Grays - Back

Question 1

What type of cartilage gives the tensile strength of the IV disc?

Answer 1

• Fibrous

* The tensile strength comes from the anulus fibrosus, which
limits rotation between vertebrae.

Question 2

Compression of nerves at the intervertebral forarmen indicates? What structure is most likely responsible?

Answer 2

• Disc Herniation - Protrusion of the nucleus pulposus through the annulus fibrosis POSTEROLATERALLY into the spinal cord or intervertebral foramen.

Question 3

Whiplash injuries typically injures which ligament of the vertebral bodies?

Answer 3

• Anterior longitudinal ligament

Question 4

Spinal canal stenosis syndrome is associated with?

Answer 4

• Hypertrophy of the ligamentum flavum

Question 5

What structure of the spinal nerve is solely responsible for sensory innervation?

Answer 5

• The dorsal root ganglion

Question 6

Weakness during medial rotation and adduction of the humerus would indicate injury to what nerve?

Answer 6

• Thoracodorsal n. - Innervates Latissimus dorsi m. (major muscle that medially rotates and adducts humerus)

Question 7

Which muscle is responsible for first 15 degrees of abduction?

Answer 7

• Supraspinatus

Question 8

Where is CSF typically withdrawn from?

Answer 8

• Lumbar cistern (subarachnoid space) - Between L3-L4 or L4-L5

Question 9

What level does the spinal cord usually terminate at in an adult?

Answer 9

• L1-L2

Question 10

Which nerve fibers are responsible for conveying pain, pressure, touch, temperature, and proprioception to the CNS?

Answer 10

• Somatic afferent via dorsal primary rami

Question 11

A caudal anesthetic is administered via where and enter which space?

Answer 11

The sacral hiatus and enters the epidural space

Question 12

Damage to the tip of the transverse process of the third cervical verterbra, with a significantly large pulsating hematoma will most likely damage which artery?

Answer 12

• Vertebral artery travels through the transverse foramen

Question 13

Drooping of the shoulder would indicate injury to whicg nerve?

Answer 13

• Spinal accessory nerve (CN XI) innervating Trapezius m.

Question 14

Which ligament anchors the dens laterally to prevent posterior displacement?

Answer 14

• Transverse ligament of the atlas (cruciform ligament) attaches to the pedicles and stabilizes the dens *If torn can cause compression of the spinal cord by the dens

Question 15

Spondylolysis is most commonly seen in which spinal region?

Answer 15

Cervical due to their small size and horizontally oriented articular facets the cervical vertebrae are less tightly locked than other vertebrae

Question 16

The internal vertebral venous plexus surrounds?

Answer 16

The dura mater in the spinal epidural space

Question 17

The atlantoaxial joint is primarily responsible for what type of movement?

Answer 17

Rotation of the head

Question 18

The atlantooccipital joint is primarily responsible for what type of movement?

Answer 18

Flexion and Extension of the head/neck

Question 19

In a lumbar puncture what is the order of structures penetrated by the needle?

Answer 19

Supraspinous ligament–> Interspinous ligament–> Ligamentum flavum –> Epidural space –> Dura mater –> Arachnoid mater –> Subarachnoid space *SILEDAS*

Question 20

How does the head of the rib articulate with verterbrae?

Answer 20

The rib articulates with the superior facet on the body of its own vertebra and with the inferior facet on the body of the vertebra above *The fourth rib articulates with the superior facet of T4 and the inferior facet of T3

Question 21

What vertebral level is the conus medullaris located at?

Answer 21

L1 to L2

Question 22

Which condition presents with protrusion of the spinal cord and meninges in the lower back?

Answer 22

Meningomyelocele

Question 23

At which locations are the spinal nerves most likely to be compressed during IV disc compression?

Answer 23

Between the superior and inferior vertebral notches

Question 24

Caudal epidural blocks are typically administered into what space, using what as the landmark?

Answer 24

• The sacral canal, through the sacral hiatus - Using the Sacral Cornua as a landmark

Question 25

Vertebral arch separation at the zygapophysial joint is called?

Answer 25

• Spondolysis

Question 26

Anterior displacement of the vertebra is known as?

Answer 26

• Spondylolisthesis

Question 27

The odontoid process, or the dens, projects superiorly from the body of the axis and articulates with?

Answer 27

Anterior arch of the atlas *Commonly injured with fracture of the dens

Question 28

What is often seen in the vertebral column, as a secondary condition to muscular dystrophy and polio?

Answer 28

Scoliosis can be a secondary condition in such disorders as muscular dystrophy and polio in which abnormal muscle does not keep the normal alignment of the vertebral column and results in a lateral curvature.

Question 29

What is the embryologic origin of the anulus fibrosus and nucleus pulposus, respectively?

Answer 29

• Annulus fibrosis = Mesenchyme
• Nucleus Pulposus = Notochord

Question 30

A “hangman’s fracture” results from forcible hyperextension and fractures which structure of the cervicle spine?

Answer 30

The pedicles (pars articularis) of C2 are fractured and the cruciform ligament is torn (fracture of the vertebral arch).

Question 31

The erector spinae muscle is supplied by the
dorsal rami, which carry motor, sensory, and autonomic
fibers. What are the location of the cell bodied of the nerve fibers?

Answer 31

The cell bodies of the motor part are found in the anterior horn, while the cell bodies of the sensory fibers are found in the dorsal root ganglia. The cell bodies of the sympathetic fibers are found in
the paravertebral ganglia.

Question 32

Where is the most superiorly positioned IV disc? If there was an acute posterolaeral herniation of the most superiorly located IV disc, which exiting nerve would be compressed?

Answer 32

• The most superiorly positioned intervertebral disc is between the C2 to C3 vertebrae.
• The spinal nerve of C3, since cervical spinal nerves exit superior to their corresponding vertebrae.

Question 33

What is the origin and insertion of the Latissimus dorsi muscle?

Answer 33

Latissimus dorsi, which attaches to the spinous processes of vertebrae T7 to L5 and the floor of the intertubercular sulcus.

Question 34

What is the best radiographic views for revealing bilateral pars interarticularis fractures of the L5 verterbra?

Answer 34

The oblique radiographic view is ideal to show the pars interarticularis.

Question 35

What are branches of the segmental spinal arteries that supply blood to the anterior and posterior roots?

Answer 35

The radicular arteries are branches of the
segmental spinal arteries. They occur at every vertebral
level and follow and provide blood supply to the
anterior and posterior roots (spinal neural tissue).

*A space occupying lesion that compresses the posterior roots will also compressthe arteries that supply them.

Question 36

What branches of the segmental spinal arteries supply the spinal arteries?

Answer 36

Anterior and Posterior Segmental Medullary A.

Question 37

Spina bifida oculta is caused by undervelopmet of what?

Answer 37

The primary ossification center in the vertebral arch

Question 38

Which is the last structure to be penetrated before reaching the epidural space by a needle during an epidural anesthetic?

Answer 38

• Ligamentum flava

Question 39

What is the function of the alar ligament in crevical spine and where is it located?

Answer 39

The alar ligament connects the dens to the medial surface of the occipital condyles. It limits excessive rotation of the atlanto-axial joints.

Question 40

Anterior displacement of the vertebral body and narrowing of the vertebral canal would include what type of pathology?

Answer 40

Compression of the cauda equina and bilateral lower limb weakness