscle, articular processes

115
Q

key ultrasonographic structures in the parasagittal OBLIQUE view (interlaminal)

A

laminae, POSTERIOR COMPLEX, INTRATHECAL SPACE, ANTERIOR COMPLEX

116
Q

key ultrasonographic structures in the parasagittal of the transverse interlaminar (interspinous) view

A

anterior complex, posterior complex, midline interspinous ligament, articular processes, transverse processes

117
Q

the ______ ______ is the MOST IMPORTANT ultrasonographic landmark

A

anterior complex

118
Q

needle insertion and redirection should be guided by:

A

tactile feedback
(contact with bone, ‘feel’ of the ligamentum flavum, loss of resistance)

Regional Anesthesia (5 decks)

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