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Gross Anatomy > Back: Spinal Cord > Flashcards

Back: Spinal Cord Flashcards

1
Q

Spinal Cord

A
  • Part of the central nervous system
  • Located in the vertebral canal
  • Spans from the foramen magnum to L2
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2
Q

Cervical Enlargement

A
  • C4-T1 segments of cord
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3
Q

Lumbar Enlargement

A
  • L1-S3 segments of cord
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4
Q

Conus Medullaris

A
  • End of the spinal cord located at L2
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5
Q

Thoracic Spine

A
  • Gives rise to the nerves that innervate the upper extremity
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6
Q

Lumbar Spine

A
  • Nerves that innervate the lower extremities
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7
Q

Embryology

A
  • Differential growth between cord and vertebral column/dura mater
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8
Q

Embryo/Fetus Prior to 8 Weeks

A
  • Cord extends length of vertebral canal
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9
Q

Embryo/Fetus 6 Months Onward

A
  • Tip of cord is at vertebral level S1
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10
Q

Spinal Cord Segment

A
  • Gives rise to rootlets at a particular level
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11
Q

Anterior (Ventral) Rootlets

A
  • Contain efferent (motor) nerve fibers
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12
Q

Posterior (Dorsal) Rootlets

A
  • Contain afferent (sensory) nerve fibers
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13
Q

Dorsal Root Ganglion

A
  • Cell bodies of pseudounipolar sensory neurons
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14
Q

Anterior and Posterior Root

A
  • Unite to form spinal nerve
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15
Q

Spinal Nerve

A
  • Mixed nerve (motor and sensory)
  • Representative of spinal cord segment
  • Exits out intervertebral foramen
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16
Q

Cauda Equina

A
  • spinal nerve roots from the lumbosacral enlargement and conus medullaris
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17
Q

Posterior and Anterior Rami

A
  • Spinal nerves branch into these
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18
Q

Posterior Ramus

A
  • Facet joints of vertebral column
  • Deep back muscles
  • Skin over the back
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19
Q

Anterior Ramus

A
  • Supply almost everything else
  • Anterior and lateral trunk/abdomen (intercostal nerves)
  • Upper and lower extremity (brachial & lumbosacral plexuses)
  • Neck (cervical plexus)
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20
Q

Meningeal Branches of Spinal Nerves

A
  • Recurrent meningeal nerve

- Branch off the spinal nerve of anterior ramus

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21
Q

Supplied by Recurrent Meningeal Nerve

A
  • Periosteum of portion of the vertebra
  • Outer annulus fibrosis
  • Dura mater
  • PLL
  • Blood vessels
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22
Q

Recurrent Meningeal Nerve

A
  • Loops back/passes through the IVF
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23
Q

Posterior Ramus

A
  • Provides motor to deep back muscles and branches that supply the skin, facet joints, zygapophyseal joints
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24
Q

Anterior Ramus

A
  • Larger component of the spinal nerve that innervates everything else
  • Forms a plexus (network of nerves)
  • T1 and sometimes T2, the lumbar and sacral region nerves connect with each other to for plexus
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25
Q

PLL

A
  • Supplies dura mater
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26
Q

Cervical Spinal Nerves

A
  • Exit vertebral canal above same number vertebrae
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27
Q

Cervical

A
  • 8 spinal nerves
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28
Q

Thoracic

A
  • 12 spinal nerves
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29
Q

Lumbar

A
  • 5 spinal nerves
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30
Q

Thoracic and Lumbar Spinal Nerves

A
  • Exit vertebral canal below same number vertebrae
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31
Q

Sacral

A
  • 5 spinal nerves
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32
Q

Spinal Nerve S5

A
  • Exits through sacral hiatus
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33
Q

S1-S4

A
  • Anterior/posterior rami exit through anterior/posterior sacral foramina
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34
Q

Coccygeal

A
  • Nerves exit through sacral hiatus
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35
Q

Anterior Rami

A
  • Give rise to the intercostal nerves in the thoracic region

- Form plexuses in the cervical and lumbosacral regions

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36
Q

Plexuses

A
  • Give rise to multi-segmental peripheral nerves
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37
Q

Peripheral Nerve

A
  • Nerves that come together from different regions to form a new name nerve
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38
Q

Somatic Nervous System

A
  • Sensory and motor to everything except viscera, smooth muscle, glands
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39
Q

Somatic Nerve Fibers

A
  • Sensation from the body, typically reaches consciousness
  • Pain, temperature, touch, pressure
  • Proprioceptive (mostly subconscious)
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40
Q

Afferent

A
  • General sensory
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41
Q

Efferent

A
  • Somatic motor
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42
Q

Somatic Motor (Efferent) Nerves

A
  • Skeletal muscle (voluntary)

- Single neuron from spinal cord to muscle

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43
Q

Dermatome

A
  • Area of skin supplied by a spinal segment and spinal nerve

- Usually there is overlap between them

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44
Q

Peripheral Nerve Distribution

A
  • Area of skin supplied by peripheral nerve
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45
Q

Myotome

A
  • Group of muscles innervated by a spinal nerve
  • Most muscle groups of the extremity are innervated by multiple spinal nerves (formed by multiple of these)
  • One or two are more strongly associated with each muscle groups
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46
Q

Peripheral Nerve Innervation

A
  • Can innervate one or muscle groups
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47
Q

Visceral Innervation

A
  • Cardiac and smooth muscle, glands
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48
Q

Visceral Sensory

A
  • Normally not perceived, subconscious reflexes
  • Not sensitive to touch, vibration
  • Sensitive to chemical irritation, ischemia
  • Large amounts of distension, contraction
  • Referred pain
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49
Q

Visceral Motor

A
  • Autonomic nervous system
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50
Q

Visceral Motor (Autonomic Nervous System)

A
  • Involuntary muscle (cardiac and smooth muscles)

- Glandular tissue

51
Q

Autonomic Nervous System

A
  • Efferent to cardiac and smooth muscle, glands
52
Q

Autonomic Nervous System

A
  • Sympathetic (thoracolumbar) division

- Parasympathetic (craniosacral) division

53
Q

Autonomic Nervous System

A
  • 2 neuron chain
  • Presynaptic and postsynaptic neuron
  • Pre-synaptic neuron synapses on the postsynaptic in an autonomic ganglia
54
Q

Presynaptic Neurons (Sympathetic ANS)

A
  • Originate in the intermediolateral cell columns (IML)
  • Lateral horn of T1-L2(3) gray matter
  • Leave through the ventral root
  • Enter sympathetic trunk via white rami communicantes
55
Q

White Rami

A
  • Enter sympathetic trunk via these communicantes

- Only found at T1-L2(3) spinal cord segments

56
Q

Upon Entering Sympathetic Trunk

A
  • Synapse at same level
  • Ascend or descend to synapse in paravertebral ganglia at another level (above T1 or below L3)
  • Pass through w/o synapsing
57
Q

Gray Rami Communicantes

A
  • 1 & 2 exit sympathetic trunk exit through this
58
Q

Postsynaptic Neurons

A
  • Reach destination via spinal/peripheral nerves and periarterial plexus
59
Q

Parasympathetic Division of ANS (Craniosacral)

A
  • Innervates head, viscera, erectile tissue

- Not found in the limbs or body wall

60
Q

Presynaptic Fibers Originate

A
  • Brainstem
  • Follows cranial nerves III, VII, IX, X
  • S2-4 segments of spinal cord
  • Pelvic splanchnic nerves
61
Q

Parasympathetic Ganglia

A
  • 4 associated with the head (later)
62
Q

GI Tract and Heart

A
  • Have their own network of neural tissue that governs their function
  • Modulated by sympathetic and parasympathetic
63
Q

Spinal Meninges

A
  • Connective tissue membranes
  • Support the cord and nerve roots
  • Contain the CSF
64
Q

Dura Mater

A
  • Tough outermost fibrous sheath

- Continuous with cranial dura

65
Q

Arachnoid Mater

A
  • Deep to dura (stays in contact with dura)
  • ** trabeculae connect with pia mater
  • Encloses CSF filled subarachnoid space
  • Ends at S2
  • Forms spinal dural sac (dural sheath)
66
Q

Dural Sac

A
  • Ends at S2
67
Q

Pia Mater

A
  • Covers spinal cord and nerve roots

- Thin and delicate

68
Q

Leptomeninges

A
  • Arachnoid & pia
69
Q

Filum Terminale

A
  • End of the conus medullaris
70
Q

Filum Terminale Internum

A
  • Pia mater (L2 – S2)
71
Q

Filum Terminale Externum

A
  • Coccygeal ligament: pia and dura

- Attaches to coccyx (S2-coccyx)

72
Q

Denticulate Ligaments

A
  • 20 – 22 pairs of sawtooth fibrous extensions of pia mater - Attach to inner dural sac
  • Pass between dorsal and ventral roots
73
Q

Epidural Space

A
  • Between bony wall of vertebral canal and dura mater
  • Fat
  • Internal vertebral venous plexus
  • Spinal nerves
  • Blood vessels
74
Q

Dural Root Sleeve

A
  • Extension of dural sheath around roots and dorsal root ganglia
75
Q

Subarachnoid Space

A
  • Between arachnoid and pia mater

- Continuous with cranial **

76
Q

Content of Subarachnoid Space

A
  • CSF
  • Arteries and veins
  • Arachnoid trabeculae
  • Cauda equina
  • Filum terminale
77
Q

Vertebral Column From Outside Inward

A
  1. Bone
  2. Epidural space (extradural space)
  3. Dura mater
  4. Subdural space (potential space)
  5. Arachnoid mater
  6. Subarachnoid space
  7. Pia mater
  8. Spinal cord
78
Q

Lumbar Cistern

A
  • Enlargement of subarachnoid space in the dural sac
  • Caudal to conus medullaris (L2 – S2)
  • Site of lumbar puncture
79
Q

Lumbar Puncture

A
  • Performed midline between L3/4 or L4/5
  • Patient position in a flexed position
  • Gain access to subarachnoid space (anesthesia or CSF sample)
80
Q

Lumbar Puncture Entry Order

A
  1. Skin
  2. Superficial fascia
  3. Supraspinous ligament
  4. Interspinous ligament
  5. Ligamentum flavum
  6. Epidural space
  7. Dura mater
  8. Arachnoid mater
  9. Subarachnoid space
81
Q

Spinal Anesthesia

A
  • Anesthesia introduced into subarachnoid space
82
Q

Epidural Anesthesia (Blocks)

A
  • Similar to lumbar puncture

- Between lamina or through sacral hiatus (caudal)

83
Q

Spina Bifida

A
  • Developmental neural tube defect that is the result in nonunion of the neural arches.
  • Caused by disruption of neurulation in the embryo
84
Q

Spinal Bifida Occulta

A
  • Neural tissue IS NOT involved
85
Q

Spina Bifida Manifesta (Cystica)

A
  • Neural tissue and/or meninges ARE involved
86
Q

Meningocele (SB Manifesta)

A
  • Meninges protrude through the defect
87
Q

Meningomyelocele (SB Manifesta)

A
  • Meninges and cord/nerve roots protrude through the defect
88
Q

Blood Supply of Vertebral Column and Spinal Cord

A
  • Anterior and Posterior Spinal Arteries
89
Q

Spinal Branches that Pass through the IVF

A
  • Vertebral
  • Ascending cervical
  • Segmental arteries
  • Posterior Intercostal
  • Subcostal
  • Lumbar
  • Lateral sacral
90
Q

Anterior Spinal Artery

A
  • Branch of vertebral artery
  • Runs in anterior median sulcus
  • Gives off sulcal arteries
  • Supply anterior 2/3 cross-sectional area
91
Q

Posterior Spinal Arteries

A
  • Branch of posterior inferior cerebellar (most common) or vertebral artery
92
Q

A/P Radicular Arteries

A
  • Supply the nerve roots
93
Q

A/P Segmental Medullary Arteries

A
  • Supplement blood supply to spinal cord

- Not present at every level

94
Q

Great Anterior Segmental Medullary Artery

A
  • Artery of Adamkiewicz
95
Q

Artery of Adamkiewicz

A
  • Largest segmental medullary artery
  • Origin varies: usually left side from lower intercostal or upper lumbar artery
  • Blockage can result in caudal cord ischemia
96
Q

Bastons plexus (Venous Drainage)

A
  • Network of paraspinal veins
97
Q

Vertebral Column

A
  • Internal/external vertebral venous plexus (epidural venous plexus)
  • Basivertebral veins
  • Intervertebral vein
98
Q

Internal/External Vertebral Venous Plexus (Epidural Venous Plexus)

A
  • Communicate with each other through IVF
99
Q

Basivertebral Veins

A
  • Drain the vertebral bodies

- Communicates with internal & external plexuses

100
Q

Intervertebral Vein

A
  • Drain cord & column drain into segmental veins
101
Q

Ant/Post Spinal Veins

A
  • Communicate with internal and external venous plexuses
102
Q

Vertebal Veinous Plexuses

A
  • Communicate with the dural venous sinuses and deep pelvic veins
  • Route of metastasis
  • Valveless
103
Q

Content/Boundaries of IVF

A
  • Spinal nerve
  • DRG
  • Recurrent meningeal nerve
  • Spinal branches of segmental arteries
  • Intervertebral veins
  • Adipose
104
Q

Flexion

A
  • Increases IVF size
105
Q

Extension

A
  • Decreases IVF size
106
Q

L5

A
  • Has the thickest spinal nerve but smallest IVF (of the lumbar region)
107
Q

Anatomical Sources of Lower Back Pain

A
  • IVD
  • Spinal nerve
  • Zygapophyseal joints
  • Subchondral bone
  • Ligaments
  • Muscles
  • Viscera (kidneys)
  • Sacroiliac joint
108
Q

Viscera (Kidneys)

A
  • Refer pain to the lower back
109
Q

Spondylosis

A
  • More generic, broad term that refers to any type of degenerative changes to the spine
110
Q

Narrowing of IVF

A
  • Osteophytes (bone spurs) on the facet joint

- Osteophytes on uncovertebral processes in the cervical spine

111
Q

Herniation

A
  • Can decrease the size of the IVF
112
Q

Herniated Discs

A
  • Can also compress cauda equina and impinge on nerves
113
Q

Narrowing of Vertebral Canal Causes

A
  • Ligament hypertrophy
  • Osteophyte formation
  • Disc herniation
  • Congenital
114
Q

Ligament Hypertrophy

A
  • Repeated injuring and healing with additional scar tissue to the point where they become larger
  • Can result in narrowing of vertebral canal
115
Q

Laminectomy

A
  • Removes the lamina of vertebrae (both sides is complete and one side is partial/hemi)
116
Q

Laminotomy

A
  • Does not remove the lamina, but burrows an opening and removes a portion that is encroaching on cauda equina, nerve roots, etc.
117
Q

Foraminotomy

A
  • Opens up IVF if it gets narrowed
118
Q

Discectomy

A
  • Removes pieces if IVF gets narrowed
119
Q

Herniated Nucleus Pulposus

A
  • Can cause spinal and foraminal stenosis

- Can put pressure on the nerve roots and/or spinal cord

120
Q

Posterolateral Herniation

A
  • L4/5 and L5/S1 are the most common in lumbar spine

- Typically affects the nerve root below the level of the herniated disc

121
Q

L4/5 Disc Herniation

A
  • Affects L5 nerve
122
Q

L5/S1 Disc Herniation

A
  • Affects S1 nerve
123
Q

Radiculopathy

A
  • Abnormal nerve root sensation depending on what is compressed

Gross Anatomy (50 decks)

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