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MSK 2023 > Cervical and thoracic vertebrae > Flashcards

Cervical and thoracic vertebrae Flashcards

1
Q

How many cervical vertebrae?

A

7

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2
Q

How many thoracic vertebrae?

A

12

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3
Q

Size and movement cervical?

A

Smallest (VERY MOBILE)

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4
Q

Movement thoracic?

A

Not very mobile (articulate with ribs)

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5
Q

Typical cervical vertebrae numbers

A

C3-C6

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6
Q

Typical cervical vertebrae structure

A

Same as lumbar spine (lamina, pedicle, articular processes, body and foramen)

BUT BIFID spinous process
Transverse Foramen (holes in transverse process)
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7
Q

Function of transverse foramen

A

Vertebral artery, vein and sympathetic nerve plexus (C1-C6)

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8
Q

What is different about transverse foramen of C7?

A

Transmits vertebral vein only

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9
Q

Atypical vertebrae?

A

C1 (atlas)
C2 (axis)
C7

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10
Q

Atypical C1 (Atlas) structure

A

No vertebral body (odontoid process makes)
No spinous process
Widest
Largest transverse process (not usually symptomatic if problem as lots of space)

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11
Q

Arches on C1

A

Anterior arch - attachment for anterior longitudinal ligament
Posterior arch - attachment for ligamentum nuchae

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12
Q

C1 masses?

A

Large Superior - to support head weight

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13
Q

Atypical C2 vertebrae (Axis)

A

Odontoid process/Dens forms body of C1

Broadest spinous process (of cervical)

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14
Q

What prevents horizontal displacement of Atlas?

A

Odontoid process and transverse ligament

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15
Q

C1 ans C2 articulation

A

Pivot allows rotation

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16
Q

Problem C1 and C2

A

Atlantoaxial instability (from ligament weakness)

C1 can move forward over C2 (separate movement and compress cord)

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17
Q

C7 atypical vertabrae structural differences

A

Longest spinous process (Vertebrae Prominens)
NOT BIFID spinous process

Transverse process large, foramen is small (only transmits vertebral vein)

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18
Q

Facet joints cervical

A

Superior articular facet: faces upward and backward
Inferior articular facet: faces down and forward

45° angle

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19
Q

Cervical nerve roots

A

Exit more horizontally (than lumbar)

Nerve roots exit above vertebrae (until C7-T1)

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20
Q

Nerve root vs vertebrae cervical

A

7 cervical vertebrae
8 spinal roots = C8 exits below C7
C1 does not exit via foramen `

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21
Q

Ligaments of cervical

A 
Same as lumbar 
Anterior to posterior:
Anterior LL
Posterior LL
Ligamentum Flavum
Interspinous 
Supraspinous
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22
Q

Additional ligament cervical

A

Ligamentum nuchae (thickening of supraspinous ligament)

23
Q

Ligamentum nuchae attach

A

Septa splits muscles

Attach:
External occipital bone
Spinous processes of all cervical vertebrae

24
Q

Function of ligamentum nuchae (3)

A

Maintains secondary curvature of spine

Helps cervical spine support head (running)

Site of attachment for neck and trunk muscles (eg Trapezius and Rhomboids)

25
Q

Movements of cervical spine

A

Multiplanar

flexion and rotation 80, extension 70, lateral flexion 40

26
Q

Movements of cervical spine contributions

A

Atlanto-occiptal joint = 50% of flexion, extension and rotation of head

Other 50% is rest of cervical spine (C2/3 –> C7/T1)

27
Q

Thoracic vertebrae structure (3)

A

Heart shaped vertebral body
Demi facets (T2-T8)/ Whole facets (T9-T10) to articulate with head of rib
Vertebral foramen is small and circular

28
Q

Problems with small foramen?

A

If problem with spinal canal, more likely to be symptomatic as suppressed spinal cord likely

29
Q

Where does rib articulate with thoracic vertebrae (costal articulations)?

A

The head of rib with vertebral body

The neck of rib with transverse process/facets (except T11/T12)

30
Q

Where does neurovascular bundle lie?

A

Within Costal groove on rib

31
Q

Facet joint orientation thoracic vertebrae

A

Coronal (60 degrees)

permits rotation but LIMITS flexion

32
Q

What is Cervical spondylosis?

A

Osteoarthritis

Age related changes

33
Q

Cervical spondylosis triad

A

Loss of disc height (loss of water)
Osteophytes
Facet joint arthritis

34
Q

Consequences of cervical spondylosis

A

Radiculopathy (osteophyte in foramen)

Myelopathy (osteophyte in vertebral canal)

35
Q

Symptoms of cervical radiculopathy

A

Sensory: dermatome parathesia/numbness, pain
Motor: myotome weakness

36
Q

Cervical prolapsed intervertebral disc presentation

A

30-50 year olds
No history of injury
Wake up with stiff neck

37
Q

Why does Cervical prolapsed intervertebral disc occur?

A

Tear of annulus fibrosis

Nucleus pulposus migrates through into spinal canal

38
Q

Which nerve root affected in C5/C6 disc prolapse?

A

C6
Always the nerve root below usually (exiting nerve roots only in cervical spine)

Pain in neck and dermatome areas
Weakness in myotome
Numbness/parathesia in dermatome

39
Q

What happens if prolapse of C7/T1 disc?

A

C8 nerve root affected

40
Q

Cervical myelopathy presentation

A

Older (50-80 year olds)

Compression usually as a result of spondylosis

41
Q

Anatomy change in cervical myelopathy

A

Thickening ligamentum flavum
Osteophyte
(can lead to spinal cord signal change)

42
Q

Cervical myelopathy symptoms

A

Progressive
Clumsiness
Loss of fine movements (buttoning shirt, writing)
Loss of balance

43
Q

C4 myelopathy problems?

A

Neck pain
Motor weakness in all distant myotomes
Numbness from shoulders distally

(latter spinal cord is disrupted)

44
Q

What is a Jefferson fracture?

A

Burst fracture C1 (fracture of anterior and posterior arch of Atlas)

Usually caused by axial load (diving into shallow water and hitting head)

45
Q

What is a Hangman’s fracture?

A

Hyperextension of head on neck
Forward displacement of C1 and C2 over C3
Fracture through pars interarticularis (joins facet joints)

46
Q

Odontoid peg fracture

A

Hyperextension injury

Happens in elderly (slower reflexes do not put out hands to protect as they fall)

47
Q

Visualising odontoid peg fracture

A

Open mouth AP x ray

CT scan?

48
Q

Thoracic cord compression causes

A

Tumour or fracture

Most likely to give issues as vertebral foramen is narrowest

49
Q

Thoracic cord compression at T10?

A

Lower thoracic pain
Weakness of all muscles distally (in legs)
Loss of sphincter control
Numbness/paraesthesia below umbilicus

50
Q

T5 compression?

A

Weakness legs and INTERCOSTALS
Loss of sphincter control
Numbess/paraesthesia distal from nipples

51
Q

What is infection of spine called?

A

Spondylodiscitis

52
Q

How does spondylodiscitis occur?

A

Bacteria enters spine via vertebral body nutrient artery
Migrates to end plate
Extends towards disc (not many cells to fight infection here so suitable environment)

53
Q

What can spondylodiscitis lead do?

A

Abscess in epidural space

Vertebral osteomyelitis

54
Q

Whiplash injury

A

Hyperextension then hyperflexion injury of cervical spine

head rotates back and then forward

MSK 2023 (55 decks)

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