Anatomy- back, vertebrae, spinal cord Flashcards
(blank) may cause compression of nerve roots or spinal cord
fractures
(blank) is the forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a break or fracture. Backward displacement is referred to as retrolisthesis.
Spondylolisthesis
What can spondylolisthesis end up damaging?
spinal cord, roots or exiting spinal nerves :(
What can slip and end up putting pressure on exiting nerve roots?
herniating discs
What can osteophytes impinge on?
exiting spinal nerves
What are abnormal bony growths that are associated with degeneration of cartilage and may impinge on the exiting spinal nerves?
osteophytes
What are the four types of pain associated with back problems?
nerve root pain
muscular back pain (caused by guarding)
periosteal pain
meningeal pain
What causes nerve root pain?
herniated discs usually at L5,S1
What causes muscular back pain?
ANY back abnormaility typically caused by guarding
What is guarding?
when you attempt to alleviate pain by contracting alternative back muscles which eventually leads to back pain
What kind of pain is periosteal pain?
bone tenderness and local pain
What are the components to the axial skeleton?
Is the pelvis included in this?
skull
vertebral column
ribs
sternum
NO, the pelvis is not included!
What is the typical number of vertebrae?
33
What are the primary curvatures of the vertebral column?
the thoracic and sacral
What are the secondary curvatures of the vertebral column?
cervical
lumbar
How many cervical vertebrae are there?
7 cervical
How many lumbar vertebrae are there?
5 lumbar
How many thoracic vertebrae are there?
12 thoracic
How many segments make up the sacrum?
5
How many segments make up the coccyx?
4
How many nerves are there and why is this weird?
there are 31 nerves, cuz there are 33 vertebrae!
Whats up with being a fetus and your vertebral column?
Everything is primary and you make all your nerve connections so once you grow you get secondary curves and since you just grow upward this is why your spinal cord stops short :)
What two things articulate with and support the skull to provide a pivot joint that allows for the great range of motion of the neck.
The atlas (C01) and the axis (C02)
What doesnt that atlas have the other vertebrae have?
it doesnt have a body or spinous process, it is instead a ring-like structure the has an anterior and posterior arch and two lateral masses
Does the axis rotate around the atlas or visa versa?
that atlas rotates around the axis
What does the vertebral formane allow for?
the passage of the spinal cord
How do the transverse process project off of the atlas?
they are large and project downard
What does the spinous process and the transverse process function in?
muscle attachment and movement
What does the articular processes function in?
restriction of movement
What does the lamina and pedicle function in?
protection of spinal cord
What makes up the neural arch?
the penicle, the lamina, and the spinous process :) (protects the spinal cord)
What is a laminectomy?
remove the neural arch (posterior aspect) so you can get access to the spinal cord
So the superior and inferior articular processes meet with with adjacent vertebrae via what?
articular facets
What all make up the vertebral foramen for the spinal cord?
body, pedicle and lamina
(blank) is made from the inferior and superior vertebral notches. Which part the inferior or the superior notch make up the majority of this foramen?
Where are nerve roots located in the foramen?
intervertebral formen
inferior notch :)
inferior notch
This is a round eminence on the lateral aspect of the superior articular facet (for muscle attachment) of lumbar vertebrae
mammillary process
In the lumbar region, the superior facet is (blank) and the inferior facet is (blank)
medial
lateral
Describe the sacrum
it is fused with 8 anterior and posterior foramen along with a sacral hiatus
What go through the foramen of the sacrum? what goes through the sacral hiatus?
4 pais of sacral nerves
the last pair of sacral nerves and the coccygeal nerve
Does the sacral hiatus open up posteriorly or anteriorly?
posteriorly and has some nerve roots here so a good place for anesthesia
Where do dorsal rami go?
true back muscles
Describe a cervical vertebrae
has a bifid spinous process with transverse foramen (for passage of vertebral artery on its way to the brain) which articular facets pointing inferiorly and superiorly to allow for cervical movement
Describe Thoracic vertebrae
large vertebral bodies with articular facets for the ribs. Spinous processes are pointing inferiorly and the facets are pointing anteriorly and posteriorly
Describe the lumbar vertebrae
large body with massive neural arch with large square spinous process that points straight back to allow for attachment of erector spinous muscle, the superior articular facets is facing medially and the inferior articular facet is facing laterally (allows for rotation, bending, flexion and extension)
Atlas is C(blank)
Axis is C(blank)
C1
C2
Where does the dens sit and what does it do?
in the articular arch and allows for easy rotation around each other. (i.e for the atlas to spin around the axis)
What runs in the groove of the posterior arch?
vertebral artery and C1 nerve
the dens is held in position against the posterior aspect of the anterior arch of the atlas by the (blank).
(i.e how do you attach the dens to the atlas)
transverse ligament of the atlas
creates the foramen in the atlas for dens so that it can slip right into the atlas
The head spins on the (blank) and rocks on the (blank)
axis
atlas
The (blank) allows for rotation of the skull and the (blank) allows for flexion and extension of the head.
atlanto-axial joint (b/w c1 and c2)
atlanto-occipital joint (atlas and the occipital)
Does the dens allow for flexion or extensions?
no
How do you connect the atlas to the skull?
via the occiptial condyles + superior articular fovea
Name the axis for the movement:
1) flexion and extension
2) lateral bending
3) rotation
Transverse
AP
Vertical
The movement of the trunk can be allowed or restricted by many factors. What are they (4)?
1) thickness of intervertebral discs
2) orientation of articular facets
3) attachment of ribs
4) size, elasticity, orientation of muscle of back and abdominal wall
What is the most mobile region of the spine?
The cervical region
What part of the spine allows for considerable flexion and extension?
the lumbar :)
Why is the thoracic region of the spine less mobile than the cervical region?
due to ribs and thin discs
What gets bigger as you go towards the bottom end of the spine?
you get bigger vertebral bodies
Where do you get spondylolysis and what is it?
At the pars interarticularis ( in between the inferior and superior articular facets)
It is a stress fracture of the pars interarticularis (scotty dog broken neck, commonly occurs due to repeated stress to the spine)
How do you know you are looking at a lumbar vertebrae?
if the articular facets are pointing medially or laterally then you got yourself a lumbar vertebrae
What is spondylolisthesis and where does it commonly occur?
when you have spondylolysis bilaterally resulting in vertebral slipping (can crush spinal cord) L5.
What is the anterior longitudinal ligament and where do you find it?
limits extension and covers half of the anterior vertebral body and attaches to individual vertebrae
nerve root pain is usually (blank) pain.
referred
(blank) pain is usally associated with a problem with the dura because it is super innervated.
meningial pain
What is the posterior longitudinal ligament and where do you find it?
limits flexion and found on the posterior side of the spine underneath the spinous process.
(blank) limits direct posterior disc herniation, and protect the spinal cord for damage, because of this the disc will slip out laterally and impinge upon spinal nerve roots rather than the spinal cord.
the posterior longitudinal ligament
the (blank), found on the posterior side of the vertebrae is an elastic ligament that allows for stretching and snapping back from flexion and extension.
ligamentum flavum
What is a vertebral lamallea? And what lies on this?
it is the vertebral arch
ligamentum flavum
What lies within the suboccipital triangle?
C1 and vertebral artery
What holds the spinous processes together?
supraspinous liaments and intraspinous ligaments
What is between the posterior longitudinal ligament and the ligamentum flavum?
the spinal cord
The dens of the atlas is attached to the occipital bone by the (blank).
alar ligaments
What do the alar ligaments do?
limits rotation and connects axis to occipital bone
The capsule of the atlanto-occiptal is where and what does it do?
it is between the occipital bone and the atlas and it provides strength
What is the cruciate ligament?
has three components, a strong transverse and 2 weaker parts which are the superior and inferior.
What does the transverse portion of the cruciate ligament do?
stabilizes the dens on the atlas
What does the inferior and superior parts of the cruciate ligament do?
holds axis to occiptal bone
c2 to the skull
What is a continuation of the posterior longitudinal ligament?
the tectorial membrane
What all is covered by the tectorial membrane?
covers the dens and its ligaments (alar ligament, cruciate ligaments)
What happens if you tear your cruiciate ligament?
you push your dens into your spinal cord.
Atlas allow for what kind of movement? Axis allow for what kind of movement?
up and down neck movement
rotation
Describe an intervertebral disc
a central core made up of water called the nucleus pulposis, with fibrocartilage surrounding it called the annulus fibrosis
What is the nucleus pulposis?
the water filled core of the intervertebral disc that is derived from the notochord that is gelatinous and responsible for flexibility b/w vertebral bodies
If you bend forward, which part of the vertebral disc becomes thinner?
the anterior portion :)
posterior portion becomes thicker
HOWEVER posteriorly the annulus fibrosis is thinner!
What is this, when the intervertebral disc bulges out through the lateral or posterior lateral side which will impinge upon the nerve root?
herniation
What is the annulus fibrosis?
it is a peripheral ring of fibrcartilage that is thinner posteriorly and surrounds the nucleus pulposis
What can occur when there is excessive pressure on the disc?
What direction does a herniated disc usually occur?
herniated disc
posterolateral direction
Where do you most commonly get herniated discs?
(most common) L5-S1
(second most common) L4-L5
When a disc herniates which nerve roots are most likely compressed?
the nerve below… i.e if you have an L4/L5 herniated disc you will impinge on your L5 nerve root.
If you have a C3/C4 you will impinge on your C4
Where do cervical nerves come out? Where do thoracic and lumbar nerves come out?
above the respective vertebrae
below the respective vertebrae
What structurally allows for some nerve fibers to avoid being hit by a herniated disc?
the large inferior intervertebral notch (remember that when you have an L3/L4 herniation only the L4 will get pinched because the L3 can slip through the inferior intervertebral notch)
What are the three layers of the meninges?
dura mata, arachnoid, pia mata
(blank) is highly innervated and the most outside layer of the meninges.
the dura mater
Is the dura matter fused to the periosteum?
no it is separated by the epidural fat space EXCEPT for in the skull
the dura matter WILL fuse with what?
the outter sheath of the nerve called the epineurium
What is a potential space in the spinal cord that is important when having a spinal cord bleed?
the subdural space
(blank) is pushed tightly against the dura.
arachnoid space
What is below the arachnoid space and is filled with CSF to allow for the suspension?
the subarachnoid space
The (blank) coats the spinal cord and dorsal and ventral rootlets of the spinal nerves.
pia
To stabilize the spinal cord within the column the pia mater forms the ……?
the denticulate ligament
The ventral and dorsal rootlets are separated from each other by the (blank)
denticulate ligament
What is the path of the denticulate ligament?
the pia mater has lateral teeth like projections called denticulations that poke through the arachnoid and attach to the dura to hold the spinal cord in place in the subarachnoid space.
Can you get sympathetics off of the lateral horns for Sacral nerves?
NO!
What is white matter?
descending and ascending tracts between the brain and spinal cord
What happens if you cut the white matter?
you will lose signals from the brain to ANYTHING below the cut.
If you cut a tract going up to the brain (white matter) then what will you lose?
all incoming sensory info from BELOW the cut.
If you have a level loss what will happen to your reflexes?
it will intesify
What happens if you damage gray matter?
You will lose all motor neurons pertaining to that level i.e segmental loss
(can be caused by viral infections or tumors)
There are enlargements of the spinal cord in the cervical and lumbosacral levels because of???
the need for refined movement (i.e. you need more neurons)
Why does the spinal cord end at the vertebral level L2?
because nerve connections and spinal cord are made when you are a baby so its embryological, you grow and your spinal cord stays the same :)
What is the inferior, tapered end of the spinal cord?
the conus medullaris
Where do pelvic splachnics come from? What do the pelvic splachnics do?
the conus medullaris
Rectal, bladder, sexual function
As you move down the spinal cord towards the cauda equina each successive nerve root must get (blank) to reach its appropriate intervertebral foramen.
longer :)
Where does the dural sac (the dura matter that surrounds the end of the spinal cord) end? WHy is this important?
it ends at the S2 vertebral level
so that you can inject anesthesia outside dural sac and bathe caudal spinal nerves, this is called an epidural block
What part of the spinal cord has a large subarachnoid space, and why is this awesome?
L2-S2
Because you can do a fantastic lumbar puncture and anesthetize if warranted
Because the spinal cord ends at vertebral level L2, how do dorsal and ventral roots below this exit the spine?
they descend within the vertebral canal before exiting through the correct intervertebral foramina.
What are the collection of the nerve roots below L2 called?
cauda equina
What kind of fibers to you find on the ventral root?
somatomotor and some sensory depending where you are
Why kind of loss will a herniated disc most likely result in?
sensory losses
muscle weakness and referred pains are signs of herniation
What side of the spinal cord will a herniated disc compress?
the ventral side
Dermatome is defined as the area of skin innervated by a single (blank)
spinal nerve
T10? T12? T4? S1? S1, S2, L5?
umbilicus groin/inguinal region nipples lateral side of foot back of leg
What communicates with the posterior spinal artery?
the posterior radicular artery
What communicates with the anterior spinal artery (only present at specific levels)?
anterior medullary artery
What does the posterior intercostal artery feed into?
the spinal branch
What will the spinal branch feed into?
to the nerve roots and vertebral body via anterior medullary artery and posterior radicular artery
Descibe the blood supply to the spinal cord.
aorta-> posterior intercostal arteries-> spinal branch-> [anterior medually artery -> anterior spinal artery] OR [posterior radicular artery -> posterior spinal artery]
What does every dorsal and ventral root have (in terms of blood supply)?
a radicular artery
The anterior spinal artery doesnt have enough flow to supply the entire length of the cord, so how do we compensate for this?
segmental contributions from medullary arteries (however we have very few of these )
What is the most important anterior medullary artery that supplies the anterior spinal artery? Where is it located?
Why is it important?
the artery of ademkiewicz
T8-L2
Prevlance of aortic aneurysm here
What happens if you have a blockage of the anterior spinal artery?
anterior spinal artery syndrome
If you get a blockage of ademkiewicz artery, what will happen?
you will get damage to the ventral 2/3rds of the spinal cord
(cuz you lose blood supply to the anterior spinal artery in that region)
In anterior spinal artery syndrome what will be damaged?
Complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract
Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract
Retained proprioception and vibratory sensation due to intact dorsal columns
Areflexia, flaccid anal sphincter, urinary retention and intestinal obstruction may also be present in individuals with anterior cord syndrome.
The most important point about the venous drainage of the spinal cord is that the internal vertebral venous plexus communicates with two things, what are they?
So why is this important?
1) the venous sinuses of the brain
2)venous plexus associted with pelvis (prostatic venous plexus)
Important because prostate cancer can metastasize to CNS
Loss of sensation or muscle strength in a specific location that correlates with either a dermatome or a myotome is considered to be a (blank)
segmental loss
Loss of sensation or muscle strength that starts at the toes and ascends to a particular level is called a (blank)
level loss
What is the first palpable spinous process that is useful as a surface landmark?
C7 spinous process
At what vertebral level is the iliac crest at?
L4/L5
The cute dimples (posterior superior iliac spines PSIS) on the back mark what vertebral level?
S2
Name all the extrinsic back muscles
levator scapulae trapezius rhomboids (min and maj) latissimus dorsi serratus pos inf. and sup.
The (blank) attaches to the superior aspect of the scapula.
levator scapulae
What goes from the spinous process to the medial border of the scapula?
rhomboid min and maj. (minor is more superior than major)
What do the rhomboids do?
help you shrug and pull and retract the scapula
What innervate the extrinsic back muscles?
ventral rami of spinal nerves????
Where does the serratus posterior inferior and superior attach?
to the ribs
What are the three layers of the intrinisc back muscles
Spinotransverse
Erector spinae
Transversospinae
What are the intrinsic back muscles innervated by?
dorsal rami!
What are the three groups of the erector spinae (intermediate group) and how do the lay in relation to each other?
I Like Spaghetti
Ileocostalis (most lateral)
longissimus (medium lateral)
spinalis (medial)
What are the oblique (superficial) intrinsic back muscles?
the spinotransverse= splenius
What are the transversospinal intrinsic back muscles (deep)?
semispinalis
multifids
long/short rotators
How does the splenius/ spinotransverse travel?
from spine to head of skull (midline to superior lateral)
What movement does the splenius capitus allow for?
rotates the head to the same side of muscle (i,e right muscle right rotation)
What is the intermediate group that points vertically and consists of three groups?
erector spinae
What kind of movement are the erector spinae muscles involved in?
flexion and extensions
What are the following:
concentric contraction
eccentric contraction
isocentric contraction
shortening
lengthening
same
How does the transversospinae muscle travel?
from inferior transverse process to superior spine in an oblique fashion oppositie to the spinotransverse.
If you contract the right transverospinal which way will your anterior surface turn?
towards the left (i.e opposite side)
Where does the splenius muscle attach?
from spinous process to the skull or to transverse processes of cervical vertebrae
What is the most important splenius muscle?
the splenius capitus
What makes up the splenius group?
capitis and cervicis
How are the erector spinae muscles orientated?
vertically along either side of the vertebral column
What innervate the erector spinae muscles?
dorsal rami
What makes up the erector group of intrinisc back muscles?
iliocostalis
longissimus
spinalis
How are transversospinae muscles oriented?
from inferior transverse to superior spine
How is the transversospinae muscles divided into four muscles and how many vertebrae do each span?
semispinalis 6-8
multifidus 3-5
long rotators 2
short rotators 1
What movement do the transversospinae muscles allow for?
rotation (except for semispinalis capitis)
Why is the semispinalis capitis the only muscle that doesnt aid in rotation out of the transversospinae muscles?
because it attaches to the skull instead of spinous process and is the most powerful extender of the head.
What movement does the inferior oblique allow for?
same side rotation
What movement does the the superior oblique allow for?
extension
Can you rotate your head on C1?
no, member you rock on the atlas and rotate on the axis
What movement does the rectus capitus posterior major allow for?
extender and some rotation
What movement does the rectus capitus posterior minor allow for?
extender
What makes the suboccipital triangle?
inferior oblique, superior oblique, rectus capitis minor and rectus capitis major
C1 provides what kind of innervation?
C2?
motor to back of head
sensory to back of head
What are suboccipital muscles important for?
fine control of head movements
rectus capitis and oblique
What is the greater occipital nerve (C2)?
What is the suboccipital nerve?
it is a sensory nerve, dorsal ramus of C2 (good landmark for inferior oblique muscle)
C1 :) for motor
