Back and Vertebral Flashcards

1
Q

Vertebral arch

A

is firmly anchored to the posterior surface of the vertebral body by two pedicles, or lateral pillars of the arch. The roof of the arch is formed by the right and left laminae, which fuse at the midline. The vertebral arches are aligned to form lateral and posterior wall of the vertebral canal, extending from C1 to S5. This bony canal contains the spinal cord and its protective membranes, together with proximal portions of spinal nerves, vasculature, connective tissue, and fat. The vertebral arch has a number of characteristic projections which serve as: attachments for muscles and ligaments, levers for the actions of muscles, and sites of articulation with adjacent vertebrae.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Two types of spina bifida

A

Occulta,

more severe spina bifida involves complete failure of fusion of the posterior arch at he lumbosacral junction with a large out pouching of the meninges. This may contain CSF = meningocele; or a portion of the spinal cord = myelomeningocele. These abnormalities may result in a variety of neurological defects including problems ambulating (walking) and or bladder function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Occulta

A

(most common type (10% of population) where there is a defect in the arch of L5 or S1. Often asymptomatic although often a tuft of hair is observed over the spinous process.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

lumbrosacral myelomeningocele

A

This is a T1-weighted MRI in the sagittal plane demonstrating a lumbrosacral myelomeningocele. There is an absence of the laminae and spinous processes in the lumbosacral region. You can also see the continuity of the spinal cord into the outgrowth and evidence of the meninges encompassing the cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spinal nerves exit

A

the intervertebral foramen inferior to the vertebrae of the corresponding spinal level for which the nerve is named, EXCEPT: C1-C7 which exit the interverebral foramen superior to the vertebrae level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Vasculature of vertebral column

A

vertebrae are supplied by periosteal and equatorial branches of major cervical and segmented arteries and their spinal branches.
Spinal branches are of the:
vertebral and ascending cervical arteries in the neck
posterior intercostal arteries in the thoracic region
subcostal and lumbar arteries in the abdomen
Iliolumbar and lateral and medial sacral arteries in the pelvis
Spinal branches enter the IV foramen and divide into anterior and posterior vertebral canal branches

vertebrae are drained by anterior external vertebral plexus, anterior internal vertebral plexus, basivertebral veins that drain to the intervertebral vein to the posterior intercostal vein (in this example) and the accessory hemiazygos vein (in this example) Note that the extra dural venous plexus of veins also anastomoses here. Epidural plexus (both anterior and posterior) = Batson’s plexus. All these drain to the IVC ultimately in the lumbosacral regions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Innervation of the vertebral column:

A

the zygapophysial joints are innervated by articular branches of the medial branches of the posterior rami

The vertebral column is innervated by the (recurrent) meningeal branches of the spinal nerves.
those inside supply the periosteum, ligamentum flava, annuli fibrosi posteriorly, posterior longitudinal ligament, spinal dura mater, and blood vessels within the vertebral canal.
Most meningeal branches run back through the IV foramen, some remain outside and supply the annuli fibrosi and anterior longitudinal ligament.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Vasculature of spinal cord:

A

3Longitudinally oriented vessels (anterior spinal a.) & feeder aa that enter the vertebral canal through the intervertebral foramina = segmental aa.

Anterior spinal artery arises from the vertebra a. – off the subclavian a. – and descends on the anterior surface of the spinal cord.

The anterior spinal artery also anastomoses with the segmental medullary arteries branching off the posterior intercostal aa.

Also have the anterior and posterior radicular aa from the posterior intercostal aa anastomosing with the posterior spinal a. which originate in the cranial cavity from the terminal branch of the each vertebral a = PICA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Venous drainage:

A

Veins from a number of longitudinal channels. 2 pairs on each side bracket the connections of the posterior and anterior roots to the cord. These drain into the extensive internal vertebral plexus within the extradural fat in the epidural space of the vertebral canal. These then drain into segmentally arranged vessels that connect with major systemic veins such as the azygos system in the thorax. The internal vertebral plexus also communicates with intracranial veins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Back Musculature

- 3 groups

A

Superficial, intermediate, deep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Superficial

A

anchor UL to axial skeleton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

intermediate

A

Intermediate – assist in respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Deep

A

Deep – maintain posture; act on vertebral column (raise & lower spine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Superficial Back Musculature

A
Trapezius m.
Latissimus dorsi m.
Rhomboid major m.
Rhomboid minor m.
Levator scapulae m.

The superficial muscles are immediately deep to the skin and superficial fascia. They attach the superior part of the appendicular skeleton (clavicle, scapula and humerus) to the axial skeleton (skull, ribs & vertebrae).

Because they function to move the appendicular skeleton (upper portion, UL) they may also be referred to as the appendicular group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Trapezius m

A

upper fibers elevate, middle fibers adduct and lower fibers depress scapula, and assists in rotating the scapula during abduction of the humerus above horizontal.

motor: CN XI
proprioception: C3, C4

Accessory n. (CNXI):
runs deep to m., posteroinferiorly from jugular foramen
Ventral rami of C3-C4:
runs deep to m., posteriorly from intervertebral foramina
Transverse cervical a. & v.:
runs deep to m., posterolaterally from thyrocervical trunk

Proprioception = ability to sense position, location, orientation and movement of the body and/or parts of the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nerves and vessels contributing to the subtrapezial plexus.

A

CN XI & C3-C4 ventral rami for subtrapezial plexus

CN XI: motor to trapezius & SCM
C3-C4 ventral rami: proprioception

Accessory nerve on deep surface of the trapezius m
Note: C3-C4 ventral rami (cut) at the medial edge that contribute to the plexus

Transverse cervical a. & v. = runs deep to the trapezius m., posterolaterally from the thyrocervical trunk

Transverse cervical a. gives rise to the superficial cervical a., deep to the trapezius m but superficial to the scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Splenius capitus & cervicis (spinotransversales mm.)

A

Cervical
Capitis: Bilaterally - draw head backward and extend neck; individually – rotate head/face ipsilaterally
Cervicis: Bilaterally - extend neck; individually – rotate head/face ipsilaterally

N: Posterior rami of the middle and lower cervical nn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Greater Occipital N

A

C2 passes through the semispinalis capitis m. (easily found during superficial dissections, see Grant’s Dissector for more details)
If you can find the Greater Occipital n. (C2) superficially with the Occipital a. it will be easier to trace it deeper. However, you may not be able to see it well until you get the semispinalis capitis m.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Occipital a. & v

A

in sub-Q tissue

Just lat. to greater occipital n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Vertebral artery

A

Passes through transverse foramen. Postganglionic Sympathetic nerves travel with this.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Sympathetic nerves

A

Travel with all blood vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ganglia in head

A

In superior/middle/inferior cervical.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ganglionic cell bodies for head

A

C1. ** double check this.

24
Q

C1 joint

A

Yes joint - extension flexion

25
Q

C2/C1 Atlantoaxial joint

A

Rotation - right in the middle of oropharynx.

26
Q

Spina bifida

A

Lack of fusion of lamina, no spinous processes.

27
Q

Spinal nerves exit

A

Inferior intervertebral foramen. C1 emerges between skull and C1 vert. Above*** Everything from thoracic down is below. Thus, you end up with 8 cervical nerves with only 7 cervical vertebrae. This is driven by embryological organization. This is a result of embryological reseparation.

28
Q

Recurrent arteries/branches/nerves

A

Branch that comes off and backtracks along its own course. Supplies meninges in spinal cord.

29
Q

Pia mater

A

Right against tissue. Arachnoid layer - in subarachnoid space, all of the vessels are present.

30
Q

Extradural fat

A

Additional cushioning around spinal cord.

31
Q

Back muscles

A

3 groups
-Superficial - anchor UL to axial skeleton
=Intermediate - assist in respiration
- Deep maintain posture, act on vertebral column, rasie and lower spine

32
Q

Trapezius

A

A: elevates, depresses & retracts scapula

N: accessory n. (CN XI) & C3, C4; & transverse cervical vessels

Accessory n. (CNXI):
runs deep to m., posteroinferiorly from jugular foramen
Ventral rami of C3-C4:
runs deep to m., posteriorly from intervertebral foramina
Transverse cervical a. & v.:
runs deep to m., posterolaterally from thyrocervical trunk

33
Q

Latissimus dorsi

A

A: adducts, extends & medially rotates humerus

N: thoracodorsal n. & vessels & intercostal vessels

34
Q

Levator Scapulae

A

A: elevates scapula

N: C3, C4, dorsal scapular nerve and vessels

35
Q

Rhomboid minor/major

A

A: retract (adducts) & elevates scapula

N: dorsal scapular n. & vessels

36
Q

Serratus posterior superior/inferior

A

Helps in breathing

37
Q

Splenius capitus & cervicis (spinotransversales mm.)

A

Cervical
Capitis: Bilaterally - draw head backward and extend neck; individually – rotate head/face ipsilaterally
Cervicis: Bilaterally - extend neck; individually – rotate head/face ipsilaterally

N: Posterior rami of the middle and lower cervical nn.

38
Q

Ipsillaterally

A

Right turns face/part to the right.

39
Q

Semispinalis capitis, cervicis, & thoracis (transversospinalis mm.)

A

Cervical & Thoracic
Bilaterally: Extend vertebral column (like erector spinae group)
Individually: Rotate trunk contralaterally (*capitus – rotates head ipsilaterally)

Longitudinally originated muscle.

40
Q

C1 motor supplies

A

suboccipital muscles.

41
Q

C2 pierces

A

semispinalis capitis

42
Q

Occipital a. & v.

A

Occipital a. & v. – in sub-Q tissue

Just lat. to greater occipital n.

43
Q

Greater occipital n

A

C2 - in subq tissue - just inferior/lateral to external occipital protuberance

44
Q

3rd occipital nerve C3

A

Lower and just lateral to midline.

45
Q

Listen to slide 32-34 - there was a note in there

A

**

46
Q

Erector Spinae (Sacrospinalis muscle group)

A

A: erect spine (postural mm.) 1° extensors of spine & head
N: dorsal rami of spinal nn. & lumbar & intercostal vessels

47
Q

Multifidus and rotatores

A

transversospinalis muscle group

48
Q

Multifidus

A

Largest in lumbar region. Present at most vertebral levels.

If muscle spans 2 or more verrt, it is a part of this.
A: laterally flexes & rotates spine* - * acting unilaterally, rotate trunk contralaterally

N: dorsal rami of spinal nn. & lumbar vessels

49
Q

Rotatores

A

Most prominant in thoracus region.

span 1-2 vertebrae

A: rotate spine* - * acting unilaterally, rotate trunk contralaterally
Bilaterally – extend vertebral column

N: dorsal rami of spinal nn. & intercostal

50
Q

Interspinalis

A

Between spinous processes
Minor extensors of spine

deep muscle

51
Q

Intertransversarius

A

Between transverse processes

Minor lateral flexors of spine

52
Q

Levatores costarum

A

From transverse processes to ribs

Minor elevators of ribs

53
Q

Innervation of the Back Mm.

A

Superficial: supplied by ventral rami
Due to embryological migration from ventrum
Intermediate: supplied by ventral rami
Due to embryological migration from ventrum

Deep: supplied by dorsal rami
Due to original dorsal embryological location

54
Q

Serratus Anterior M

A

A: protracts scapula & holds it to body wall
N: long thoracic n. & supplied by lateral thoracic vessels

55
Q

Triangle of Auscultation

A
Auscultate = to listen to
Between 6th & 7th ribs = 6th intercostal space
Listening to organs of thorax (stethoscope) – diagnostic importance
Boundaries:
Superior = Trapezius m.
Inferior = Latissimus dorsi m.
Lateral = Rhomboid major m.
Floor (deep) = 6th intercostal space

Note: Triangle is accentuated when scapula

56
Q

Lumbar Triangle

A
Boundaries:
Medial = Latissimus dorsi m.
Lateral = External oblique m.
Inferior = Iliac crest
Floor (deep) = Internal oblique m.

Note: Triangle can become a site of lumbar hernia