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MSK > Back Neurology > Flashcards

Back Neurology Flashcards

1
Q

What is the start and end point of the Spinal Cord?

A
  • start: Medulla Oblongata
  • end: Conus Medullaris
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2
Q

What are the 5 categories of structures within the back that can be sources of pain?

A
  • Fibroskeletal structures: periosteum, ligaments, and anuli fibrosi of IV discs
  • Meninges: coverings of the spinal cord
  • Synovial joints: capsules of the zygapophysial joints
  • Muscles: intrinsic muscles of the back
  • Nervous tissue: spinal nerves or nerve roots exiting the IV foramina
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3
Q

What are the innervations of the structural categories of back pain?

A
  • Fibroskeletal structures: Recurrent Meningeal Ns.
  • Meninges: Recurrent Meningeal Ns.
  • Synovial joints: Posterior Rami
  • Muscles: Posterior Rami
  • Nervous tissue: Posterior Rami
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4
Q

What are the 3 most common causes of back pain?

A
  • muscular pain: result of spasm in muscular tissue producing ischemia
  • joint pain: result of osteoarthritis or disease arthritis (RA)
  • fibroskeletal pain: result of fractures and dislocation of ligamentous structures
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5
Q

What are the different types of spinal cord injury and associated losses of function?

A

Complete transection of the Spinal Cord results in a loss of sensation and motor function below the lesion

  • C1-3: no function below the Head, respiratory necessary for life
  • C4-5: no function of Limbs, respiration capable
  • C6-8: loss of hand and variable upper limb function, may be able to propel a wheelchair
  • T1-9: paralysis of both lower limbs
  • T10-11: some thigh muscle function, may allow walking with leg braces
  • L2-3: most lower limb function present, may be able to walk with short leg braces
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6
Q

What are the components and order (from outermost to innermost) of the Spinal Meninges?

A
  1. Epidural Space: occupied by the Internal Vertebral Venous Plexus and Epidural fat
  2. Dura-Arachnoid Interface: potential space, no natural space exists here
  3. Spinal Dural Sac: long tube-shaped sheath surrounding the Spinal Cord lining the Vertebral Column
  4. Dural Root Sheath: lateral tapering extension of Spinal Dura Mater that surround Anterior and Posterior Roots
  5. Filum Terminale Externum: Dural part of the Terminal Filum; continuation of the Filum Terminale Internum inferior to the Dural Sac with an additional layer of Dura, travels through the Sacral Hiatus and inserts on the Coccyx
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7
Q

What is the Spinal Arachnoid Mater and its components?

A
  • thin membranous intermediate layer, lines the Spinal Dural Sac, held firmly to the Dural Sac by the pressure of Cerebrospinal Fluid which circulates in the Subarachnoid Space
    1. Subarachnoid Space: Cerebrospinal Fluid filled space between Arachnoid and Pia Mater
    2. Arachnoid Trabeculae: delicate strands of connective tissue that span the Subarachnoid Space joining the Arachnoid and Pia Mater
    3. Lumbar Cistern: enlargement of the Subarachnoid Space inferior to the Conus Medullaris containing the Cauda Equina
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8
Q

What is the Pia Mater and its components?

A
  • thinnest innermost covering of the Spinal Cord, follows the entire surface of the Spinal Cord, lines the Spinal Roots
    1. Denticulate L.: lateral extension of fibrous Pia Mater at regular intervals between the Spinal Roots to attach to the Dural Sac, suspend the Spinal Cord in the Dural Sac
    2. Filum Terminale Internum: inferior continuation of Pia Mater inferior to the Conus Medullaris, eventually picks up a layer of Dura Mater, inferior to the Dural Sac and becomes the Filum Terminale Externum
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9
Q

an important diagnostic procedure for evaluating a variety of central nervous system disorders

  • a needle is inserted between either L3/4 or L4/5 at the level of the iliac crest; this level is typically chosen to avoid the needle injuring the spinal cord
  • as the needle passes through the Ligamentum Flavum, it “pops” and passes into the Lumbar Cistern deep to the Spinal Dura and Arachnoid Mater
  • Cerebrospinal Fluid can then be drawn out and evaluated
A

Lumbar Puncture of Spinal Tap

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10
Q

swelling of the Spinal Cord from C4-T1 segments of the Spinal Cord that corresponds with the Brachial Plexus and Upper Extremity

A

Cervical Enlargement

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11
Q

swelling of the Spinal Cor from T11-S1 segments of the Spinal Cord that corresponds with the Lumbar and Sacral Plexuses and Lower Extremity

A

Lumbosacral Enlargement

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12
Q

part of the Spinal Cord that produces Spinal Rootlets that converge to form Spinal Roots that converge to form Spinal Nerve that then branches into Spinal Rami

A

Spinal Cord Segment

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13
Q

central projections from neuronal cell bodies in the Anterior Horn (and sometimes Lateral Horn) of the Spinal Cord, converge with a Posterior Root to form a Spinal Nerve at each Spinal Cord Segment

A

Anterior Root

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14
Q

small fibers originating from the Spinal Cord that converge to form a single Anterior Root at each Spinal Cord Segment

A

Anterior Rootlets

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15
Q

central projections from neuronal cell bodies in the Spinal Ganglion, converge with an Anterior Root to form a single Spinal Nerve at each Spinal Cord Segment

A

Posterior Root

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16
Q

small fibers originating from the Spinal Cord that converge to form a single Posterior Root at each Spinal Cord Segment

A

Posterior Rootlets

17
Q

collection of Sensory nerve cell bodies associated with the Posterior Root

A

Spinal Ganglion

18
Q
  • Mixed General Sensory and Somatic Motor
  • 31 pairs: 8 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, and 1 Coccygeal
  • very short union of Anterior and Posterior Roots that very quickly branches into Anterior and Posterior Rami
A

Spinal Nerves

19
Q

Where do the Cervical Spinal Nerves exit?

A

8 pairs

  • C1 Spinal nerve exits the Vertebral Column above C1
  • C2 Spinal nerve exits the Vertebral Column between C1 and C2
20
Q

What are the Anterior Rami of the Cervical Spinal Nerves?

A
  • Cervical Plexus (C1-4)
  • Brachial Plexus (C5-T1)
  • Recurrent Meningeal Branches: sensory and Sympathetic fibers to the Dura Mater
21
Q

What are the Posterior Rami of the Cervical region?

A
  • Suboccipital N.: Posterior Ramus of C1, innervates Suboccipital musculature, travels through Suboccipital Triangle
  • Great Occipital N.: Posterior Ramus of C2, cutaneous to the posterior Scalp, appears below the Suboccipital Triangle traveling superiorly
  • Least Occipital N.: Posterior Ramus of C3, cutaneous and muscular innervation
  • C4-8 (cutaneous and muscular innervation): Medial Branch: Muscular Branches (to Transversospinalis muscles), Articular Branches (to Zygopophyseal Joints), Cutaneous Branches (to Skin of Dermatome); Lateral Branch: Muscular Branches (to Erector Spinae and Splenius muscles), Cutaneous Branches (to Skin of Dermatome)
22
Q

What nerve is this?

A

Suboccipital N.

23
Q

What nerve is this?

A

Greater Occipital N.

24
Q

What are the Anterior Rami of the Thoracic Spinal Nerves?

A
  • Atypical Intercostal N. (T1, T2, T7-11): T1,2 send branches to the Brachial Plexus; T7-11 become Thoracoabdominal N. as they travel over the Abdomen
  • Typical Intercostal N. (T3-6)
  • Subcostal N. (T12)
  • Recurrent Meningeal Branches: sensory and Sympathetic fibers to the Dura Mater
25
Q

What are the Posterior Rami of the Thoracic Spinal Nerves?

A
  • Medial Branch: Musclar Branch (to Transversospinalis muscles and Longissimus Thoracis muscle), Articular Branch (to the Zygopophyseal Joint), Cutaneous Branch (to the Skin of Dermatome)
  • Lateral Branch: Muscular Branch (to Erector Spinae muscles), Cutaneous Branch (to Skin of Dermatome)
26
Q

What are the Anterior Rami of Lumbar Spinal Nerves?

A
  • Lumbar Plexus (L1-4)
  • Lumbosacral Trunk (some of L4 and all of L5, travels inferiorly to join with the Sacral Plexus)
  • Recurrent Meningeal Branches: sensory and Sympathetic fibers to the Dura Mater)
27
Q

What are the Posterior Rami of the Lumbar Spinal Nerves?

A
  • Medial Branch: Muscular Branch (to Transversospinalis, Interspinalis, and Intertransversarii muscles), Articular Branch (to Zygopophyseal Joint), Cutaneous Branch (to Skin of Dermatome)
  • Lateral Branch: Muscular Branch (to Erector Spinae muscles), Cutaneous Branch (to Skin of Dermatome), Superior Cluneal N. (Lateral Branch of the Posterior Rami of L1-3)
28
Q

What are the Anterior Rami of Sacral Spinal Nerves?

A
  • Sacral Plexus (L4-S4)
  • Coccygeal Plexus (some of S4 and all of S5)
  • Recurrent Meningeal Branches: sensory and Sympathetic fibers to Dura Mater
29
Q

What are the Posterior Rami of Sacral Spinal Nerves?

A
  • Medial Branch
  • Lateral Branch: Middle Cluneal N. (Lateral Branch of Posterior Rami of S1-3)
30
Q

distal cone shaped terminal end of the Spinal Cord that typically begins tapering off at T12 and ends at L2

A

Medullary Cone or Conus Medullaris

31
Q
  • bundle of Anterior and Posterior Roots from the Lumbosacral Enlargement and Medullary Cone
  • occupies the Vertebral Canal inside the Lumbar cistern from the level of the Medullary Cone inferiorly
A

Cauda Equina

32
Q

What nerve is this?

A

Spinal Accessory N.

33
Q

What nerve is this?

A

Thoracodorsal N.

34
Q

What nerve is this?

A

Dorsal Scapular N.

(another view)

MSK (33 decks)

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