Exam 2 - Lecture 4 Flashcards
C1 vertebra is named _________. Why?
Atlas. Mythical god had weight of world on his shoulders, like the head on C1.
Is there a vertebral body on C1?
No.
Anterior arch
Replaces vertebral body on C1
Anterior tubercle
Nub on anterior side of anterior arch on C1
Facet for dens
Cartilage on posterior side of anterior arch on C1
Place where C2 connects to C1
Dens
Top of cylinder structure coming up from C2 to C1, connecting to facet for dens
What replaces C1 spinous process since there isnt one?
Posterior tubercle on posterior side of posterior arch
What connects C1 to the skull?
Superior articular facets, connects to projections coming off base of skull.
Opening at base of skull
Foramen Magnum
Occipital condyles
Downward projections next to foramen magnum, on occipital bone
Anterior/posterior atlantooccipital ligament
Connect top of spine through opening in foramen magnum.
They call it that cause it connects atlas to occipital bone.
What allows us to nod our head in base of skull?
Superior articular processes in C1, the way they are curved with cartilage.
Specialized structure not found anywhere else except C2
Dens, on anterior side of C2. Connects to posterior side of anterior arch of C1.
Cartilage on front/back of dens gets wrapped by
ligaments
Does C2 have a vertebral body?
Yes
What allows you to swivel your head side to side?
Dens of axis, where C2 connects to C1.
Front of our spine ligament that runs entire anterior side of spine?
Anterior longitudinal ligament, from skull to sacrum
Posterior side of vertebral body ligament?
Posterior longitudinal ligament
Ligament that links transverse processes together
intertransverse ligament
Ligament that connects spinous processes on top?
Supraspinous ligament
Ligament that connects spinous process inside?
Interspinous ligament, covers more area than supraspinous.
Ligaments that connect vertebral arch to another vertebral arch? how does it differ?
Ligamentum Flava. Lots of elasticity, makes it stretchy. Allows you to feel change in resistance of needle to feel how deep you are.
Rest of ligaments are fibrous collagen with not a lot of elasticity, but they are strong.
midline hole in ligamentum flava
MOST people have this Incomplete fusion of ligament, may result in you not detecting change of resistance with needle and misjudge depth. Take a slightly off midline approach so you can hit ligament and know where you are.
Nuchal ligament
Expansion of ligaments in the neck, fan-like expansion of interspinous ligaments.
Nub on back of your skull
Where nuchal ligament and supraspinous ligament connect to base of skull
ligaments are not _____ and have weak points.
infalible.
dens on MRI is easily identifiable how?
Looks like little circle that comes off body of axis
Bump on base of neck is called what? What is it?
Vertebral prominens. Textbook says C7 but dr Schmidt says it’s T1, cause t1 spinous process is bigger than C7.
Spinous process on thoracic spine is different because:
Steep downward angle and difficult to axis from midline approach with a needle. come from a different approach.
How many pairs of ribs?
12 pairs
Why is the thoracic spine stronger?
Extra things connected to it like ribs, not much t-spine injuries cause its robust
Most injuries with spine are in
Neck and lower back.
Where do ribs connect at t-spine? How many possible spots per rib?
inferior/superior bodies of vertebra and Transverse process costal facets, 3.
Last 2 ribs are 11 and 12, how are they different
floating ribs, not connected to sternum at all. easy to displace.
Top of sternum
manubrium
Middle of sternum
body
Bottom of sternum
xiphoid process
Which ribs are connected directly to cartilage to sternum?
True ribs, 1-7.
Ribs connect to sternum how?
Not directly to sternum, they connect to cartilage that is connected to sternum, to give us flexibility and not be susceptible for crush injuries.
Which ribs are indirectly connect to cartilage at rib 7?
false ribs, 8-10.
On thoracic vertebra, costal facets are
Superior and inferior, and transverse.
7th rib connects to which costal facets?
Inferior costal facet of T6, and superior costal facet of T7.
Tip of the rib is called
Head, connecting to inferior/superior costal facets.
Neck forms the rest
of the ribcage
Costal tubercle
Nub coming off top of neck that connects to transverse costal facet.
Most ribs connect to ____ vertebral body(ies)
2
t-spine vertebral body is shaped
Like a heart
Left side of t-spine vertebral body is more ____. why?
flat, due to the aorta.
L-spine is ______ because it supports ____.
Bigger; a lot of weight.
Are the spinous processes of L-spine straight or downward?
Straight, but patient may lean forward to make it even easier.
L-spine are not ______ and pretty basic
Don’t have much special about them
Inferior articular process of L5 connects to what?
Superior articular process of S1
L5 sits on top of
Sacrum
which spinal anatomy is easier for spinal anesthesia
Lumbar
Inferior/superior vertebral notch
Notch for spinal nerves to exit spine
Intervertebral foramen
Opening that forms from the combination of inferior and superior vertebral notchs
When does sacral vertebra fuse?
By the time you’re 14/15 years old
Transverse lines
points of fusions of individual vertebra on sacrum
Top of sacrum
promontory, wait supporting structure on top of sacrum
Sacral canal
Enclosed space inside sacrum
Where do spinal nerves and roots hangout in sacrum before they exit at different points?
sacral canal
Where do spinal nerves/roots exit in sacrum? Where can they be seen?
Sacral foramina, from front and back. anterior sacral foramina seen from front, posterior sacral foramina seen from back.
How many sacral foramina are there?
8, 4 on front 4 on back.
Palpable bodies on midline back of sacrum
Remnants of spinous processes after they were fused, median sacral crest.
Ridge on each side of sacrum, how is it formed?
Lateral sacral crest, from fused transverse processes
Ridge that runs between the lateral sacral crest and median sacral crest?
Medial sacral crest, just lateral to midline.
How is the medial sacral crest formed?
Formed front superior and inferior articular processes
When do the ligaments that run up and down the spine terminate?
through the sacral hiatus and terminate at the coccyx.
Opening at base of sacrum that is an exit for coccygeal spinal nerves?
Sacral hiatus
Raised ridges/projections on sides of sacral hiatus
Sacral Cornu
Coccyx
4 coccyx vertebra fuse into 2 separate vertebra. top 1 stays on its own and the bottom 3 fuse together (as an adult?)
conduit or pathway for nerve roots/spinal nerves to leave the sacrum?
Sacral foramina.
How can you get drugs into the sacral canal?
Sacral foramina
Illiac crest
superior ridge of the pelvis, palpable even for obese people.
If you draw a line between two ridges of iliac crest, where is it?
Middle of vertebral body of L4, just below that line will be L4/5 interspace, just above will be L3/L4 interspace. Used a lot for epidurals.
Bumps that you can see in people wearing bathing suit
Posterior/inferior iliac spines. You can visibly see them, easy to palpate.
How to estimate access to S2 posterior sacral foramina?
palpate posterior superior iliac spine and drop down 1 cm, move 1 cm midline, should be in the opening to access sacral canal.
Why don’t you use S1 sacral foramina
Opening is difficult to hit straight on, it opens up more towards the side/laterally.
Lesser used marker for S2 sacral foramina
posterior inferior iliac spine, much harder to palpate.
Promontory
top of sacrum that top of L-spine sits on, with superior articular processes coming off
Anterior superior iliac spine
Front side of pelvis thats palpable
Anterior inferior iliac spine
Front side of pelvis, no one uses
Pubic tubercle
Raised bump that inguinal ligament attaches to on anterior pelvis
Inguinal ligament
stretches from anterior superior iliac spine to pubic tubercle. You can palpate/see this, where the line is in your pelvis where your weight folds over the top.
Iliolumbar ligament
Connects L4/L5 vertebra to back rear part of pelvis.
Female pelvis has:
Wider opening and wider hips than male.
Pubic symphysis
Provides connection point for anterior pelvis near pubic tubercle.
Two sets of palpable hip
Superior is illiac crest, inferior is the greater trochanter sticking out top of femur
Umbilicus marker
Should be intervertebral disc between L3/L4, but its not reliable due to extra weight, bony markers much more reliable.
Intervertebral discs serve as:
Cusion
Anulus fibrosus
superficial fiberous housing on outer layer of vertebral disc that wrap around the nucleus pulposus
Nucleus pulposus
gel-filled center of vertebral disc
Sandwiches the vertebral disc
Hyaline cartilage on top and bottoms of intervertebral discs
Anterior structure of anulus fibrosus
On the anterior side, reinforced cross hatched fiber pattern that is very strong.
Posterior structure of anulus fibrosus
fibers run in same direction, isn’t nearly as strong as front side.
What happens if anulus fibrosus has weak spots?
Herniated disc. Nucleus pulposus leaks out posteriorly and puts pressure on spinal nerves. Gives spinal nerves less space to exit spine, causes a lot of pain.
How to fix herniated disc?
Discectomy, removing part of disc that’s causing problems. tough to get right.
Stabilize the spine by fusing vertebra together, usually with screws/plates in the front.
Laminectomy: creates more space in the intervertebral foramen for spinal nerves in their openings, by removing part of the lamina. much safer if you can get away with removing only a little part of bone.
Half the time they don’t work
Consequence of fusing vertebral bodies together
Causes more stress on the levels above and below the fusion, 6-7 years down the road the nearby vertebral discs also need to be fused, further causing MORE stress on spine! Reduces integrity of shock absorber
When deciding on back surgery, must consider:
Quality of life and if it’s worth the risk
If you’re going to get back surgery done, get it done with a ________.
A good Neurosurgeon
80% of lower back problems could probably be fixed by
Lifestyle changes and physical therapy. Most people in general are lazy, but PT is very helpful for lower back injuries.
Muscle groups on back are connected to _____________ so when they are tight and rigid, it compresses spine.
Hamstring!
Simple and extremely effective to tackle back problems
Hamstring stretches a few minutes each day.
CNS is surrounded by
connective tissues, with a goal to surround it with a controlled environment.
How many layers of connective tissue in CNS
3
First layer of connective tissue:
Pia mater: tightly stuck to neurons, glial cells. (pronounced pee-uh mah-ter)
2nd layer of connective tissue
Arachnoid mater: superficial to pia and large vessels that give perfusion to CNS
3rd layer of connective tissue:
Dura mater: super tough and robust.
What’s between pia and arachnoid mater?
CSF, large blood vessels
Where is CSF?
subarachnoid
Whats between dura mater and arachnoid mater?
subdural space. Nothing in there, but it’s a potential space. They’re basically sandwiched together.
