Anatomy: Vertebral Column, Spinal Cord, Meninges

Question 1

Vertebrae

Answer 1

33

7C

12T

5L

5S - fused

4 coccyx fused

Question 2

What are: body, pedicle, laminae, travserve processes, spinous sprocesses, articular processes, superior/inferior vertebral notches, vertebral foramen?

Answer 2

See flashcard

Question 3

Vertebra prominens

Answer 3

C7

Question 4

Cervical vertebrae specializations

Answer 4

bifid spinous process

transverse foramina for vertebral arteries

C1 - atlas

C2 - axis

Question 5

Lumbar vertebrae specializations

Answer 5

Larger transverse process, large intervertebral foramina, large bodies

Question 6

Thoracic vertebrae specializations

Answer 6

Costal facets

Question 7

Sacral specializations

Answer 7

Anterior and posterior foramina

Lateral surface for articulation w/ ilium (sacroiliac joint)

Question 8

Anterior and posterior longitudinal liagments

Answer 8

on anterior/posterior of vertebral bodies

Question 9

Ligamentum flavum

Answer 9

Located between laminae of adjacent vertebrae

Question 10

Interspinous ligament

Answer 10

Between spines of adjacent vertebrae

Question 11

Hangmans Fracture

Answer 11

Dislocation/fracture of C2-C3

Fatal

Question 12

Spondylolisthesis

Answer 12

break of arch to start (Fracture) = spondylolysis

Anterior displacement onto bone in front = spondylolisthesis (Frequent L5 onto sacrum)

Question 13

Kyphosis vs Lordosis

Answer 13

Kyphosis = Dowager’s hump, increased thoracic curvature - hard to breath

Lordosis = increased lumbar curvature

Question 14

Scoliosis

Answer 14

Abnormal/lateral curvature in spine

Question 15

What spinal cord segments constitute the cervical and lumbosacral enlargements? What is the extent of the spinal cord in the vertebral canal?

Answer 15

• Cervical - C4-T1
• Lumbosacral - L2-S3
• Terminates at conus medullaris (L2) → cauda equina + filum terminale

Question 16

Contrast ventral and dorsal roots, spinal nerves, spinal ganglia, dorsal and ventral rami. What is the general position of each nerve component with respect to the vertebrae?

Answer 16

V/D rootlets → roots (ganglia on DR) which join together = spinal nerves → exit intervertebral foramina → branch into rami

Question 17

3. What is the general relationship of the spinal cord segments to the vertebral body level?

Answer 17

SC shorter than VB → so SC segments are higher up than their VB segment (i.e. SC segment C8 is in the C6/C7 space) – run down to exit

Note: Actual Spinal nerve exits in intervertebral space BELOW body (i.e. L5 extits at L5/L6)

Question 18

Differentiate dura, arachnoid, subdural space, subarachnoid space, pia, epidural space. How are the denticulate ligaments formed and what is thought to be their function? What occupies the subarachnoid space?

Answer 18

• Dura mater - tough outer layer → skull to S2 → external filum (coccygeal ligament) → coccyx
  
  • Subdural space - potentially enlarged if filled with something
• Arachnoid - next layer → S2
  
  • Subarachnoid space has CSF → still when forms lumbar cistern
• Pia - innermost layer, forms denticulate ligaments which connect to the dura inner wall (stability)
• Epidural space - above the dura (with fat, connective tissue, internal vertebral venous plexus)

Question 19

How do blood vessels (arteries and veins) outside the vertebral canal reach the spinal cord? Where is the internal vertebral venous plexus located and what is its significance in metastases?

Answer 19

• Internal vertebral venous plexus - laterally through intervertebral foramina
• Within spinal cord (Epidural space)
• Infection/cancer can metastasize through IVVP (especially when drainage veins of organ are connected)

Question 20

What is the lumbar cistern? Why is it safe to do a lumbar puncture between the spinous processes of L3/L4 or L4/L5?

Answer 20

• Enlargement of subarachnoid space between end of SC (conus medullaris) at L2 and end of dura/arachnoid at S2 - has CSF
• Nerves in the cistern are individual (cauda equina) and will just move away

Question 21

7. How is the difference between spinal anesthesia and epidural anesthesia?

Answer 21

• Spinal anesthesia - anesthetic agent directly into CSF - blocking nerve roots in subA space
• Epidural anesthesia - through sacral hiatus - ie birth canal

Question 22

Coccydynia

Answer 22

• Pain in the coccyx, often after fracture
• Pain when sitting - pain relief difficult to find

Question 23

Naming and number of vertebral discs is according to ______

Answer 23

vertebra below which they lie

Question 24

“Slipped Disc”

Answer 24

Herniation of nucleus pulposus = inner softer part of intervertebral disc

L4 disc –> pressure on L5 –> pain in leg/dorsum of foot

L5 disc –> pressure on S1 –> pain back of leg/side of foot

Question 25

Ligamentum nuchae

Answer 25

holds neck together

Question 26

Erector spinae

Answer 26

trunk extensors iliocostalis (lateral) longissimus Spinalis (medial) dorsal rami

Question 27

Spinal cord terminates at

Answer 27

Conus medularis (L2 or L3) --\> filum terminale (internal terminal filum or internal medullary filum) = pia --S2

Question 28

Internal medullary filum --\> external medullary filum

Answer 28

pia from L2-S2 after conus medullaris --\> fused dura/arachnoid/pia at s2 --\> coccyx (coccygeal ligament)

Question 29

Lumbar cistern

Answer 29

subarachnoid space w/ CSF after SC ends

Question 30

Where should spinal tap be?

Answer 30

Below L2, L3

Question 31

**What is meant by sacralization of the fifth lumbar vertebra and lumbarization of the first sacral vertebra?**

Answer 31

* **Sacralization → L5 fused with sacrum** * **Lumbarization → S1 not fused with sacrum**

Question 32

**What is spinal stenosis, and what clinical complications may occur in a patient with lumbar spinal stenosis?**

Answer 32

* **Vertebral foramen narrowing on spinal cord** * **Physiological narrowing, IV disc bulging, age** * **Treat with laminectomy** * **Pressure on nerves - pain/difficulty in motion**

Question 33

**. What is spina bifida occulta and spina bifida cystica, and where do they occur? Define the difference between a meningocele and a meningomyelocele**

Answer 33

* **Spina bifida occulta - L5/S1 poorly formed vertebral arch → herniation of spinal cord, tuft of hair** * **Cystica - actual cyst of meninges/spinal cord** * **meningocele not SC** * **Myelomeningocele - SC**

Question 34

**11. What ligament is involved in so-called "whiplash" injury? When is injury to the posterior longitudinal ligament and interspinous ligaments most likely to occur?**

Answer 34

* **Whiplash - anterior longitudinal ligament - one NOT inside foramen (when whipping back)** * **Hyperflexion (blow to back of neck, some car accidents), disc herniation**

Question 35

**Differentiate strains and sprains. How would one differentiate a back strain from a herniated disc?**

Answer 35

* **Sprain - stretch/tear ligament** * **Strain - stretch/tear muscle/tendon** * **Strain - often localized pain vs. herniated disc is referred (feel in foot/leg)**

Question 36

**How is innervation of the superficial or extrinsic back muscles different from innervation of the deep or intrinsic back muscles?**

Answer 36

* **Superficial from ventral rami** * **Deep from dorsal rami**

Question 37

Where are somatic motor bodies?

Answer 37

Upper levels of neuraxis (brain stem, cerebellum) - no synapsye