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Medicine year 2 semester 2 > Case 24- Anatomy > Flashcards

Case 24- Anatomy Flashcards

1
Q

Vertebral column

A

Made of 33 vertebrae, intervertebral disc in between them which act as shock absorbers. Flexible column

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2
Q

Function of vertebral column

A
  • Protect the spinal cord and spinal nerve roots
  • Supports the skull
  • Transmits bodyweight through the pelvis to the lower limbs, role of sacral vertebra
  • Role in posture and locomotion
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3
Q

What makes up the vertebral column

A
  • 7 cervical vertebrae- C1 is called Atlas and C2 is called Axis
  • 12 thoracic vertebrae- each articulate with a pair of ribs
  • 5 Lumbar vertebrae- larger then thoracic and cervical
  • 5 Sacral vertebrae- fuse to form one bone called the Sacrum
  • 1-4 Coccygeal vertebrae- very small and variable, fuse to form the coccyx
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4
Q

Thoracic and Lumbar spinal processes

A

Thoracic spinal processes- long and slope posterior and inferiorly
Lumbar spinal processes- short and broad

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5
Q

Spinal nerves- 31 pairs

A

• Spinal nerves are formed by the union of the dorsal (sensory) root and ventral (motor) root, exit the vertebral canal through the intervertebral foramina and divide into a posterior and anterior ramus.
• Posterior ramus supplies the deep muscles of the back and the Zygapophysial joint. The recurrent meningeal branch supplies the bone, the intervertebral disc, the ligaments and the meninges
• Zygapophysial joints- branches of adjacent posterior rami
• Bone, IV discs, ligaments and meninges- recurrent meningeal branches of the spina nerves
• The spinal cord is continuous with the medulla oblongata posteriorly
Within the vertebral canal the spinal cord is invested by the meninges: Dura, Arachnoid and Pia mater

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6
Q

Overview of the arterial supply of the vertebral column

A

Vertebrae are supplied by branches (periosteal, equatorial and spinal) of the major cervical and segmental arteries that occur along the length of the vertebral column

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7
Q

The arteries supplying the vertebral column are

A
  • In the neck- vertebral, ascending cervical and deep cervical arteries. Supplies the cervical vertebrae
  • The segmental arteries of the trunk- Posterior intercostal, lumbar, medial and lateral sacral. Supplies the vertebral arteries of the trunk
  • Around the vertebral column the artery forms Periostea, Equatorial and spinal branches
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8
Q

Venous drainage of the vertebral column

A
  • Spinal veins form vertebral plexus’s both inside and outside the vertebral canal, The external and internal vertebral venous plexus.
  • The intervertebral veins drain into veins from the spinal cord and vertebral plexus : the vertebral veins of the neck and the segmental veins of the trunk
  • The veins lack valves- blood flow can be in either direction depending upon intra-abdominal pressure
  • Pelvic or abdominal malignancy- metastases into the vertebral bodies.
  • The internal vertebral plexus provides a venous bypass of the diaphragm, when the inferior vesicular cant cope with the increase in blood due to an increase in intra-abdominal pressure (coughing). Then goes to the posterior intercostal veins above the diaphragm
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9
Q

Structure of a vertebra

A

All vertebrae have a typical structure this includes:
• Anteriorly a vertebral body (weight bearing part)
• Posteriorly a vertebral arch
• Spinous process- projects posteriorly and inferiorly from the junction of the two laminae
• 2 transverse processes

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10
Q

Laminae

A

Flat sheets of bone which meet in the midline and form the roof of the vertebral arch

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11
Q

Articular processes

A

Has two superior and two inferior articular processes, forms the joints between one vertebrae and the one above or below. On the articular processes are the articular facets

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12
Q

Vertebral foramen

A

The vertebral body and the vertebral arch form the vertebral foramen, this is a large hole through which the spinal cord passes. When the vertebrae are stacked on top of each other the vertebral foramen are called the vertebral canal

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13
Q

Pedicles and vertebral body

A

Pedicles- each vertebrae has two pedicles which are bony pillows attaching the vertebral arch to the vertebral body
Vertebral body- the weight bearing portion of the bone

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14
Q

Cervical vertebrae

A
  • Small size and foramen in each transverse process
  • Bifid spinous process
  • Vertebral foramen- triangular in shape when viewed from above
  • Vertebral body- short and square when viewed from above, has a concave superior surface and a convex inferior surface
  • Uncinate process- the lateral margins of the upper surface of the typical cervical vertebrae are elevated into crests or lips
  • The vertebral arteries travel to the brain through the transverse foramina
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15
Q

C1

A
  • Also known as the Atlas, it articulates with the skull
  • No vertebral body or spinous process
  • No intervertebral disc between C1 and C2
  • Posterior arch- join the two lateral masses
  • Lateral masses- contains a superior articular facet for articulation with the occipital condyles and an inferior articular facet (on the inferior surface) for articulation with C2
  • Anterior arch- connects the two lateral masses
  • Facet for dens- facet for articulation with the dens
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15
Q

C1

A
  • Also known as the Atlas, it articulates with the skull
  • No vertebral body or spinous process
  • No intervertebral disc between C1 and C2
  • Posterior arch- join the two lateral masses
  • Lateral masses- contains a superior articular facet for articulation with the occipital condyles and an inferior articular facet (on the inferior surface) for articulation with C2
  • Anterior arch- connects the two lateral masses
  • Facet for dens- facet for articulation with the dens
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16
Q

C2

A
  • Also known as the axis
  • The Atlanto-axial joint is between C1 and C2
  • Superior articular facet- articulates with the inferior articular facet of the atlas to form the lateral atlanto-axial joints
  • Dens (or Odontoid process)- articulates with the anterior arch of the atlas creating the medial atlanto-axial joint which allows the head to rotate
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17
Q

Thoracic vertebra

A
  • The thoracic vertebrae are characterised by their articulation with ribs
  • Two posterior facets on its body- superior and inferior costal demi facet
  • The vertebral body is heart shaped
  • Vertebral foramen is circular
  • Spinous process- long and slopes inferiorly, offers increased protection to the spinal cord
  • Transverse costal facet- articulates with the tubercle of the rib
  • Inferior costal demifacet- articulates with the head of the rib below
  • Superior costal demifacet- articulates with the head of the adjacent rib
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18
Q

Lumbar vertebra

A
  • Large size
  • They lack facets for articulations with ribs which are present in thoracic vertebrae
  • Cylindrical body
  • Triangular vertebral foramen
  • Spinous process- short and broad
  • Mamillary processes- found on the posterior surface of each superior articular process, acts an attachment for the deep muscles of the back
  • Transverse process- long and slender
  • Vertebral body- large and kidney shaped
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19
Q

How do the vertebra articulate with each other

A

Via the intervertebral joints and the Zygapophyseal joint

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20
Q

Intervertebral joints: Symphyses

A
  • Between adjacent vertebral bodies
  • IV discs between vertebrae (except C1&2, in the sacrum and coccyx)
  • Designed for weight bearing and strength
21
Q

Zygapophyseal/facet joints

A
  • Plane synovial joints
  • The joints of the vertebral arches between the inferior articular process of the vertebrae above and the superior articular process of the vertebrae below
22
Q

Ligaments of the vertebral column

A

1) Posterior longitudinal ligament
2) Anterior longitudinal ligament
3) Interspinous ligament- between the two adjacent spinous processes, limits flexion of the vertebral column
4) Supraspinous ligament- connects the tips of the spinous processes
5) Ligamentum flavum (elastic)- between adjacent laminae, limits flexion of the vertebral column
6) Intertransverse ligament- between the adjacent transverse processes
The ligaments help to support the vertebral column

23
Q

Ligaments of the vertebral column- Posterior longitudinal ligament

A

On the posterior surface of the vertebral bodies, narrows gradually as it passes downwards. Weaker then the anterior longitudinal ligament. Restricts flexion of the vertebral column (leaning forwards). Prevents posterior herniation of the intervertebral discs. Lies along the back of the bodies of the vertebral columns

24
Q

Ligaments of the vertebral column- Anterior longitudinal ligament

A

On the anterolateral aspect of the vertebral bodies, limits extension movement of the vertebral column (leaning backwards). Maintains stability on the intervertebral discs. Extends from the scalp to the sacrum

25
Q

Joints of the vertebral column

A
  • Atlanto-occipital joint= between the skull and the Atlas, connects to the occipital condyles and the superior articular surfaces of the lateral masses of the atlas
  • Lateral atlanto-axial joint= between the axial and the Atlas, two of them with one being on either side. Between the inferior surface of the lateral masses of the atlas and the superior facet of the axial
  • Medial atlanto-axial joint= between the dens of the axial and the medial arch of the atlas
26
Q

Ligaments in the cervix

A
  • In the cervical region the Supraspinous and Interspinous ligaments begin to form the Ligamentum nuchal which extends from C7 to the external occipital protuberance of the skull. Provides attachment for trapezius and rhomboid minor muscle and supports the neck and prevents hyperflexion
  • The anterior longitudinal ligament continues upwards and becomes the anterior atlantooccipital membrane
  • The Posterior longitudinal ligament becomes continuous with the Tectorial membrane
  • The Ligamentum flavum is continuous with the Posterior atlantooccipital membrane
27
Q

Intervertebral disc

A
  • Has an outer layer of Anulus fibrosis which is a zona fibro cartilage which is arranged in a lamina configuration
  • Surrounds the central Nucleus pulposus which is gelatinous and absorbs compression forces between vertebrae
  • Nerves and vessels pass through the intervertebral foramen
  • When the disc herniates it can impinge on a nerve and causes back pain
28
Q

Primary curvature of the back

A
  • Thoracic kyphosis- concave anteriorly

* Sacral kyphosis- concave anteriorly

29
Q

Secondary curvatures of the back

A

Develop after birth
• Cervical lordosis- concave posteriorly
• Lumbar lordosis- concave posteriorly

30
Q

Lordosis

A

Excessive curvature of the secondary curves. Lumbar lordosis causes anterior tilting of the pelvis with increased extension of the lumbar vertebrae. Often associated with weakened trunk musculature, often temporarily seen in late pregnancy. Can happen in obesity

31
Q

Kyphosis

A

Excessive outward curvature of the primary curves. In Thoracic kyphosis you get an abnormal increase in thoracic curvature, can be due to anterior erosion of one or more vertebrae in osteoporosis causing a short wedge shaped thoracic vertebrae. Can cause muscle fatigue and stiffness or spinal nerve compression. Can reduce pulmonary capacity causing shortness of breath, chest pain and pulmonary or heart failure

32
Q

Scoliosis

A

Abnormal lateral curvature of the spinal column due to rotation of the vertebrae. Normally the cause is unknown, can be either thoracic or lumbar vertebrae

33
Q

Change of curvature- age

A
  • Flexed- into the letter C, is both the thoracic and sacral kyphosis
  • Newborn- after the baby raises their head, the cervical lordosis forms
  • 4 years- the lumbar lordosis forms when toddlers begin to stand or walk
34
Q

Movement of the vertebral column

A
  • Range of movement varies according to region and the individual
  • Primarily from the compressibility and elasticity of the IV discs
  • Movements in specific regions are determined by shape and orientation of joint surfaces – zygapophysial joints.
  • The Nucleus pulposus is semi-fluid and allows for the flexibility of the intervertebral disc
  • Throughout the vertebral column the thickness of the discs varies, what matters is the size of the intervertebral disc relative to the vertebrae. Movement between the vertebrae is due to the intervertebral disc and the joints between the articular processes on the vertebrae
35
Q

What causes the movements of the vertebral column

A

These movements are produced by back muscles, gravity and the action of the anterolateral abdominal muscles

36
Q

Relation of the intervertebral disc to the vertebra

A
  • Cervical- sloped from anterior to posterior
  • Thoracic- vertical
  • Lumbar- wrapped
37
Q

Types of movement in the vertebral column

A
  • Flexion and extension- primarily at the cervical and lumbar region
  • Lateral flexion- occurs most commonly in the cervical and lumbar regions
  • Rotation around longitudinal axis- primarily at the craniovertebral joints (neck) and the thoracic region
38
Q

Movement of C1 and C2

A
  • Flexion and extension (nodding motion), rotation
  • No IV disc
  • Atlanto-occipital joint= allows the head to nod up and down
  • Atlanto-axial joint= Dens act as a pivot which allows the atlas and attached skull to rotate on the axis, allows looking from side to side. The cranium and C1 rotate on C2 as a unit
39
Q

Movement of the cervical region (C3-C7)

A
  • Flexion and extension, lateral flexion and extension
  • IV disc= large relative to the size of the vertebral bodies, allows more movement
  • Zygapophysial joints- the joints between the articular facets, nearly horizontal, slopes inferiorly from anterior to posterior- facilitates flexion and extension
  • Small amount of surrounding body mass allows greater range of movement
40
Q

Movement of the thoracic region

A
  • Rotation, some lateral flexion
  • IV discs- thin relative to size of the vertebral bodies, limits movement as there is less compressibility of the intervertebral disc
  • Zygapophysial joints- between the superior and inferior articular facets of the vertebra. Orientated vertically, limits flexion and extension. Joint planes on an arc centred on the vertebral, permits rotation and some lateral flexion
  • Other features that limit movement- connection to the sternum by the ribs, overlapping spinous processes limit flexion and extension, they are long and slope inferiorly
40
Q

Movement of the thoracic region

A
  • Rotation, some lateral flexion
  • IV discs- thin relative to size of the vertebral bodies, limits movement as there is less compressibility of the intervertebral disc
  • Zygapophysial joints- between the superior and inferior articular facets of the vertebra. Orientated vertically, limits flexion and extension. Joint planes on an arc centred on the vertebral, permits rotation and some lateral flexion
  • Other features that limit movement- connection to the sternum by the ribs, overlapping spinous processes limit flexion and extension, they are long and slope inferiorly
41
Q

Movement of the lumbar region

A
  • Flexion and extension, lateral flexion and lateral extension. Very limited rotation
  • IV discs- large relative to the size of the vertebral bodies, allows for more movement as they are more compressible
  • Zygapophysial joints- curved and adjacent processes interlock. Laterally facing inferior articular processes are gripped by medially facing superior processes, limiting rotation
42
Q

Limitations of rotation 1-4

A
  • Thickness, elasticity and compressibility of the IV discs. Thin IV discs allow for less movement as they are less compressible
  • Shape and orientation of the Zygapophysial joints between the superior and inferior articular process
  • Tension of the joint capsule of the zygapophysial joint. In the cervical region the capsule is relatively thin and loose which allows for a wide range of movement
  • Resistance of back muscle and ligaments- anterior longitudinal ligament prevents hyperextension, posterior longitudinal ligament prevents hyperflexion. The accessory ligaments help stabilise the joints limiting movement.
43
Q

Limitation of rotation 5-7

A
  • Ligaments between the anterior and posterior articular process- Interspinous ligament, Supraspinous ligament and the Ligamentum flavum (connects laminae of adjacent vertebral arches- limits flexion). The Interspinous and Supraspinous ligament join the spinous processes of adjacent vertebrae. The ligaments are important in maintaining the curvature of the vertebral column
  • Attachment to the thoracic cage
  • Bulk of surrounding tissue- in the cervical region there is not a lot of tissue so movement is not limited.
44
Q

Position for lumbar puncture

A

Lateral recumbent or sit and lean forward. They need to arch their back, tuck their chin in. Hips and knees should be flexed. Fetal position increases the distance between the spinous process

45
Q

Lumbar puncture- Palpations

A

You locate the area by palpating the top of the iliac crest and where they meet in the midline should be the 4th lumbar vertebra, this is below the termination of the spinal cord. You try and insert the needle below the L4 spine, so it reaches the subarachnoid space around the cauda equina

46
Q

What does the needle go through in a lumbar puncture

A

The needle penetrates the skin, subcutaneous tissue, supraspinous and interspinous ligament (connects the spinous processes), Ligamentum flavum (connects the laminae), the epidural space, Dura mater, Arachnoid mater, and enters the subarachnoid space

47
Q

Lumbar puncture

A

T12-L3 vertebral levels represent the normal range at which the spinal cord ends to become cauda equina. Insert needle between L3-4 (or L4-5) to avoid damage to the spinal cord
Lumbar puncture is used to take a sample of CSF for diagnosis and therapeutically to inject medications or relieve CSF pressure

48
Q

Lumbar puncture

A

T12-L3 vertebral levels represent the normal range at which the spinal cord ends to become cauda equina. Insert needle between L3-4 (or L4-5) to avoid damage to the spinal cord
Lumbar puncture is used to take a sample of CSF for diagnosis and therapeutically to inject medications or relieve CSF pressure

Medicine year 2 semester 2 (47 decks)

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