Anatomy--Back Flashcards
1
Q
Back pain is the second most common reason to do what 2 things?
A
go to the doctor & miss work
2
Q
What leads into spondylolisthesis?
A
spondylolysis
3
Q
Where does the spinal cord end? What is the significance of this for spinal cord damage w/ spondylolisthesis?
A
spinal cord ends @ L2.
If spondy is below that-no spinal cord damage. If above that, could damage the spinal cord.
Could damage nerve roots at any level. Can damage spinal nerves.
4
Q
What are the neural ramifications of fractures?
A
may cause compression of nerve roots or spinal cord
5
Q
What are the neural ramifications of herniating discs?
A
they may put pressure on exiting nerve roots b/c they narrow the intervertebral foramina w/ the degenerated disc
6
Q
What is the purpose of intervertebral foramina?
A
to allow for passage of exiting spinal nerves.
7
Q
What are osteocytes & what are its neural ramifications?
A
abnormal bony growths
if the bones start rubbing together they form spiny processes that impinge on spinal nerves.
8
Q
Describe what causes muscular back pain.
A
you get this from guarding, constant tonic contractions used to keep the body in a position that alleviates pain.
Keep in mind that muscular back pain is often secondary to another injury.
9
Q
Where does bone pain come from?
A
usu from the periosteum that surrounds the bone & is suspectible to fractures
feels like localized point tenderness
10
Q
What is meningeal pain?
A
meninges cover parts of the nervous system
the dura is particularly well innervated
anything that pushes on the dura can cause meningeal pain
11
Q
If you have an L5/S1 herniated disc, which nerve will it compress?
A
It will compress one down–S1.
12
Q
Describe the nerve root pain of an L5/S1 herniated disc.
A
The person will feel non-classic referred pain down the S1 dermatome=lateral side of the thigh & leg
13
Q
Is the pelvis a part of the axial skeleton?
A
Not really. The sacrum and coccyx are…which make up a part of the pelvic girdle. But the ilium etc are a part of the appendicular skeleton.
14
Q
How many vertebrae are there in the skeleton? What are the 2 main categories of curves?
A
33 vertebrae
primary & secondary curvatures
15
Q
Can there ever be variation in having 33 vertebrae?
A
Yeah, could have 32 or 34. Men are more likely to have 34. Women are more likely to have 32.
16
Q
How many nerves are associated w/ 33 vertebrae?
A
31 nerves!
17
Q
Where are the 31 nerves found?
A
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal
18
Q
How many vertebrae are in the following sections? cervical thoracic lumbar sacral coccygeal
A
cervical: 7
thoracic: 12
lumbar: 5
sacral: 5 segments
coccyx: 4 segments
19
Q
Which type of curve of the spinal cord is associated with the fetus? Generally & specifically.
A
primary curves
specifically: thoracic & sacral regions
concave side faces anterior of body
20
Q
How are secondary curves formed? Which sections are secondary curves?
A
these are formed after the baby gains some strength
include lumbar & cervical
get them when you can sit up & stand erect
get them by 4 years of age
concave side faces posterior of body
21
Q
Which vertebral structures make up the vertebral foramen or vertebral arch? Which structure lies in the middle of this foramen?
A
body
pedicle
lamina
*spinal cord housed in here
22
Q
Which parts of the vertebrae function in muscle attachment & movement?
A
spinous process
transverse processes
23
Q
Which parts of the vertebrae function in restricting movement & connecting adjacent vertebrae together?
A
articular processes & facets
there is a superior & inferior one!
24
Q
Which part of the vertebrae support body weight?
A
vertebral body
25
What separates the vertebral bodies that lie on top of each other?
intervertebral discs
26
What is laminectomy? What is the purpose for this procedure?
this is a procedure where you take off the posterior aspect of the vertebral arch.
Its purpose is to allow access to the spinal cord.
Not common now, but used to be a standard procedure for a herniated disc
27
T/F People often slip a vertebrae?
FALSE
28
What is the zygapophyseal joint?
This is the joint formed b/w the superior articular process of one lower vertebrae w/ the inferior articular facet of a higher vertebrae.
It is considered a synovial joint.
29
What are the components of the zygapophyseal joint?
Made up of a superior articular process & inferior articular facet
**has a joint capsule, synovial fluid, & ligamentous structures holding it together.
30
What forms the intervertebral foramen? What is their function?
This is a hole formed when 2 vertebrae come together. It is formed by the inferior notch of a higher vertebrae & the superior notch of a lower vertebrae. This is the space by which nerve roots leave the spinal cord.
31
What makes up the greater component of the intervertebral foramen? The superior or inferior notch?
The inferior notch makes up a greater proportion of the intervertebral foramen. This is also where more of the nerve roots are tucked in!
Note: as you age, this foramen gets smaller & you can sometimes compress your nerve roots.
32
Where are the mamillary processes found & what are their function?
These are found on the lateral surface of the superior articular facets. It is a roughened area & is a site of attachment for muscles.
33
What are the positions of the superior articular facet & inferior articular facet in the following regions?
Cervix
Thorax
Lumbar
Cervix: face superior (superior) & inferior (inferior)
Thorax: face anterior (inferior) & posterior (superior)
Lumbar: face laterally (inferior) & medially (superior)
34
Why are L5S1 disc herniations so common?
b/c of the prominent joint b/w the lumbar vertebrae & the sacrum
makes the internal sacral promontory landmark @ this joint
35
Are there any holes in the sacrum? If so, how many & what is their purpose?
Yes! There are 8 anterior sacral foramina & 8 posterior sacral foramina & 1 posterior sacral hiatus.
The anterior foramina are for the ventral rami of the sacral nerves to go to anterior structures.
The posterior foramina are for the dorsal rami of the sacral nerves to go to true back muscles posteriorly. These are for the first 4 sacral nerves.
36
Where does the S5 nerve exit?
thru the posterior sacral hiatus
37
What is the last spinal nerve? Where does it exit? Where does it go?
C1
| it exits thru the posterior sacrum (sacral hiatus) & it goes to the coccyx.
38
Where do you feel the first bump of your spine?
first palpable point is C7 in your neck
39
Describe the spinous process of the following vertebrae.
Cervical
Thoracic
Lumbar
Cervical: bifid spinous process
Thoracic: not bifid, but points inferiorly
Lumbar: large spinous process for erector spinae muscles
40
T/F Vertebral bodies get larger as you move toward the cervical region.
FALSE They get larger as you move toward the lumbar region b/c that is an area that requires more load bearing.
41
How many degrees of freedom does each region have?
Cervical
Thoracic
Lumbar
Cervical: 3 degrees of freedom
Thoracic: 2 degrees of freedom
Lumbar: 1 degree of freedom
42
What is the main movement of the thoracic region? Which movement is restricted?
Main movement: lateral bending
| Restricted Movement: posterior-anterior flexion
43
What is the main movement of the lumbar region? Which movement is restricted?
Main Movement: flexion & extension
| Restricted Movements: lateral bending & rotation
44
What is a unique feature of the cervical vertebrae?
transverse foramen for vertebral arteries.
45
What is a unique feature of the thoracic vertebrae?
articular facets for the ribs
46
The head rocks on the ____ & spins on its _____.
The head rocks on the atlas & spins on its axis.
47
Describe the structure of the atlas.
it doesn't have a vertebral body
it has an anterior arch for the dens of the axis to sit in, with a ligament holding it in place
dens can rotate nicely in the atlas b/c of lack of body
have anterior & posterior arch
have superior & inferior articular fovea
have transverse foramen
48
What allows the head to spin on the axis?
the lack of vertebral body of the atlas--doesn't impede this movement
49
Where do the occipital condyles rest?
in the superior articular fovea of the atlas
50
Describe the structure of the axis.
has a big body, the dens, that articulates with the atlas
has superior & inferior articular surfaces
has an anterior articular surface on the anterior of the dens
has transverse processes
has transverse foramen
has vertebral body
has lamina
has bifid spinous process
51
What's the deal with the atlanto-occipital joint?
this is the joint b/w the atlas & the occipital bone
it causes nodding of the head yes, flexion & extension)
it is a synovial joint
52
What's the deal with the atlanto-axial joint?
this is the joint b/w the atlas & axis
| it is responsible for shaking the head no (some rotation)
53
What is the axis of movement in the vertebral column for the following motion?
Flexion
bending forward
transverse axis
movement toward anterior side
54
What is the axis of movement in the vertebral column for the following motion?
Extension
bending backward
transverse axis
movement toward posterior side
55
What is the axis of movement in the vertebral column for the following motion?
lateral bending
anteroposterior axis
56
What is the axis of movement in the vertebral column for the following motion?
rotation
vertical axis
57
What are the 4 main factors that allow or restrict movement of the back/trunk?
1. thickness of intervertebral discs
2. orientation of articular facets
3. attachment of ribs
4. size, elasticity & orientation of back muscles & abdominal wall
58
How much movement is there in the following areas?
Cervical
Thoracic
Lumbar
Cervical: considerable, highest amount (also b/c such light weight)
Thoracic: less movement (ribs get in the way)
Lumbar: less movement, but considerable flexion & extension
59
Where are the intervertebral discs the most thin?
the cervical region
60
What shows up as a collar on a scotty dog?
a stress fracture of the pars interarticularis
spondylolysis
**scotty dog seen w/ oblique view of the vertebrae
61
Where is the pars interarticularis?
this is in the vertebrae b/w the superior & inferior articular facets
62
```
What makes up the following parts of the dog?
eye
nose
neck
ear
body
tail
hind leg
front leg
```
eye: pedicle
nose: transverse process
neck: pars interarticularis (w/ collar: spondylolysis)
ear: superior articular process
body: lamina
tail: spinous process
hind leg: contralateral inferior articular process
front leg: inferior articular process
63
If you have a double dog collar on a transverse CT of a vertebrae--what is that called?
spondylolisthesis. here the vertebrae may slip
| bilateral spondylolysis
64
What is a common cause of spondylolysis?
repeated stress to the spine often from sports, like gymnastics
65
The ligament on the anterior of the body of the vertebrae is called:_______. This limits which action?
anterior longitudinal ligament
| limits extension
66
The ligament on the posterior of the body of the vertebrae is called _______. This limits which action?
posterior longitudinal ligament
| limits flexion
67
T/F Joint capsules are found around interarticular processes & intervertebral joints.
TRUE
68
Where is the ligamentum flavum? What action does it limit? What type of a ligament is it?
It is found sort of opposing the posterior longitudinal ligament (on the other side of the vertebral canal).
attaches b/w the inferior & superior articular processes
limits flexion
**segmental ligament
**elastic ligament
69
Why does a herniated disc usu come out posterolaterally?
b/c of the posterior longitudinal ligament protecting the spinal nerve.
70
Where is the interspinous ligament found?
Interspinous: b/w the spinous processes
71
Where is the supraspinous ligament found?
Supraspinous: super posterior, across the tips of the spinous processes
72
The head rotates on its _____. What limits this rotation? Describe the location.
Axis, limited by alar ligaments.
| Alar ligaments attach the dens of the axis to the occipital bones
73
What are the 3 parts of the cruciate ligament? Which part is the thickest/strongest?
transverse (stronges, thickest)
inferior
superior
74
What are the parts of the cruciate ligament covered by posteriorly? What is this a continuation of?
covered posteriorly by a tectorial membrane
| this is a continuation of the posterior longitudinal ligament
75
What is the transverse portion of the cruciate ligament attached to?
attached on either side to the atlas.
76
What would happen if you didn't have a cruciate ligament?
your dens could get shoved backward into your spinal cord. You could die. Bad news.
77
What makes up the intervertebral disc?
central core (nucleus pulposis) + outer ring of dense fibrocartilage (annulus fibrosis)
78
What is the nucleus pulpous like? What is it derived from?
gelatinous core
95% water
allows for flexibility
derived from the notocord
79
T/F The annulus fibrosis is thicker posteriorly.
FALSE It is thinner posteriorly, thicker anteriorly.
80
Why do herniated discs occur?
b/c there is excessive pressure put on the disc
81
Where are the most common spots for herniated discs? What do they push out against in this case?
Most common: L5-S1 level
2nd most common: L4-L5 level
**past L2 if they aren't pushing against a spinal nerve posterolaterally they are pushing against the cauda equina
82
When a herniated disc compresses a nerve root, where does it bulge? Which nerve does it compress?
it is bulging into the superior aspect of the intervertebral foramen (inferior notch of the higher vertebrae). This means that it is compressing the nerve of the vertebrae below it.
83
If a herniated disc is compressing a nerve in the cervical region: C3-C4...which nerve is it compressing? Why is this?
It would be compressing C5?
| This is b/c in the cervical region, the nerve comes out above the vertebrae of the same name.
84
If a herniated disc is compressing a nerve in the thoracic region: T6-T7...which nerve is it compressing? Why is this?
It would be compressing T7. This is b/c in the thoracic region, the nerves comes out below the vertebrae of the same name.
85
If a herniated disc is compressing a nerve in the lumbar region...L2-L3...which nerve is it compressing? Why is this?
L3. b/c in the lumbar region, the nerves come out below the vertebrae of the same name.
86
If a herniated disc is in C6-C7...which nerve is it compressing?
C8
87
If a herniated disc is in C7-T1...which nerve is it compressing?
T1!
88
T/F Herniated discs can only pinch one nerve at a time.
False. Herniated discs can pinch a number of different nerves. If it is large enough, could hit both the nerve root above & below. If the posterior longitudinal ligament wasn't enough of a barrier, it could hit the spinal cord.
89
T/F As you get lower on the spinal cord, the nerve roots get longer.
TRUE.
90
What are the 3 coatings (meninges) around the spinal cord associated w/ the CNS? Outside--inside
```
Dura Mater
Potential Space--subdural space
Arachnoid Mater
Trabeculae
Arachnoid Space-real space w/ CSF
Pia Mater
```
91
What is the dura mater that surrounds the spinal cord like?
```
it is tough
highly innervated
CT
blends w/ epineurium of nerve
doesn't blend w/ periosteum (free floating)
arachnoid mater pushed up against it
```
92
What is the arachnoid mater that surrounds the spinal cord like?
the arachnoid is pushed up tightly against the dura...it has trabeculae going to the pia. CSF fills up the arachnoid space.
93
What is the pia mater that surrounds the spinal cord like?
it is up against the spinal cord & follows the sulci of the spinal cord
94
What is above the dura mater of the spinal cord?
epidural space. filled w/ fat. b/w the vertebrae & the spinal cord
95
What keeps the spinal cord anchored in the middle of the arachnoid space? What other functions does it accomplish?
```
denticulate ligaments (extension of pia mater)
it also separates the ventral roots from the dorsal roots
```
96
Where are the autonomic preganglionic neurons found in the spinal cord?
in the lateral horn of the grey matter
97
Where do the sympathetic preganglionic neurons come from?
they come from T1-L2 in the lateral grey horn.
98
Where do the parasympathetic preganglionic neurons come from?
from the cell bodies in the brain stem &
| from S2-4
99
What comes into the dorsal grey horn?
sensory info
| some of this ascending to the brain via surrounding white matter
100
What is the white matter composed of?
ascending & descending fibers w/ various tract names
| carries various info up to the brain & down from the brain
101
What are the 2 types of losses when you are talking about spinal cord injury?
Segmental & Level Losses
102
What is an example of a segmental loss?
you damage a dorsal root coming in
| you get a loss of sensation in a particular dermatome
103
What is an example of a level loss?
If you cut a white tract at a certain level...no sensory info from below that level will reach the brain...also no motor info of the tract from the brain will reach below that cut.
104
How does the concept of spasticity relate to spinal cord injuries?
after a spinal cord injury, you are in spinal shock for 2-3 weeks
then your reflexes are stronger b/c there isn't inhibition descending from the brain to the gamma motor neuron system
Called spasticity.
105
What is the groove on the back of the spinal cord called? On the front of the spinal cord?
Back of spinal cord: posterior median sulcus
| Front of spinal cord: anterior median fissure
106
What is the gray commisure?
a portion of grey matter that connects the 2 wings of the butterfly in the spinal cord & surrounds the central canal
107
What are the 3 parts of the white matter & where are they located?
Anterior funiculus: in b/w the wings of the butterfly on the anterior side
Lateral funiculus: on the side of the wing
Posterior funiculus: in b/w the wings of the butterfly on the posterior side
108
What is the inferior tapered end of the spinal cord called?
conus medullaris
109
What are 2 areas of the spinal cord the are enlarged?
cervical
| lumbosacral
110
@ which level does the spinal cord end?
L2
111
Where does the dural sac end?
S2
112
What is an epidural block? Where is it usu injected & why?
Epidural Block: where anesthesia is injected outside the dural sac & bathes the most caudal spinal nerves
usu done L2-S2: b/c here there is a large subarachnoid space
113
In addition to being a good location for an epidural block, what else is done @ the L2-S2 level?
lumbar puncture
| spinal anesthesia
114
T/F As you move closer to the cauda equina, each nerve root gets shorter & shorter, making it hard to reach the intervertebral foramen.
FALSE. they get longer & longer.
Cervical Region: come straight out
Near the end: have to extend 5 or 6 levels before they come out.
115
What are the 2 branches of the dorsal ramus & what sensations does it communicate?
```
one branch goes to true back muscles
intrinsic back muscles
Carries:
general sensory
viscero sensory
```
116
Which root does a herniated disc usu damage? What are the implications of this?
usu the ventral root, carries motor info. So, not as noticeable at first as pain. But weaker muscle. If continues with time, could lead to paralysis of that muscle.
117
T/F If you take out a nerve root innervating muscle X...muscle X will be completely flaccid & paralyzed.
FALSE b/c remember that muscle X is innervated by a bunch of other nerves too. But it will be weaker.
118
What is a dermatome? T4=? T10=? Back of legs=? Front of legs=?
```
area of skin innervated by a single spinal nerve (cutaneous branch)
T10=periumbilical area
T4=nipple line
Back of legs=sacral nerves
Front of legs=lumbar nerves
```
119
What is the posterior line that you can see on someone's lower back?
this is the line marking the top of the iliac crest, L4/L5
120
What are the dimples in the back correlated w/?
mark the spine @ S2
121
Most extrinsic back muscles = ____ ____ ____. 2 are something else, though. What are they?
Extrinsic Back Muscles = Upper Limb Muscles
| 2 are accessory respiratory muscles
122
Dorsal ramus supplies:
| Ventral ramus supplies:
Dorsal Ramus: true back muscles
| Ventral ramus: extrinsic back muscles
123
What are the upper limb muscles of the extrinsic back muscles?
```
levator scapulae
trapezius
rhomboid minor (higher)
rhomboid major
Latissimus Dorsi
```
124
What are the accessory respiratory muscles of the extrinsic back muscles?
Serratus Posterior Superior
| Serratus Posterior Inferior
125
Where does the rhomboid minor extend from?
goes from spinous process to medial border of the scapula
126
Which actions do the rhomboids help you to do?
shrug your shoulders
| retract your scapula
127
The trapezius covers what set of muscles?
intrinsic back muscles
128
What are the 3 layers of the intrinsic back muscles & what are they all innervated by?
```
innervated by dorsal ramus of the spinal nerve
Superficial-->Deep:
Spinotransverse
Erector Spinae
Transversospinae
```
129
The posterior intercostal artery gives off which branches?
among others, the posterior radicular artery & anterior medullary artery
130
What does the posterior radicular artery feed into? What does the anterior medullary artery feed into?
Posterior radicular artery-->posterior spinal artery
| anterior medullary artery-->anterior spinal artery
131
Blood vessels to nerve roots are called:
radicular arteries
132
The anterior spinal artery can't handle the blood flow for the entire anterior spinal cord, so it needs contributions from __________. If this contributing artery gets blocked it is called________.
anterior segmental medullary arteries
| If blocked: anterior spinal artery syndrome
133
What is the deal with the medullary artery of adamkiewicz?
this is the largest segmental medullary artery
it is found somewhere in the T8-L2 region, usu closer to T8.
common site for aortic aneurysm...can create a level loss
134
Why is it possible for prostate cancer to metastasize to the CNS?
b/c the vaginal & prostatic venous plexuses communicate w/ the internal vertebral plexuses up the spinal cord & eventually the venous sinuses of the cranial cavity
135
The spinotransverse group is also called the _____ group. What are its muscles? What is the origin & attachment like with these muscles?
splenius group
splenius capitis
splenius cervicis
**spinous processes-->skull or transverse processes of cervical vertebrae
136
What is the splenius cervicis covered by?
serratus posterior superior muscle
137
What is the action of the splenius capitis?
extension & rotation of the head.
| Rotation: (right muscle contracts, goes to the right side).
138
What is the general location of the erector spinae group? What are their actions? What is the their innervation?
alongside the spinal column, oriented vertically
extension MAINLY, also flexion thru eccentric contractions (letting out)
dorsal rami innervate them (true back muscles?)
139
From lateral to medial, what are the muscles of the erector spinae group?
Lateral: Iliocostalis
Longissimus
Medial: Spinalis
I like talk guys. I like long spines.
140
As a group, what actions are the transversospinae group involved in? What is their innervation?
As a group, involved in rotation
Rotation: flex right side, move to left side
Innervation: dorsal rami
141
What are the muscles of the transversospinae group, & how many vertebrae does each span?
```
Semispinalis capitis (6-8)
multifidus (3-5)
long rotators (2)
short rotators (1)
```
142
What is the most powerful extender of the head?
semispinalis capitis
143
Which muscle must be removed to get to the sub occipital triangle?
splenius capitis
144
What do concentric & eccentric contractions mean?
Concentric: shortening
Eccentric: lengthening
145
Which muscles do you have to get thru to get to the sub occipital triangle? Which bones is this triangle associated with?
Trapezius
Splenius capitis
Semispinalis capitis
Bones: occipital bone, atlas, axis
146
Which muscles make up the sub occipital triangle & what are their relative positions?
Base of triangle: inferior oblique
Lateral part of triangle: superior oblique
Medial part of triangle: rectus capitis major
Outside medial part of triangle: rectus capitis minor
147
Which nerve goes thru the triangle & ends at the inferior oblique muscle? What does this innervate? What info does it carry?
Greater Occipital Nerve (dorsal ramus, carries sensory)
C2 dermatome innervated
Sensory info
148
Aside from the greater occipital nerve, what else do you see in the sub occipital triangle?
motor roots
| vertebral artery
149
As a group, what are the muscles of the sub occipital triangle involved in?
fine control movements of the head
150
The inferior oblique muscle is involved in what action?
Rotation, moves right-->right
151
The superior oblique is involved in what action?
Extension
152
The rectus capitis major is involved in what action?
extension, plays a role in rotation
153
The rectus capitis minor is involved in what action?
extension
