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MRCS Part B > Anatomy - Spine > Flashcards

Anatomy - Spine Flashcards

1
Q

What makes up the spinal column?

A

24 separate vertabrae + sacrum + coccyx

7 Cervical
12 Thoracic
5 Lumbar
5 fused Sacrum
3-4 fused Coccyx

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2
Q

How are the articular processes arranged in the thoracic vertabrae?

A

Superior - faces backward
Inferior - faces forward

Allows articulation between adjacent vertabrae

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3
Q

How are the articular processes arranged in the thoracic vertabrae?

A

Superior - faces inward
Inferior - faces outward

This arrangment limits rotation of lumbar spine

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4
Q

What is the name of the most anterior point on the sacrum?

A

Sacral promontory

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5
Q

What are the parts of the intervertebral disc called?

A

Outer - annulus fibrosus (fibrocartilaginous type I collagen)
Inner - nucleus pulposus (type II collagen)

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6
Q

Which spinal ligament runs on the anterior aspect of adjacent lamina?

A

Ligamentum flavum

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7
Q

Which spinal ligament holds the vertebral bodies of adjacent vertabrae together?

A

Anterior (stronger) and posterior longitudinal ligaments

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8
Q

Vertebral level: termination of dural sac

A

S2

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9
Q

Vertebral level: conus medularis

A

L1/2

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10
Q

What are the three dural layers?

A

Dura mater
Arachnoid mater
Pia mater

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11
Q

Which areas within the spinal column transmit light touch and vibration sensation?

A

Dorsal columns

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12
Q

Where is the spinothalamic tract located and what does it transmit?

A

Anterolaterally, transmitting sensation of sharp pain and temperature

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13
Q

Where is the corticospinal tract located and what does it transmit?

A

Posterior to the spinothalamic tract, transmitting motor fibres

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14
Q

Describe the findings in Brown-Séquard syndrome

A

Hemisection of the spinal cord leades to:
1. contralateral loss of pain and temperature beginning a few levels below the level of injury (due to how the spinothalamic tract decussates)
2. ipsilateral spastic paralysis, loss of light tough, vibration, proprioception

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15
Q

What is the common mechanism of injury causing a central cord syndrome?

A

Hyperextension injury of the neck

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16
Q

What are the upper limbs more affected than the lower limbs in a central cord syndrome?

A

Motor fibres supplying the upper limb run more centrally within the corticospinal tract, therefore more likely to be injured

17
Q

Describe the blood supply of the spinal cord

A

Anterior spinal artery originates from the vertebral arteries

Two posterior spinal arteries originate from the posterior inferior cerebellar arteries

Multiple radicular arteries at multiple levels

18
Q

Landmark for Lumpar Puncture

A

Iliac crests correspond to the supracrestal plane at L4

The spinal cord terminated at the conus at L1

LP is safe to perform at L3/4 or L4/5

19
Q

Layers transversed by a LP needle

A
  1. Skin
  2. Subcutaneous tissue
  3. Supraspinous ligament
  4. Interspinous ligament
  5. Ligamentum flavum
  6. Epidural space (contains venous plexus)
  7. Dura mater
  8. Subdural space
  9. Arachnoid mater
  10. CSF (obtained for subarachnoid space)
20
Q

What is cauda equina?

A

Syndrome consisting severe back and bilateral leg pain resulting from compression of the nerve roots at the cada equina
Failure to manage compression promptly may lead to irreversible loss of bowel, bladder and lower limb function

21
Q

How many pairs of spinal nerves are there?

A

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

21
Q

What fascial layers would be encountered in the neck during an anterior cervical spinal decompression and fusion (ACDF)?

A
  1. Superficial fascia - platysma and fat
  2. Investing layer of the deep cervical fascia - enveloped entire neck including trapezius and SCM
  3. Carotid sheath - common carotid and the internal carotid arteries, internal jugular vein and vagus nerve
  4. Pretracheal layer - thyroid gland, trachea, oesophagus, “strap” muscles
  5. Prevertebral fascia - vertebral column and muscles
22
Q

What type of joint is the intervertebral joints?

A

Secondary cartilaginous

23
Q

What is the most important radicular artery providing additional blood supply to the spinal column?

A

Artery of Adamkiwicz

24
Q

What are the parts of the dorsal column called?

A

Medial fasciculus gracilis - lower limb

Lateral fasciculus cuneatus - upper limb

25
Q

What are the key features of a cervical vertabrae?

A
  1. Bifid spinous process
  2. Transverse foramina
  3. Triangular vertebral formaina
26
Q

What are the key features of a Thoracic vertabrae?

A
  1. Demi facets for rib articulation
  2. Transverse processes with costal facets
  3. Oblique inferior angled spinous process
  4. Round vertebral foramen
27
Q

What are the key features of a lumbar vertabrae?

A
  1. Large square vertebral bodies
  2. Triangular vertebral foramina
  3. Short horizontal spinous process
28
Q

Vertebral body: spinal cord termination in the newborn

A

L3

29
Q

Which part of the spine is the embryological remanant of the notochord?

A

Nucleus pulposus (type II collagen)

30
Q

What is the most common direction of intervertebral disc herniation?

A

Posterolaterally

31
Q

What is the most common levels of intervertebral disc herniation?

A

C5/6
C6/7
L4/5
L5/S1

** 95% in the latter two**

32
Q

Which nerve root is affected in a L5/S1 disc herniation?

A

S1 - numbness over lateral foot with decreased ankle jerk reflex

33
Q

What is the commonest partial spinal cord injury?

A

Anterior cord syndrome usually caused by interruption of the anterior spinal artery

34
Q

What are the signs of an anterior cord syndrome?

A

Corticospinal - loss of power below level of injury
Spinothalamic - loss of pain and temperature sensation
Lower extremity > Upper extremity
Dorsal columns intact

35
Q

What percentage of patients with Borwn-Séquard return to ambulation?

A

90%

36
Q
A

MRCS Part B (7 decks)

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