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Anatomy II > Back > Flashcards

Back Flashcards

0
Q

Vertebral arch consists of:

A
  • 2 pedicles that attach to the body (walls of the house)

- 2 laminae that unite to form the spinous process (roof)

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1
Q

How many vertebrae are in the vertebral column?

A
  • 33 but only 24 individual: 7 cervical, 12 thoracic, 5 lumbar
  • five fused sacral = sacrum
  • four coccygeal = cocyx
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2
Q

Spina Bifida:

A
  • when laminae fail to fuse to form the spinous process

- most common in the lower lumbar or sacral vertebrae

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3
Q

Types of Spina Bifida:

A
  • occulta: spinous processes fail to form at lumbar or sacral level. Asymptomatic - may show tuft of skin over defect
  • cystica: cyst protrudes from the defect at the vertebral arch. Diagnosed in utero due to elevated alpha-fetoprotein. May result in hydrocephalus and neurological defects.
  • Cystic with Meningocele: cyst lined by dura/arahnoid and contains cerebrospinal fluid
  • cystica with meningomyelocele: lumbosacral spinal cord displaced into the cyst. Lumbosacral spinal nerves stretch. Results in bladder, bowel, and lower limb weakness.
  • Myeloschisis/rachischisis: caudal end of the neural tube fails to close in the dorsal midline and is exposed on the surface of the back
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4
Q

Transverse process:

A

formed by the costal processes and projects between the pedicle and the lamina

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5
Q

Four curvatures in adults:

A
  • cervical and lumbar: secondary curves directed anteriorly

- thoracic and sacral: primary curves directed posteriorly

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6
Q

kyphosis:

A
  • abnormal curvature of the spine
  • an abnormal increase in the posterior curvature of the spine
  • most common is postural kyphosis
  • can also be caused by anterior wedge-shaped thoracic vertebrae OR resorption of the anterior parts of the thoracic vertebral bodies (from osteoporosis)
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7
Q

lordosis:

A
  • abnormal curvature of the spine
  • abnormal increase in the anterior curvature of the spine that may be caused by a weakening of the anterior abnormal wall musculature (due to weight gain)
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8
Q

scoliosis:

A
  • abnormal lateral curvature that may be caused by:
    1) an absent half of a vertebra or

2) a wedge-shaped vertebra OR
3) by an asymmetric weakness of back musculature

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9
Q

Individual vertebrate articulate at:

A
  • facet joints
  • through intervertebral disks
  • supported by ligaments
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10
Q

Zygapophysel (facet) joints:

A
  • formed between the facets of superior/inferior processes at the junction of each pedicle and lamina
  • permit gliding motions
  • deep back muscles act on facet joints
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11
Q

intervertebral disk consists of:

A

fibrocartilaginous annulus fibrosus that surrounds a nucleus pulposus (postnatal remnant of the fetal notochord)

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12
Q

intervertebral disk functions:

A
  • movement of the adjacent bodies produce compression and tension in different parts of the disk
  • the disks function to absorb shock and distribute weight over the entire surface of the body
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13
Q

anterior longitudinal ligament:

A
  • covers the anterolateral parts of the body

- functions to limit vertebral extension

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14
Q

posterior longitudinal ligament:

A
  • covers the posterior part (inside the vertebral foramen) of the disk
  • functions to limit vertebral flexion
  • narrower and weaker than anterior
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15
Q

elastic ligamentum flavum:

A
  • extends between the laminae of adjacent vertebrae
  • like posterior they limit vertebral flexion
  • maintain normal vertebral curvatures
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16
Q

intervertebral foramina:

A
  • separate individual vertebra
  • transmit dorsal and ventral roots of spinal nerves into and out of the vertebral canal
  • bounded by the pedicles of adjacent vertebrae, posteriorly by facet joints and anteriorly by bodies/intervertebral disks
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17
Q

vertebral canal:

A
  • formed by all of the individual vertebral foramina/ligaments and disks that interconnect them
  • consists of meninges, spinal cord, and the roots of spinal nerves
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18
Q

epidural space:

A
  • outside the dural layer of the meninges

- contains fat and the internal venous plexus

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19
Q

internal venous plexus:

A
  • connects veins that drain the thorax, abdomen, and pelvis with the dural venous sinuses of the cranial cavity
  • provides a route for metastasis of neoplasms of the prostate, uterus, and rectum to the cranial cavity
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20
Q

dura mater:

A
  • continuous with the meningeal dura of the cranial cavity
  • ends at the level of S2
  • lateral extensions of the dural sac contain the roots of spinal nerves
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21
Q

subdural space:

A

-potential space between the dura and the arachnoid mater

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22
Q

arachnoid mater:

A

-extends to the level of S2 and pressed against the dura by the pressure of CSF

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23
Q

subarachnoid space:

A

contains CSF

  • CSF is secreted into ventricles of the brain then circulates through the subarachnoid space and returns to the venous system
  • CSF has normal pressure of 100 mmH2O
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24
Q

CSF functions:

A
  • cushions the brain & spinal cord
  • absorbs waste products
  • transports hormones
  • it is a clear fluid containing few cells, low protein content, and lower glucose concentration than serum
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25
Q

pia mater:

A
  • covers the spinal cord and roots of the spinal nerves
  • denticulate ligaments: lateral extensions of pia that anchor the spinal cord to the dura
  • filum teminale: consists of pia that extends from the inferior end of the cord at level L2 and joins the dura/arachnoid to end in the sacral canal (S2)
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26
Q

intervertebral disks and aging:

A
  • as you age you lose annulus fibrosus as the nucleus pulposus invades
  • lose some cushion
  • nucleus pulposus becomes more brittle and vulnerable to tears
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27
Q

Spinal Cord location:

A
  • occupies superior 2/3 of the vertebral canal
  • ends inferiorly at L2
  • conus medullaris: tapered inferior end of the spinal cord that contains the sacral and coccygeal cord segments (at L2)
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28
Q

Spinal nerves exit:

A

-through the intervertebral foramina, sacral foramina, or sacral hiatus

29
Q

Cervical nerves exit:

A

-first seven exit superior to the cervical vertebra for which they are named

(IE) CN 4 exits between C3 and 4

**After T1 they exit inferiorly

30
Q

How does the 8th cervical nerve exit:

A

-through the intervertebral foramen between C7 and T1

because there are 8 cervical nerves but only 7 cervical vertebrae

31
Q

cauda equina:

A

formed by dorsal and ventral roots of lumbar and sacral spinal nerves that extend inferior to the end of the spinal cord at L2

32
Q

Lumbar puncture:

A
  • procedure used to sample CSF (cerebral spinal fluid) or to introduce anesthetic agents into the subarachoid space
  • typically performed between the L4 and L5 (well below inferior end of spinal cord)
33
Q

Meninges

A
  • thin membranes that cover the spinal cord and brain

- pia (closest to the spinal cord) -> > subarachnoid space containing CSF -> arachnoid -> dura

34
Q

in a midline lumbar puncture a needle will transverse:

A
  • skin
  • superficial and deep fascia
  • supraspinous and interspinous ligaments
  • intralaminar space
  • epidural space
  • dura
  • arachnoid

*if it were done off of the midline it would transverse a ligamentum flavum instead of supraspinous/interspinous/intralaminar space

35
Q

Radiculopathies:

A

What is it:
-compression of the roots of spinal nerves in the intervertebral foramina or vertebral canal

Symptoms:

  • pain and paresthesia (tingling/numbness) in dermatomes supplied by the root
  • weakness of skeletal muscle

Causes:
-osteoarthritis, spondylitis, spondylosis, herniated disk

36
Q

Osteoarthritis:

A

inflammation that results in additional bone growth by osteophytes at the facet of bone joints

37
Q

Spondylitis:

A
  • inflammation that results in additional bone growth at the MARGINS of the vertebral bodies
  • anterior longitudinal ligament and sacroiliac joint may undergo calcification

SYMPTOMS:

  • ankylosis (joint stiffening)
  • bamboo spine (Marie-Strumpell disease)

(“ITIS” = growth)

38
Q

Spondylosis:

A
  • degenerative changes in intervertebral disks
  • usually combined with osteoarthritis at the margins of the vertebral bodies

(“SIS” = degeneration)

39
Q

Cervical vertebrae characteristics:

A
  • small bodies
  • short spinous processes with bifid tips
  • transverse processes that transmit vertebral arteries
  • they have facet joints of C3-C7 vertebra that are oriented at a 45 degree angle relative to the transverse plane (allows flexion, extension, lateral bending, and rotation)
  • uncinate processes on the bodies of C3-C7 form uncovertebral synovial joints with the vertebral bodies superior to them
40
Q

Whiplash:

A

-caused by the strong extension then flexion of cervical vertebrae which results in an anterior dislocation of the facet joints

41
Q

Osteoarthritic changes in uncovertebral synovial joints:

A

result in compression of the roots of C3-C7 cervical spinal nerves

42
Q

Atlas:

A
  • C1
  • posterior arch and anterior arch (no body or spinous process)
  • NO intervertebral disk between C1 and C2
  • superior articular processes of the atlas articulate with the occipital condyles of the skull
  • these facet joints permit flexion (tilt head forward - decrease angle of neck) and extension (tilt head back back - increase angle of neck)
  • YES joint
43
Q

Axis:

A
  • dens articulates with the anterior arch of the atlas

- no (pivot) joint that permits rotation of the atlas and skull

44
Q

Transverse ligament of the atlas

A
  • holds the dens of the axis in place
  • rupture causes dislocation of the atlantoaxial joint and displacement of the dens posteriorly into the cervical spinal cord
  • compression of the ventrolateral part of the cervical spinal cord by the dens may result in quadriplegia
45
Q

Alar ligaments:

A
  • attach the dens to the margins of the foramen magnum

- rupture causes excessive rotation of the skull

46
Q

C7 vertebra

A
  • vertebra prominens
  • long spinous process
  • small transverse foramina that do not transmit vertebral arteries
47
Q

Herniated disk (nucelus pulposus)

A
  • occurs when the nucleus pulposus protrudes at the posterolateral part of an annulus fibrosus
  • results in compression of spinal roots most commonly in the lower cervical and lower lumbar region
  • compressed roots are usually from the inferior spinal nerve (IE: herniations at C5-6 disk compress C6 roots)
48
Q

Herniated nucleus pulposus at cervical level:

A
  • most commonly at the disk between C6 and C7 (C7 spinal nerve compression)
  • less commonly between C7 and T1 (compresses C8 spinal nerve)
49
Q

Compression of C7 spinal nerve:

A
  • results in referred pain in the neck and shoulder
  • pain and paresthesias in index/middle fingers
  • diminished triceps reflex
  • weakness in extension of the forearm at the elbow
  • weakness in extension of the wrist and fingers (posterior forearm muscles)
50
Q

Compression of C8 spinal nerves:

A
  • results in pain in the neck and shoulder
  • pain and parethesias of ring and little finger
  • weakness in hypothenar and interosseous muscles of the hand
51
Q

Cervical Rib

A
  • may arise from the costal process of C7
  • may compress the T1 spinal nerve and subclavian artery as they course superior to the cervical rib instead of superior to the first thoracic rib

SYMPTOMS:

  • diminished radial pulse
  • pain and paresthesias in medial forearm
  • may also present similar to Horner’s Syndrome
52
Q

Thoracic vertebrae characteristics:

A
  • heart shaped bodies
  • long, obliquely oriented spinous processes
  • costal facets on the bodies
  • transverse processes
  • facet joints oriented at 60 degree angle relative to the transverse plane which allows lateral bending and rotation
  • flexion and extension are limited by fixation provided by ribs
53
Q

Lumbar vertebrae characteristics:

A
  • kidney shaped bodies
  • short, horizontally oriented spinous processes
  • long transverse processes
  • facet joints are oriented horizontally to the transverse plane allowing flexion and extension and lateral bending
  • rotation limited
54
Q

Isthmus (pars) interarticularis:

A
  • connected the superior and inferior articular processes of the lumbar vertebrae
  • Scottie Dog (it is the neck)
55
Q

Spondylolysis:

A
  • defect/fracture of the isthmus without anterior displacement of the vertebrae
  • Scottish dog wear a collar at site of fracture
56
Q

Spondylolisthesis:

A
  • unilateral or bilateral defect or fracture of the isthmus accompanied by anterior displacement of the vertebral body
  • Head of the Scottish Dog (transverse process) separated from body
  • most commonly between L5 and sacrum
  • may stretch the roots of lumbosacral spinal nerves in the cauda equina

SYMPTOMS:

-lower back pain that radiates into both lower limbs and muscle weakness in legs

57
Q

Spinal stenosis:

A
  • narrowing of the vertebral canal
  • could be caused by spondolylosis in which degenerative changes occur in the L4 and L5 intervertebral disks
  • may also be caused by osteoarthritis at the facet joints at L4 and L5
58
Q

Herniated disk at lumbar level:

A
  • most commonly between L4 and L5 (compress L5 nerve roots) or L5 and S1 (compress S1 nerve roots)
  • small herniations compress the nerve roots of spinal nerves exiting through the intervertebral foramina below the affected disk
59
Q

Compression of L5 or S1 spinal nerve roots:

A
  • may result in sciatica (pain that radiates from the back into the thigh, leg, and foot)
  • compression of L5: pain and paresthesias in the posterior thigh, anterolateral leg, and dorsum of the foot.
  • there may be weakness in extension of the great toe (extensor hallucis longus) and weakness in dorsiflexion (tibialis anterior)
60
Q

Compression of S1 spinal nerve roots:

A
  • result in pain and paresthesias in the posterolateral leg, heel, and lateral side of the foot
  • may be weakness in flexion of the leg at the knee (hamstrings), weakness in plantar flexion (gastrocnius and soleus), and diminished Achilles tendon reflex
61
Q

Sacrum:

A
  • composed of 5 fused sacral vertebrae
  • superior aspect bears and transmits weight to the pelvic girdle
  • contains median crest (fused sacral spinous processes) and intermediate crests (fused articular processes)
  • promontory forms the ventral surface, boundary of the pelvic inlet (important in obstetrics)
  • articulates at the sacroiliac joints (formed by the lateral surfaces of the superior part of the sacrum and medial surface of the ilium)
  • four pairs of dorsal sacral foramina and four pairs of ventral sacral foramina that transmit the dorsal and ventral rami of S1-S4
  • contains the sacral canal which ends at the sacral hiatus in the dorsal midline and contains the roots of the S1 coccygeal spinal nerves
  • the sacral hiatus transmits S5 and coccygeal spinal nerves
62
Q

Caudal Block

A
  • epidural block
  • performed by administering anesthetic through the sacral hiatus which diffuses through the meninges anesthetizes the roots of the sacral and coccygeal spinal nerves in the cauda equina
63
Q

Coccyx

A
  • formed by 3-5 fused coccygeal vertebrae
  • it is an attachment site for the gluteus maximus and anococcygeal ligament (attachment site for muscles of the pelvic diaphragm)
64
Q

Superficial muscles of the back:

A
  • attached to the pelvic girdle and act on the upper extremity
  • trapezius, latissimus dorsi, rhomboid major, rhomboid minor, and levator scapulae
  • innervated by ventral rami of spinal nerves through branches of the brachial plexus (except for trapezius which is supplied by CN XI accessory nerve)
65
Q

Intermediate muscles of the back:

A
  • attach to the ribs and act as accessory muscles of respiration
  • serratus posterior inferior and 12 pairs of levator costarum muscles
  • innervated by ventral rami of spinal nerves
66
Q

Deep (intrinsic) muscles of the back:

A
  • attach mainly to transverse and spinous processes of vertebrae and act on the vertebral column at the intervertebral joints
  • erector spinae (includes 3 parallel muscles: iliocostalis, longissimus, and spinalis (medial)
  • splenius capitis and splenius cervicis (lie superficial to components of the erector spinae in the neck) and act unilaterally to produce lateral bending of the cervical vertebrae
  • transversospinalis muscles: 3 muscle groups that lie deep to the erector spinae
  • muscles of suboccipital triangle contribute to extension at the atlantooccipital joins and rotation at the atlantoaxial joints
  • innervated by dorsal rami of spinal nerves
67
Q

Function of the erector spinae:

A
  • act bilaterally to extend the vertebral column at intervertebral joints
  • act unilaterally to produce lateral bending of the vertebral column at intervertebral joints
68
Q

splenius capitis

A

extends the head

69
Q

splenius cervicis

A

rotates the head

70
Q

transversospinalis muscles

A

-superficial to deep:

semispinalis -> multifidus -> rotatores

  • acting bilaterally they extend the vertebral column
  • unilaterally they produce rotation of the vertebral column

Anatomy II (10 decks)

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