Anatomy: Vertebral Column, Spinal Cord, Meninges Flashcards
Vertebrae
33
7C
12T
5L
5S - fused
4 coccyx fused
What are: body, pedicle, laminae, travserve processes, spinous sprocesses, articular processes, superior/inferior vertebral notches, vertebral foramen?
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Vertebra prominens
C7
Cervical vertebrae specializations
bifid spinous process
transverse foramina for vertebral arteries
C1 - atlas
C2 - axis
Lumbar vertebrae specializations
Larger transverse process, large intervertebral foramina, large bodies
Thoracic vertebrae specializations
Costal facets
Sacral specializations
Anterior and posterior foramina
Lateral surface for articulation w/ ilium (sacroiliac joint)
Anterior and posterior longitudinal liagments
on anterior/posterior of vertebral bodies
Ligamentum flavum
Located between laminae of adjacent vertebrae
Interspinous ligament
Between spines of adjacent vertebrae
Hangmans Fracture
Dislocation/fracture of C2-C3
Fatal
Spondylolisthesis
break of arch to start (Fracture) = spondylolysis
Anterior displacement onto bone in front = spondylolisthesis (Frequent L5 onto sacrum)
Kyphosis vs Lordosis
Kyphosis = Dowager’s hump, increased thoracic curvature - hard to breath
Lordosis = increased lumbar curvature
Scoliosis
Abnormal/lateral curvature in spine
What spinal cord segments constitute the cervical and lumbosacral enlargements? What is the extent of the spinal cord in the vertebral canal?
- Cervical - C4-T1
- Lumbosacral - L2-S3
- Terminates at conus medullaris (L2) → cauda equina + filum terminale
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?
V/D rootlets → roots (ganglia on DR) which join together = spinal nerves → exit intervertebral foramina → branch into rami
3. What is the general relationship of the spinal cord segments to the vertebral body level?
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)
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?
-
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)
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?
- 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)
What is the lumbar cistern? Why is it safe to do a lumbar puncture between the spinous processes of L3/L4 or L4/L5?
- 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
7. How is the difference between spinal anesthesia and epidural anesthesia?
- Spinal anesthesia - anesthetic agent directly into CSF - blocking nerve roots in subA space
- Epidural anesthesia - through sacral hiatus - ie birth canal
Coccydynia
- Pain in the coccyx, often after fracture
- Pain when sitting - pain relief difficult to find
Naming and number of vertebral discs is according to ______
vertebra below which they lie
“Slipped Disc”
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
Ligamentum nuchae
holds neck together
Erector spinae
trunk extensors
iliocostalis (lateral)
longissimus
Spinalis (medial)
dorsal rami
Spinal cord terminates at
Conus medularis (L2 or L3) –> filum terminale (internal terminal filum or internal medullary filum) = pia –S2
Internal medullary filum –> external medullary filum
pia from L2-S2 after conus medullaris –> fused dura/arachnoid/pia at s2 –> coccyx (coccygeal ligament)
Lumbar cistern
subarachnoid space w/ CSF after SC ends
Where should spinal tap be?
Below L2, L3
What is meant by sacralization of the fifth lumbar vertebra and lumbarization of the first sacral vertebra?
- Sacralization → L5 fused with sacrum
- Lumbarization → S1 not fused with sacrum
What is spinal stenosis, and what clinical complications may occur in a patient with lumbar spinal stenosis?
- Vertebral foramen narrowing on spinal cord
- Physiological narrowing, IV disc bulging, age
- Treat with laminectomy
- Pressure on nerves - pain/difficulty in motion
. What is spina bifida occulta and spina bifida cystica, and where do they occur? Define the difference between a meningocele and a meningomyelocele
- 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
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?
- Whiplash - anterior longitudinal ligament - one NOT inside foramen (when whipping back)
- Hyperflexion (blow to back of neck, some car accidents), disc herniation
Differentiate strains and sprains. How would one differentiate a back strain from a herniated disc?
- Sprain - stretch/tear ligament
- Strain - stretch/tear muscle/tendon
- Strain - often localized pain vs. herniated disc is referred (feel in foot/leg)
How is innervation of the superficial or extrinsic back muscles different from innervation of the deep or intrinsic back muscles?
- Superficial from ventral rami
- Deep from dorsal rami
Where are somatic motor bodies?
Upper levels of neuraxis (brain stem, cerebellum) - no synapsye
